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!