Transcript

The Social Determinants of Health | Dr. Thomas Ward | TEDxSpringHillCollege

I'm gonna talk to you all today about healthcare and healthcare obviously is something that is we're right around a election and health care is something central to everybody's concern in many ways but I'm going to talk about it a little differently than probably how you think about it most of the time you know we think about health care we think about insurance which is obviously important and we think about getting our flu shot which is important we think about getting our annual checkup which is important you should do all those things but I'm going to talk about what's known as the social determinants of health and I'm gonna get into that in a little bit greater detail and in a second but when I when I start I want you to think about health care as a civil right and once again that's something we hear about a lot especially around election time is you know as health care is silver right or not what I'm going to talk about right now is that health care and we don't think of it very much was part of the civil rights movement and health care came directly out of the civil rights movement in many ways our current health care systems dr. King talked about healthcare and we don't think once again about healthcare in civil rights movement we think about voting rights we think about desegregation we think about schools but health care was very central to what a lot of the civil rights leaders were talking about dr. King talked about it Malcolm X talked about it fannie lou hamer talked about the Black Panthers Black Panthers created healthcare clinics in Oakland and in many places so health care was was very central to the message of what was important to civil rights and so you know this is not a new thing when we talk about health care being viewed as a as a civil right and during the civil rights movement there was a group of physicians black and white northern and southern the group called the medical committee for Human Rights and what they did is they traveled throughout the south mainly in Mississippi and Alabama in 1962 1963 1964 1965 and they patched up the civil rights workers you've all seen images of civil rights workers getting beaten up well doctors didn't treat them in the south hospitals didn't take them in you didn't we didn't have a Good Samaritan law back in the 1960s so they weren't they were not treat so this group of doctors travelled around the South patched them up took care of these civil rights workers but what happened as they were doing this is they were traveling throughout the south and they were patching up these civil rights workers they got very frustrated they saw the good work that these civil rights workers were doing they saw that they were fighting for desegregation fighting for voting rights all the things that we think of when we think of the civil rights movement but they also saw the deplorable conditions that the black community and a lot of the white community in the south was living in and they these doctors literally sat around at night in the hotel rooms they were saying they're saying 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 people living in conditions that are unhealthy and so they started to think about what could they do and the father of this movement is a guy by the name of dr. H Jack Geiger and and Jack Geiger was one of these physicians one of the members of the committee a medical committee on human rights and Jack said we've got to think about not just treating people not just trying to make them better when they get sick but it alleviate the conditions that make themselves sick and so he talked about the social determinants of health what are the things that make people sick and how what can we do to alleviate them because what he saw were conditions as he traveled throughout the south that were making a making it a situation that people couldn't get better he said our job isn't just to get people better when they get sick but to prevent them from getting sick in the first place and so he first with some of these other doctors started a small clinic outside of Jackson Mississippi that basically did that out of their own back pockets they said that's inadequate that's not enough so then they went and they wrote a grant this is during the the Great Society and the war on poverty and they got a demonstration grant to start the first two community health centers in the United States one in Mississippi and one in Boston and we now have 2900 community health centers in the United States it's the single largest way that people get health care in this in this country 27 million I think people now get health care through the Community Health Center and it comes right out of the civil rights movement and one of the things that Jack wanted to do was deal with the problems at the grassroots level and the first one he dealt with was poverty and when he was in Mississippi he set up a the first Community Health Center in the south and mound Bayou Mississippi and dealt with basically sharecroppers in north Bolivar County and he dealt with conditions like this and you know this picture is is very powerful it's also very illustrative because one of the things that when Geiger set up his first Community Health Center in Mississippi he knew about he knew statistics he knew that maternal and infant mortality rates in Mississippi were terrible in 1966 1967 1968 so he recruited pediatricians he recruited people to come down and do these things but what he found out was that there were other problems he had to deal with and I said this picture is very illustrative this is a if you can see this is a stove this is a sharecropper Shack as a stove is a stove made out of a 55-gallon drum that was you know left on the