The other day I was working with several researchers with GHETS (Global Health through Education, Training and Services), a US-based nonprofit head by a colleague Dr. David Egilman, to expand the emphasize on community organizing and community action as a critical tool in training health professionals around the world in developing countries. We were discussing what they call the “social determinates of health,” which in layman’s language concentrates on the huge numbers of poor people in many areas around the globe who are killed or cut down way to early in some ways by the very nature of their poverty, as manifested in inadequate sanitary conditions, unsafe water, poor housing, inadequate diet, blocked access to education, pollution, and the endless obstacles that no amount of praise for bootstrapping can ever overcome.
At the same time the National Research Council and Institute of Medicine released a report this week finding that life expectancy in the United States trails 16 other industrialized countries. The reason for Americans’ sorry prospects, according to the summary in the Wall Street Journal, was cited largely as the “high mortality for men under age 50…” though women were also “lagging.” Reading more closely, why do you reckon, damned if it wasn’t all about the “social determinants of health.”
The authors offered a range of possible explanations for Americans’ worse health and mortality, including social inequality. They also described criticisms including limited availability of contraception for teenagers, community designs that discourage physical activity such as walking, air pollution and access to firearms, as well as individual behaviors such as high calorie consumption. [And, yes, I added the emphasis!]
Do I even need to add that conservatives are insisting that more equality has to be resisted, are blocking sex education and prevention for teens and others, are building malls, fighting to eviscerate the Clean Air and Clean Water Acts and postpone compliance and enforcement, stop any curtailment of access or increased regulation of guns, and push back at any information or reduction of high calorie consumption as part of the “nanny” state? No, I didn’t think so.
These social determinants are killing us everywhere!