The Social Determinants of Health | Dr. Thomas Ward | TEDxSpringHillCollege
## Speaker Context * Speaker identity: Speaker (unnamed). * Framing the speaker establishes for themselves: Will talk about healthcare differently than how people usually think about it, focusing on "social determinants of health." ## People * Dr. King + civil rights leader + talked about healthcare. * Malcolm X + civil rights leader + talked about it. * Fannie Lou Hamer + civil rights leader + talked about it. * Black Panthers + group + created healthcare clinics in Oakland and in many places. * Dr. H Jack Geiger + physician + father of the movement, emphasized alleviating conditions that make people sick. * Aaron surely + physician + one of the original Delta health center colleagues. * Dr. Shirley + physician + stated in the 1960s people were dying if not enough to eat. * Dr. Brown + source of quote + mentioned the issue of not doing good to treat someone and send them back into an environment when they're gonna get sick. ## Organizations * Medical Committee for Human Rights + group of physicians (black and white northern and southern) + traveled through the South to patch up civil rights workers. * Black Panthers + group + created healthcare clinics in Oakland and in many places. * Great Society + period + context for obtaining the first two community health centers. * Department of Health/Government body (implied) + responsible for setting up the food stamp program. * Food Relief (program) + initiated by Dr. Geiger's efforts + temporary measure after the initial efforts. * Public universities + institution + many now have food banks for their students. ## Places * Oakland + location where the Black Panthers created healthcare clinics. * The South + region traveled through by the Medical Committee for Human Rights, notably Mississippi and Alabama. * Mississippi + location where the Medical Committee for Human Rights traveled, site of the first Community Health Center in the South (Mound Bayou). * Alabama + state mentioned in connection with low poverty rates and issues like sewage. * Lowndes County Alabama + location showing current issues, with sewage in the streets in 2018. * Mississippi Delta + region experiencing malnutrition issues, comparing to the 1960s. * Arkansas Delta + region mentioned in connection with malnutrition. * Louisiana + region mentioned in connection with malnutrition. * Parts of Alabama + region mentioned in connection with malnutrition. * Parts of the Appalachians + region mentioned in connection with malnutrition. * Rosewood and Alligator, Mississippi + cities where human waste accumulation was an issue. * Flint + city dealing with water issues due to infrastructure breakdown. * Baltimore + city with water issues where public school kids cannot drink tap water. * New Orleans + city with water issues where public school kids cannot drink tap water. * Austin, Texas + location where speaker was on Monday, going without water due to flooding. ## 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 needed for sanitation; subject of court cases. * Food Stamp Program + system used to provide food assistance, initially requiring payment (22 cents per dollar). * Medicaid + federal assistance program; qualifications based on income (e.g., making more than $4,000/year in Alabama). ## Concepts & Definitions * Social determinants of health + collection of factors that influence health outcomes, going beyond just 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, starting with grants during the Great Society and War on Poverty. * Maternal and infant mortality rates + metrics used in Mississippi in 1966, 1967, 1968. * Food Deserts + location where one cannot get nutritious food, even if food is available (e.g., only at a gas station). * Hookworm + parasite that had been largely eradicated by the 1940s and 1950s in the US due to sewage systems. * Commodities program + program from 1930s to early 1960s to deal with excess commodities like flour and cheese for the poor. ## Numbers & Data * 1962, 1963, 1964, 1965 + years when the Medical Committee for Human Rights traveled throughout the South. * 2900 + current number of community health centers in the United States. * 27 million + estimate of people who get health care through the Community Health Center. * 1966, 1967, 1968 + years when 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 rich for Medicaid. * 1940s and 1950s + period when hookworm was almost eradicated in the US. * 22 cents + cost to buy a dollar's worth of food stamps initially. * $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. ## Claims & Theses * Healthcare is a civil right. * Healthcare came directly out of the civil rights movement. * The job isn't just to get people better when they get sick but to prevent them from getting sick in the first place. * Poverty has a tremendous impact on someone's health. * If you live in extreme poverty, it has direct effects on your health. * A municipality can't decide to provide basic services to one part of town and not another part of town. * Water quality is directly related to good health. * In the 1960s, the lack of proper sanitation in the black part of town meant human waste was accumulating. * If you have sewage systems, you