Making America Healthier

Image by Sacred Heart Rehabilitation Center via Flickr

This week I attended the John R. Hogness Symposium on Health Care at the University of Washington. This year’s speaker was Daniel R. Williams, PhD, Professor of Public Health/African and African-American Studies/Sociology at Harvard University. Dr. Williams is a sociologist who studies the social determinants of health, including racial and socio-economic health disparities. He is prominently featured on the excellent PBS series, Unnatural Causes, being interviewed on a variety of topics related to his research.

The title of Dr. William’s talk was, “Making America Healthier: Surprising Steps for Every Health Professional.” While Dr. Williams is an excellent public speaker and delivered a cohesive lecture, most all of the information he covered was the same/similar to what is in Unnatural Causes—so it wasn’t really surprising. I suppose though that it is surprising that the information is surprising to health professionals in the US. He was mostly preaching to the choir here in Seattle. I was also surprised (and bemused) by the pre-lecture conversational content of a group of young students sitting beside me. While looking around at the increasing crowd, one student exclaimed, “Wow! So this is like a big deal!” OK, so we have work to do in our educational system.

Dr. William’s main talking points were as follows: 1) the US ranks near the bottom of all industrialized countries on most all health measures—and we are losing ground; 2) immigrants to the US become less healthy the longer they live in the US (“life in the US is bad for your health”); 3) the racial gap for blacks/whites in health is larger for higher educational levels; and, 4) racial segregation in large US cities in the 2000 census was close to the level of racial segregation in South Africa in 1991 under Apartheid. He stated that health care reform is crucial but insufficient—that we also need to address the social determinants of health in order to make America healthier. He included health behaviors/individual lifestyle choices as something we all need to work on—we are now supposed to eat at least nine servings/day of fruits and vegetables and not just five—while acknowledging how poverty and lack of access to healthy choices makes it more difficult for some to ‘do what’s right’ health-wise.

What can we as health professionals do to make America healthier? Of note is that Dr. Williams is not a health care professional, and that fact was reflected in some of his recommendations. He gave examples of successful programs that incorporate social determinants of health into mainstream health care. Heading his list (yeah!) was the Nurse Family Partnership. Then he talked about the Boston Medical Center’s Medical Legal Partnership, which links low-income families with lawyers—for instance to pressure landlords to remedy asthma-inducing mold and cockroach problems in apartments. The third program he mentioned was Health Leads, started by a Harvard undergrad. This is a service-learning project training college students to staff waiting rooms of safety net clinics, linking patients and families with needed social services.

Dr. Williams ended his talk by giving reference to four resources for further information: 1) Unnatural Causes videos, 2) Robert Wood Johnson’s “Build a Healthier America” report, 3) county-level health data at, and 4) Biology of Disadvantage: Socioeconomic Status and Health (Annals of the NY Academy of Sciences, Feb 2010–free access to report–there is a companion report/also free/less academic, “Reaching for a Healthier Life: Facts on Socioeconomic Status and Health in the United States.“)

I was left thinking, “Yes-but?” This all sounds good, but what can individual health care providers such as nurses really do to change things in the health care system? How can we include any of Dr. William’s suggested programs? For instance, our local Odessa Brown Clinic, a safety net clinic in a traditionally African-American Seattle Community, had a grant to include legal services for patients. But once the grant ended, the program ended. Our Washington State Maternity Support Services are on the chopping block in the upcoming legislative session. I suppose we could try to replicate the Health Leads program locally, but with food banks and other basic services being cut, it is hard to know what the students would be linking patients to.

I try to maintain healthy skepticism as opposed to unhealthy cynicism in terms of health policy in general, and the social determinants of health in particular. But Dr. William’s talk left me with the vivid impression of all of us health care progressives spitting into the wind. Even the authors of the Biology of Disadvantage report have somewhat similar sentiments, “…thus we face with humility the task of identifying appropriate poverty-reducing strategies that improve health.” (p.247)

2 thoughts on “Making America Healthier

  1. Hello Josephine:
    I am a current UW Seattle student in the BSN program. I enjoy reading your blog from time to time. I wonder if you have ever written a post or would consider writing a post about the pressure students and new nurses receive to work in a med-surg setting before, say, a community setting. I have been soliciting opinions from instructors and nurses I know since I started my program and they are varied. I’ve been told by some that new nurses should “spend two years in med surg to cement skills” and that “nursing is a bedside profession.” I been told by others that nurses should practice where they want to practice from the beginning and that nursing skills can be cemented anywhere. I have my own opinion of course and will be seeking a job in the community setting after I graduate.

    After attending the David Williams lecture I left the auditorium wondering to myself what it would be like if the dominant nurse-to-nurse narrative was that new nurses should spend two years working in the community before they moved to med-surg.


    1. Hi Addy,
      Thanks for this comment/question and insights. I know very well–and personally–what you are talking about having experienced it myself in my BSN program. I will think about this more and write a post on it soon as it is a good topic. The short ‘answer’ I have is that this is all about the privileging of high-tech (high cost, more glamorized) biomedicine in the US. Nursing has its roots in home and community nursing, but med-surg/acute care hospital nursing took over since that’s where the money is.They are all important–just need to be a better balance. There are nursing education reforms brewing that do start out with community health and then move to med-surg. And yes you can (and should if is what you want) go for community/PH nursing when you graduate. But the job market reality may be such that you go for a hospital job while maintaining some community health volunteer or part-time work–then transition out of the hospital when possible…
      Hope this helps!


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