The Social Determinants of Health | Dr. Thomas Ward | TEDxSpringHillCollege
Healthcare is fundamentally linked to a civil right, deriving historical roots from the Civil Rights Movement, as the speaker argues. This necessity extends beyond medical treatment to addressing social determinants, emphasizing that preventing illness through addressing underlying conditions like poor sanitation and malnutrition is paramount. The speaker cites examples from the 1960s—such as unequal services in Mississippi—to illustrate that infrastructure failure and poverty remain critical, persistent health crises today. ## Speakers & Context - Unnamed speaker; framing the talk around "social determinants of health." - Advocates for viewing health care as a civil right, linking it to historical struggles like the Civil Rights Movement. ## Theses & Positions - Health care is a civil right. - The focus must shift from merely treating illness to *preventing* illness by alleviating underlying unhealthy conditions. - Poverty, poor sanitation, and lack of infrastructure directly impact health outcomes. - A municipality cannot selectively provide basic services (like sanitation or water) to only part of the town. - Malnutrition can result from consuming the wrong items, even when food assistance is available (food deserts). ## Concepts & Definitions - **Social determinants of health:** Collection of factors influencing health outcomes, extending beyond medical care. - **Civil Right:** Legal status asserted for healthcare, central to the Civil Rights Movement. - **Community Health Center:** Facility established to provide local health care, stemming from the Great Society and War on Poverty. - **Food Deserts:** Location where nutritious food cannot be obtained, even if food is generally available (e.g., only at a gas station). - **Hookworm:** A parasite that was largely eradicated in the US by the 1940s and 1950s due to improved sewage systems. ## Mechanisms & Processes - **Medical Committee for Human Rights' travel:** Physicians traveling through the South to provide care to civil rights workers. - **Shifting focus:** Mechanism moved from "treating people when they get sick" to "alleviating the conditions that make them sick." - **Early Intervention (Prevention):** Establishing initial clinics to address environmental risks, such as building small fences around stoves to prevent burns. - **Legal Advocacy:** The struggle leading to *Shaw v. Mississippi*, establishing that basic services cannot be unequally provided across a municipality. - **Food Assistance Evolution:** The shift from the Commodities program (1930s–early 1960s, distributing excess goods like flour and cheese) to the Food Stamp Program in the 1960s. ## Timeline & Sequence - **Civil Rights Movement:** Period when healthcare was central to the movement's message alongside voting and desegregation rights. - **1962, 1963, 1964, 1965:** Years when the Medical Committee for Human Rights traveled throughout the South. - **1960s:** Decade for the initial establishment of the first two Community Health Centers. - **1930s to early 1960s:** Period when hunger was worsening in areas like the Mississippi Delta. - **Late 1960s:** Time when sanitary outhouses were built in places like Rosewood and Alligator, Mississippi. - **Early 1970s:** Time frame when *Shaw v. Mississippi* was decided. - **1940s and 1950s:** Period when hookworm was almost eradicated in the US. ## Named Entities - **Dr. King, Malcolm X, Fannie Lou Hamer:** Civil rights leaders who spoke about healthcare. - **Black Panthers:** Group that created healthcare clinics in Oakland and other locations. - **Dr. H Jack Geiger:** Physician credited as the "father of this movement." - **Aaron surely:** Physician and one of the original Delta health center colleagues. - **Dr. Shirley:** Physician who stated in the 1960s that people were dying if not enough to eat. - **Dr. Brown:** Source of quote regarding treating someone without addressing the source of sickness. - **Medical Committee for Human Rights:** Group of physicians (black and white northern and southern) who traveled throughout the South. - **Mississippi:** Region traveled through, site of the first Community Health Center in the South at Mound Bayou. - **Alabama:** State mentioned regarding low poverty rates, Medicaid qualifications, and current infrastructure issues (e.g., Lowndes County). - **Lowndes County Alabama:** Location showing current infrastructure failure with sewage in the streets (2018). - **Mississippi Delta, Arkansas Delta, Louisiana, parts of Alabama, parts of the Appalachians:** Regions mentioned experiencing malnutrition issues, echoing 1930s–1960s crises. - **Rosewood and Alligator, Mississippi:** Cities where human waste accumulation was an issue prior to sanitary infrastructure. - **Flint:** City cited as dealing with water issues due to infrastructure breakdown. - **Baltimore, New Orleans:** Cities cited as having water issues where public school kids cannot drink tap water. - **Austin, Texas:** Location where the speaker was on Monday, experiencing a water crisis due to flooding. ## Organizations - **Medical Committee for Human Rights:** Group of physicians that traveled to the South to assist civil rights workers. - **Black Panthers:** Group that established healthcare clinics in Oakland. - **Great Society:** Period/context for obtaining the first two Community Health Centers. - **Public universities:** Institutions that now maintain food banks for their students. ## Tools, Tech & Products - **55-gallon drum:** Used as a stove/heating source in a sharecropper shack; later used to carry municipal water supply. - **DDT:** Chemical found in 55-gallon drums left on plantations. - **Sewage/Sewers:** Infrastructure system required for sanitation and disease prevention. - **Food Stamp Program:** System providing food vouchers, originally required payment (initially 22 cents per dollar). - **Medicaid:** Federal assistance program, with qualifications linked to income (e.g., being unable to make more than $4,000/year in Alabama). ## Numbers & Data - **1962, 1963, 1964, 1965:** Years the Medical Committee for Human Rights traveled through the South. - **2900:** Current number of Community Health Centers in the United States. - **27 million:** Estimated number of people receiving care through Community Health Centers. - **1966, 1967, 1968:** Years Geiger found maternal and infant