don't get hookworm. ## Mechanisms & Processes * The process used by the Medical Committee for Human Rights was traveling through the South to patch up civil rights workers. * Geiger's mechanism shifted the focus from treatment to alleviating underlying unhealthy conditions. * Building little fences around stoves + process implemented to eliminate burns from heating sources. * Establishing a system to fix up houses + process to address issues like leaking roofs, lack of window screens, holes in floor boards, and rats. * Sewer/Sewage infrastructure + necessary system for sanitation and preventing disease spread. * Food stamp program mechanism + providing food vouchers that required spending at local stores. * Writing prescriptions for food + action taken by Geiger using his pharmacy budget to supply local grocery stores. ## Timeline & Events * Civil Rights Movement + period in which healthcare was central to the movement's message. * 1962, 1963, 1964, 1965 + period when the Medical Committee for Human Rights traveled through the South. * The 1960s + time frame when the Medical Committee for Human Rights operated and when the first two community health centers were established. * Late 1960s + time when sanitary outhouses were being built in places like Rosewood and Alligator, Mississippi. * Early 1970s + time frame when Shaw v. Mississippi was decided. * 1930s to early 1960s + period when hunger was seen getting worse in the Mississippi Delta/Arkansas Delta/etc. * 1960s + decade when the food stamp program was established. * 1960s + time frame for the initial establishment of community health centers. ## Examples & Cases * Civil rights workers + example of people beaten up while traveling through the South, who doctors failed to treat. * The Medical Committee for Human Rights' travel + example of physicians providing care to civil rights workers in the South. * Sharing the 55-gallon drum stove + example illustrating the poor heating conditions in a sharecropper shack. * Finding burns on small children at the first health center + specific problem discovered illustrating poor living conditions. * Sewage in the streets in Lowndes County Alabama in 2018 + example of current infrastructure failure. * The necessity of building outhouses + example showing sanitation challenges before full sewer implementation. * The fight leading to Shaw v. Mississippi + court case example concerning unequal provision of basic services in a town. * Monsoon/Flooding in Austin, Texas + example of a water crisis due to weather. * Malnourished baby + visual example presented by Geiger showing the physical effects of poverty. ## Trade-offs & Alternatives * Treating people when they get sick vs. alleviating the conditions that make them sick (prevention). * Having only rudimentary sanitation (outhouses) vs. having full sewer systems (preferred solution). * Using commodities (flour, cheese) vs. the Food Stamp Program (giving more variety, good for business). * Getting water from municipal supply (once fought for) vs. using drums previously holding DDT. ## Counterarguments & Caveats * "It's not that long [the UN report on poverty] but it's very devastating." * "If you make more than eighteen percent of the poverty rate in Alabama you don't qualify for Medicaid." * "We don't think of sanitation we don't think of sewage as being a civil rights issue." * "It's not that I have to be a doctor to figure out that that's not good for your health." * "But of course, that doesn't solve the problem in the long term that only solved immediate problems." ## Methodology * Geiger's process of traveling and observing appalling conditions in the South. * Conducting investigations that revealed underlying causes of illness (e.g., poor housing, sanitation). * Use of statistics (e.g., maternal/infant mortality rates) to guide action. ## References Cited * UN report on poverty in the United States + source cited for data on Alabama. * Shaw versus United States + Supreme Court case referenced regarding sanitation. * Shaw versus Mississippi + Supreme Court case finally deciding that a municipality cannot provide basic services unequally. ## Conclusions & Recommendations * Think about healthcare as a civil right. * Think about health beyond just my health insurance, my flu shot, my weekly by month, my yearly visit, but think about all these other social determinants of health. ## Implications & Consequences * If the infrastructure (sewage/water) fails, diseases like hookworm can return. * Poor sanitation leads to accumulation of human waste, which poses severe health risks. * If people live in extreme poverty, it directly affects their health. * Failing to address social determinants means treating only symptoms rather than the root causes of poor health. ## Open Questions * What can be done regarding sustained federal funding or policy changes for comprehensive sanitation/water infrastructure across all American communities? * How can we ensure that food assistance programs adapt to modern nutritional needs beyond just caloric intake? ## Verbatim Moments * "I'm going to talk about what's known as the social determinants of health." * "think about health care as a civil right." * "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."