Social Determinants of Hope

Back in April, I talked about the COVID19 pandemic, sharing some of the reliable sources I track for science and evidence-based information on the virus, its spread, and how public health and health policy types are working to get it under control. Last month, I tackled the uncertainty that’s embedded in our pandemic times – where is the virus spreading, are there any treatments, what’s the progress on a vaccine, all questions that will take time to answer.

It feels like the year 2020 is shouting “hold my beer,” with the pandemic still spreading, scientific uncertainty magnified by the retraction of major articles in the Lancet and the New England Journal of Medicine that purported to show that hydroxychloroquine wasn’t effective against COVID19, but the data that supposedly supported that conclusion was hidden from peer reviewers … and now Americans, and people across the globe, are in the streets protesting against police brutality toward Black citizens in the US and elsewhere.

What’s next? Will Mt. St. Helens explode again?

The impact of COVID19 in the US has hit the Black community especially hard, likely due to the health disparities already present in the community. Social determinants of health has become a watch phrase over the last two decades, as the idea that where you lived, what your access to clean water and fresh food was like, what your economic opportunities were, impacted your overall health. News coverage of the pandemic has been subsumed by coverage of the street protests, happening in all 50 US states and in countries around the world, demanding justice for Black citizens in the wake of the death of George Floyd in Minneapolis at the hands – the knees, really – of the police.

It feels exhausting, trying to manage the barrage of news, some scary, some just downright terrible. Everyone’s social determinants of health have been impacted by COVID19, with massive upticks in the number of unemployed, businesses shut down by social distancing rules, and now we’re watching our fellow citizens getting beaten and tear gassed in the streets. You could be forgiven for feeling overwhelmed – I sure do.

But here’s the thing. It’s a scary time, but I’m seeing strong signals of hope. It could be that we started to realize that we were all together, as humans, in the fight against a pandemic. It could be that, after 400 years, White America is finally waking up to the reality of the daily experiences of Black Americans who face oppression, micro and major, just going about their daily lives.

For me, one hopeful sign is how the medical community is showing up in support of the Black community, as they’re also still tackling the pandemic. In a Health Affairs piece titled Social Determinants of Death, editor in chief Alan Weil said this.

“I wrote this as the COVID-19 pandemic was raging, with emerging data showing a “consistent pattern of racial/ethnic differences”—namely a disproportionate burden borne by Black and Latinx people. As I put the finishing touches on this piece I, along with the rest of the world, witnessed the murder of George Floyd, a Black man.

It is impossible to miss the cruelty and callousness apparent in a human being’s murder when it is captured on video. But it is the same cruelty and callousness that ignores (or laments and then does nothing about) the daily premature death and disability of people of color.

These deaths are all socially determined.”

He went on to call for health care institutions to not just stand against racism, but to use their power to fight racism.

If health care institutions actually do step up, and use their power – the American health care sector, at $3.6 trillion a year, would be the fifth largest in the world based on GDP if it were a country – to end racism, we’ve got a chance to truly shift the human condition, in the US and around the world.

So, health care sector leaders, are you in? You better be.

The whole world is watching.