plantation that was the only sort source of heat the first winter they the health center was open they had all these small children that were coming in with burns and they had they weren't ready for burns in Mississippi why are we getting all these burns in Mississippi and it turns out that this is how most houses were heated and so kids were running into it so they went out they said we can't just wait for people to come to health center we got to get out into the homes and so they started building little fences around the little fences around the stoves that eliminates a problem right but then they said there's a lot of other problems the roofs leaked we got this quote from dr. Brown or it doesn't do any good to treat someone and send them back into an environment when they're gonna get sick there were no screens on the windows people were getting disease diseases from mosquitos there were holes in the floor boards that were snapped as snakes there were rats that were getting in so they set up a system just to fix up the houses right because poverty has a tremendous impact on someone's health and there are obviously lots of reasons many of which we don't have time to go into but this is just kind of an example and so this is the 1960s but today of course we still deal with poverty and poverty still has a huge impact on people's health recent UN report on poverty in the United States you know saw Alabama as the most impoverished areas in the country Lowndes County Alabama and we look at some pictures in a minute where people are dealing with some of the same conditions that Jack Geiger saw a half a century ago in the Mississippi Delta and if you live in extreme poverty it has direct effects on your health it has effects on obviously if you can afford health care we live in a state where with medical with Medicaid obviously if people say well we have we have Medicaid in this country well you have if you make more than eighteen percent of the poverty rate in Alabama you don't qualify for Medicaid so if you make if you make more than four thousand dollars a year in Alabama you're too rich for Medicaid so part of this is policy right part of this is policy we need we need we need change pause so you deal with those types of issue but poverty's today still has a direct result on health one of these issues that Geiger saw and we're saying it's still relevant today is sanitation one of the things that was horrifying to him when he went into Mississippi and and his sanitary engineer was that there were towns where the white side of town was Seward and the black side of town was not the sharecropper shacks we saw didn't have toilets they had sunshine privies open per Beason and they actually got to a point this is the late 1960s that they were building outhouses building sanitary outhouses because that was a better solution than what they had and was it was horrifying to them that they were saying look why are we why are we having to build outhouses you know we should be building sewers but they didn't have the money to do that so they're building outhouses because up to that point when you'd have you had rain in cities like rosewood and alligator Mississippi there would literally be human waste in the black part of town eventually that led to Supreme Court cases Shaw versus United you know once again we don't think of sanitation we don't think of sewage as being a civil rights issue there were boycotts there were court cases and Shaw versus Mississippi which has finally decided in the early 1970s is yes a municipality can't decide to provide basic services to one part of town and not another part of town and so you know that was a struggle that was was won in the 1960s but we've also seen deterioration of a lot of these situations this is Lowndes County Alabama 2018 there's sewage in the streets sewage bubbling up because that infrastructure has gone out of working order and has not been replaced so this UN report on poverty issued a devastating indictment of a lot of aspects of poverty in the United Sates and if you haven't had a chance to read this you can google it it's not that long but it's it's very it's very devastating and talking about the the you know the raw sewage that's found in parts of Alabama and parts of West Virginia also looked at Puerto Rico and the problems there and the fact that this is creating situations that health conditions that had gone away are coming back one of the most devastating was hookworm hookworm was a hook woman is a parasite it's something that had basically been eradicated by the 1940s and 1950s in the United States because if you have sewage systems you don't get hookworm it's coming back and and it's a parasite that's now being found again in humans in Alabama and Mississippi because of the the problems we have so sanitation basic things that pretty much everybody in here I assume takes for granted that we have toilets these are issues that are affecting health of our you know our neighbors still today related to sanitation of course is water there's another picture from the 1960s we see another one of these drums you can see there's a little spigot on it I always think this is a powerful photo those shacks that dr. Geiger came across and in the 1960s they didn't have they didn't have sewers they didn't have one at running water either and so what many people would they would get these old 55-gallon drums from the plantation and they would take them into the city the music municipal water supply and they fill them up of course these drums had previously held DDT and other chemicals on the plantation right you don't have to be a doctor to figure out that that's not good for your health so they fought and they got municipal water supplies built once again the Shaw case dealt with sewers it also dealt with