mortality rates in Mississippi to be terrible. - **18 percent:** Percentage threshold of the poverty rate in Alabama above which one does not qualify for Medicaid. - **$4,000:** Annual income level in Alabama above which one is too wealthy for Medicaid. - **1940s and 1950s:** Period when hookworm was nearly eradicated in the US. - **22 cents:** Initial cost required to buy a dollar's worth of food stamps. - **$700:** Average family income in the area where Geiger worked. - **15 percent:** Percentage of the American population that is food insecure. - **40 million:** Number of Americans who are food insecure. - **6 and a half million:** Number of children who are food insecure in the US. - **40-hour week:** Standard work week mentioned regarding eligibility for food assistance. ## Examples & Cases - **Medical Committee for Human Rights' travel:** Providing care to civil rights workers beaten in the South. - **Sharecropper shack heating:** Using a 55-gallon drum stove as the sole heat source in a shack. - **Child burns:** Discovering small children arriving at the first health center with burns, illustrating poor housing conditions. - **Structural issues:** Problems found during investigation, including leaking roofs, lack of window screens, and holes in floorboards allowing rat entry. - **Sewage failure (2018):** Sewage bubbling up in Lowndes County, Alabama, demonstrating current infrastructure breakdown. - **Water crises:** Examples include Flint, Baltimore, New Orleans, and Austin, Texas, where tap water is unsafe due to infrastructure breakdown or flooding. - **Malnutrition visual:** A malnourished baby presented by Geiger, illustrating the physical effects of extreme poverty. - **Commodities/Food Stamps:** The initial system provided excess commodities, replaced by a voucher system where the user had to pay (22 cents per dollar). ## Tools, Tech & Products - **55-gallon drum:** Used as both a stove/heating source and later for carrying municipal water supply. - **DDT:** Chemical contaminant found in 55-gallon drums left on plantations. - **Sewage/Sewers:** Essential infrastructure system for sanitation and disease prevention. - **Food Stamp Program:** Voucher system for food assistance, requiring spending at local stores. - **Municipal water supply:** The necessity of securing and using this supply after initial contamination. ## References Cited - **UN report on poverty in the United States:** Report cited as detailing devastating aspects of poverty, including Alabama. - **Shaw versus United States:** Supreme Court case referenced regarding the unequal provision of basic services. - **Shaw versus Mississippi:** Supreme Court case that determined a municipality cannot selectively provide basic services. ## Counterarguments & Caveats - The current Medicaid qualification rule: if a family makes more than eighteen percent of the poverty rate in Alabama, they do not qualify. - **Short-term vs. Long-term solutions:** Immediate fixes (like setting up outhouses) do not solve long-term systemic issues (like the need for full sewer systems). - The concept of viewing sanitation/sewage as a civil rights issue needs broader recognition. ## Methodology - **Field Investigation:** Geiger's method of traveling and observing appalling, underlying conditions in the South. - **Statistical Evidence:** Using metrics like maternal and infant mortality rates (1966–1968) to drive action. - **Direct Observation:** Investigating housing conditions (leaky roofs, unscreened windows, floor holes) to find root causes of illness. ## Timeline & Sequence - **Pre-1960s:** Period of widespread poor sanitation, leading to devastating health issues. - **1930s to early 1960s:** Period when hunger worsened, leading to the commodities program. - **1960s:** Establishment of the first Community Health Center in Mississippi; timeframe of the key sanitation and medical discoveries. - **Late 1960s:** Time frame when sanitary outhouses were built in places like Rosewood and Alligator, Mississippi. - **Early 1970s:** Time the *Shaw v. Mississippi* case was decided. - **1940s and 1950s:** Period when hookworm was nearly eradicated. ## Examples & Cases - **Black Panthers' clinics:** Establishing healthcare facilities in Oakland, demonstrating local action during the movement. - **Mound Bayou, Mississippi:** Site of the first Community Health Center in the South, addressing initial poverty-related care. - **Sharecropper housing:** Illustrating poor heating via 55-gallon drums and structural issues like holes in floorboards. - **Sewage in Lowndes County Alabama (2018):** Visual example of modern infrastructure failure mirroring historical issues. - **Water contamination:** Examples in Flint, Baltimore, New Orleans, and Austin showing public health risks from infrastructure breakdown. - **Malnourished baby:** Visual evidence presented by Geiger linking extreme poverty to physical decay. - **Gas stations vs. stores:** Demonstrating food desert realities where only fast, non-nutritious food is available. ## Implications & Consequences - Infrastructure failure (sewer/water) can cause the return of diseases previously thought eradicated (hookworm). - Failure to address social determinants means healthcare remains symptom treatment rather than preventative care. - Current policies, like Medicaid qualification rules, can create gaps in necessary care. ## Open Questions - What systemic changes are needed to ensure sustained federal funding for comprehensive sanitation and water infrastructure across all communities? - How can food assistance programs evolve to address modern nutritional science beyond mere caloric sufficiency? ## Verbatim Moments - *"I'm gonna talk about what's known as the social determinants of health."* - *"health care came directly out of the civil rights movement in many ways."* - *"our job isn't just to get people better when they get sick but to prevent them from getting sick in the first place."* - *"we need we need we need change pause."* - *"you can't decide to provide basic services to one part of town and not another part of town."* - *"what are we doing you know what is what is this fight for if people don't have enough to eat if people don't have any adequate health care..."* - *"Austin was going without water and so that was that was causing a crisis."* - *"the medicine for Mount malnutrition is food."* - *"think about all these other social determinants of health."*