Reflective: Looking Back On Volumes 4-6

Every four months we pause from conversations with public health leaders to reflect on lessons learned from their varied careers, and insights into persistent and emerging public health challenges.

We are Public Health has been honored to feature conversations with several groundbreaking, widely respected pioneers in the field.  The last three volumes highlighted Dr. Len Syme, father of social epidemiology, and Dr. Jack Geiger, a pioneer of the community health center movement in the US.  As Dr. Geiger acknowledged in his interview, “we all stand on the shoulders of others.”  The ripple effect of their unique contributions to our field is evident in the work of other featured practitioners such as Jim Bloyd, Dr. Sandra Witt and Dr. Bob Prentice, who are all working to operationalize Dr. Syme’s and others’ social determinants of health framework in communities and within government institutions.  Similarly, we see Dr. Geiger’s strategy of engaging, organizing and empowering community members to create their own solutions and successfully address public health challenges reflected in Emma Rodgers’ coalition-driven work in the Bronx, Laura Sanders’ advocacy for immigrants’ rights in Southeastern Michigan, Arnell Hinkle’s efforts to create youth-led and culturally appropriate nutrition and physical activity resources, Dr. Joe Zanoni’s work to improve the health and safety of immigrant day laborers, and finally in Dr. Joseph West’s community research on diabetes in Chicago’s North Lawndale network.

Drs. Syme and Geiger’s legacies extend beyond these amazing public health workers who continue to “stand on their shoulders”.  Their impact is also evident in current public health work and policies. These days, it is rare for public health students to graduate from any school of public health without a working knowledge of the social determinants of health. In the field, the determinants are widely considered just as critical to supporting and improving the health of communities and reducing health inequities as the delivery of clinical services. Additionally, community health centers are rapidly becoming the go-to places for many Americans to seek health care and community resources.  In the age of the Affordable Care Act, also known as Obamacare, these centers play a central role as the medical homes of low-income residents across the nation, and a growing number are finding creative ways to integrate the social determinants into primary care.

When we started this website we hoped that we would be able to feature public health’s well respected and renown pioneers. We are delighted to also see the connections between their groundbreaking work, and the current efforts of a diverse set of public health practitioners.  It is truly inspiring to witness the evolution of their audacious visions.

We are so excited about where the next three volumes will take us!  We look forward to reflecting on more trends in these public health histories.

Reflective: Looking Back On Volumes 1-3

Every four months we pause from interviews with public health leaders and true heroes to reflect on lessons learned from their varied careers, and insights into persistent and emerging public health challenges.

Our first set of interviews included late career reflections from pioneers who expanded the field, including Dr. Len Syme, the “father of social epidemiology” (later referred to as the social determinants), and Dr. Quentin Young, activist physician, who pushed for the field of health to embrace the principles of social justice and human rights.  Other interviewees shed light on the critical importance of community partnerships and grass-roots efforts, in order to improve the conditions in which communities live, work, pray, and play.  Dr. Renee Canady integrates health equity into her leadership role for the Ingham County Department of Public Health; In her career, Susan Avila brought deep commitment to her role as public health nurse in inner-city Chicago; Angela Reyes addresses youth violence and other issues affecting Latinos in Detroit; and Causandra Gaines has worked in partnership with other community leaders and residents to improve the health of Detroit residents.  Finally, a trio of public health leaders mused on the importance of institutional, state, and national policies and priorities in improving the public’s health and reducing and eventually eliminating health inequities.  These include Dr. Linda Murray, Chief Medical Officer of the Cook County Department of Public Health; Dr. Georges Benjamin, Director of the American Public Health Association; and Dr. Anthony Iton, Senior Vice President of Health Communities at the California Endowment.

A common theme across all interviews is the need to address the root causes of health inequities that affect marginalized populations throughout the US.  Poverty, violence, racism, segregation, oppression, a lack of hope and power all negatively affect the health of communities.  So does outright disenfranchisement, whether it occurs along social, political, or economic lines.  Current political debates attempt to police marginalized groups.  They do this by denying them pathways to citizenship, a living wage, quality educational opportunities, social safety nets, equal marriage, among others.  However, as our public health heroes point out, often it is community members, and not necessarily policy makers, who are intimately familiar with both the issues and the potential solutions.  As such, we need to create a way for the community to participate in the decision-making process surrounding the policies that affect their communities.  Furthermore, our heroes highlighted the need for action at the community, state, and national levels.  To do so requires the political will do live in a more just society.

The issues highlighted in this volume – poverty, violence, racism, segregation, oppression – are not new issues for the field of public health.  While the face of the forces that have created, perpetuated, and re-perpetuated these inequities may have evolved over time, these root causes remain.  And while the nature of the problems may have evolved over time – from the explosion of HIV/AIDS in the 1990s to chronic disease epidemic of the 2000s, the populations most severely affected by these public health problems remain the same.  The health problems may have shifted, but the structural processes affecting health remain largely unchanged.  Despite this, we find reason for optimism in innovative, creative, passionate collaborations currently underway at the community and state level, and applaud these heroes for their persistence and conviction in the face of so many obstacles.

Given the forces working to undermine our public health, how do we, in Dr. Iton’s words, counterbalance strong political and economic forces that overshadow the needs of disenfranchised groups? How can we ‘organize people and marshall their collective power, within these democratic processes, to advocate for a different set of priorities and a different approach to sharing these resources”?

We invite you into a discussion in the comments.  Please also like our Facebook Page and follow us on Twitter as we continue this conversation.  Stay tuned next month for a next volume of We are Public Health!