water sixty years later we have Flint alright and Flint's not the only city in the United States where we're dealing with water issues it's become the most famous but there are lots of places that are dealing with waters in part because that infrastructure has broken down and there's not been the political will to fix it and as if your water is not good your Health's not going to be very good and like so we have we have Flint there are cities Baltimore New Orleans where the public schools kids can't drink the water out of the taps out of the water fountains because it's not healthy it's got too much too much lead in it areas where there's fracking has there have been a lot of problems with the groundwater being contaminated coal ash ponds I said a lot of these issues we hear we hear about only when they kind of intrude upon middle and upper-class societies right you know when it just stays when it just stays with the poor we don't deal with it but we're seeing a situation where with Flint with the danger of coal ash ponds especially in North Carolina with the recent hurricanes the floods now this water is getting into everybody's drinking water and then it becomes a crowd I was in Austin Texas on on Monday talking about a lot of these same things and we didn't have we didn't have water when I was there because of all the with all the flooding and so Austin Austin was going without water and so that was that was causing a crisis there so water these are issues that all of us have to deal with and these are issues that are directly related to health these the an you know these social determinants of health another thing the Geiger dealt with when he showed up in Mississippi was massive malnutrition he was horrified and this is a mountain malnourished baby that he's dealing with with the extreme poverty and how that related to people's ability to get proper food and Mississippi in the late nineteen sixties of the Mississippi Delta like the Arkansas Delta like parts of Louisiana like parts of missus arts of Alabama like parts of the Appalachians many of these areas actually saw hunger getting worse in the late 60s from the 1930s to the early 1960s there was what was called a commodities program a program to deal with you know taking excess commodities flour cheese we different things and giving him to the poor that gets replaced with the food stamp program in the 1960s the idea behind the food stamp program was one who was gonna give people more variety was also gonna be good for business right you had to spend the food stamps but the initial program you had to buy the food stamps he had to pay about twenty-two cents for every dollar where Geiger was the average family made seven hundred dollars a year do you make seven hundred dollars a year twenty-two cents to buy a dollars worth of food was more than you could you could afford and he saw nutrition getting worse malnutrition getting worse in these areas and so you know one of the things he did he he actually he had a federal budget and he started writing prescriptions for food he wrote him out of his he wrote him out of his his pharmacy budget you can imagine when people in Washington found out that he was writing prescriptions to local grocery stores for milk and eggs they went bananas they say you can't do this you know prescriptions are for medicine and he said he said the medicine for Mount malnutrition is food and of course they couldn't argue with that and they set up they started setting up a new program where the worth it was going to be a food relief but of course that doesn't solve the problem in the long term that only solved immediate problems we deal with malnutrition today we deal with malnutrition in many different ways fifteen percent of the American population is food insecure forty million Americans 40 million Americans are food insecure six and a half million children are food insecure in this country and when we talk about malnutrition today we talk about certainly not having enough tea but we also deal with the issue of having the wrong things to eat one of the physicians that was in the original Delta health center one of doctor Geiger's colleagues Aaron surely was a fascinating guy was a just a hero of the the medical community in in Mississippi dr. Shirley said in the 1960s people were dying if not enough to eat he gives in the 2000 they're dying of the wrong things to eat and we deal with what many of you have probably heard about it things called food deserts right where if you live in an urban area or you live in a rural area there may be a place to get food but it's a gas station and you can't get nutritious food but it's also an issue of poverty a two liter of coke cost dollar fifty a gallon of milk cost 350 people are buying coke instead of milk for their children and so malnutrition is another one of these social determinants of health and something that is not going away right we still we do have food assistance all right we and the food stamp program has been adjusted since it was in the 60s but it is something that you probably all know is constantly under attack right constantly being limited on who can who can qualify for it and of course it's important remember it's not just people who are unemployed that need food assistance most big public universities now have food banks for their students half of all children of the Armed Forces active Armed Forces their children qualify for free or reduced meals alright if you work a 40-hour week at minimum wage you still qualify for food assistance so all of these issues I just want you to think about as you leave today you know think about health beyond just my health insurance my flu shot my my weekly by month my yearly visit but think about all these other social determinants of health thank you very much [Applause]