In order to improve public health, policymakers need to pay attention to the social determinants of health: housing, education, location and employment status. That was the overriding theme of last week's Human Services Coalition meeting at Portland State University.
Larry Wallack, who recently left his position as the dean of Urban and Public Affairs at Portland State University to work as a senior fellow at the Moore Institute of Public Health at Oregon Health & Science University, introduced his talk on the social determinants of health with quote from Frederick Douglass: “It's better to build strong children than repair broken men.”
“We're a downstream society trying to solve upstream problems,” Wallack said.
The Moore Institute was founded two years ago with a focus on prenatal nutrition and epigenetics (the science of how a mother's health affects gene expression in the womb, which has been shown to have lifelong effects. While increasingly, research from around the world is showing that prenatal nutrition – and a child's access to food during the first 1,000 days of life – has enormous lifelong impacts, Wallack said focusing solely on the health and behavior of women is not enough.
That's because the environmental factors that affect genetic expression and increase the risk of diabetes, heart disease and other health problems actually cross generations – and chronic stress during pregnancy and early childhood is one of the strongest predictors of chronic disease.
“We have focused on the mother-fetus circle,” Wallack said. “Because of what we know now, it's not enough to focus on the mother.”
Wallack, who’s been in the public health sector for more than 20 years, said while many things have changed, there are a few concepts that haven't changed since his first day: first, healthcare does not equal health, public health is about politics (and science is only understood in the context of politics) and third, the ethical basis of public health is social justice.
“This is at the core of who we are,” Wallack said. He referred to the mid-20th century period as “the great compression,” when income inequality was very low. That trend started to reverse during the Carter years and has continued for the last several presidential administrations.
“We can never treat our way, or service our way, out of the problems we face,” he said, adding that the way we frame social issues has an impact.
“Our society is based on an odds metaphor. We love people who can beat the odds,” Wallack said. “If we want an odds metaphor, what about talking about the person who is changing the odds so more people can succeed?”
Keynote speaker Sen. Jeff Merkley (D-Ore.) opened his talk with a quote from Hubert Humphrey: “The moral test of government is how it treats those who are in the dawn of life, the children; those who are in the twilight of life, the aged; and those in the shadows of life, the sick, the needy and the handicapped.”
Merkley went on to list a number of bleak statistics about the current economic picture: 60 percent of the jobs lost since the banking collapse in 2008 were living-wage jobs, and of the jobs recovered since then, only 40 percent were living-wage jobs. And Congressional support for people trying to transition out of unemployment – such as unemployment benefits and nutritional assistance – is rapidly waning.
“What we're hearing from the House [of Representatives] is, 'If you're unemployed, go get a job,'” without recognition that many people are trying without success to do just that.
A sluggish economy is just part of the problem, he added. Technological changes have also eliminated certain categories of jobs. While tens of thousands of US factories have closed in the last few decades, with many moving overseas, the efficiency of modern robotics means that some manufacturing jobs are nearly or entirely automated, since robots can work 24-7 cheaply, and run no risk of injury.
In addition, cuts in the public sector have increased the workload of those still employed in public services, Merkley acknowledged. “The work that you're doing is so complicated, important and challenging,” he said, urging audience members to contact his staff to tell them what's happening in their field, so he can continue to push for social services funding. “This is why it is so important that I have your stories."
Christen can be reached at [email protected].
