Social Determinants of Health: Claire Pomeroy at TEDxUCDavis

Claire Pomeroy talks about the social determinants of health: what they are and how they impact people's health and the American society.

I'm here to recruit you.

I'm here to get you to join me
in creating a healthier world.

But I'm also here to convince
you that we can't do that

within the traditional
healthcare paradigm.

We have to think in a new way.

We need to come together

to address the underlying social
determinants of health.

So, if you will, close your eyes
for a second,

and imagine something with me.

It's midnight.

A fourteen-year-old girl
walks down the street.

She's tired, she's hungry,
she's shaking.

She's really scared.

Where will she sleep tonight?
How will she survive?

She's just fourteen and alone.

And, yet, she knows that
this was the right choice,

because staying at home was scarier.

Had she stayed
where the abuse was,

she wouldn't have made it.

She wouldn't have survived.

And at least here she has a chance.

So, she walks on, with one destination,

one goal in mind:

survival.

So, open your eyes.

And, yes. That fourteen-year-old
girl was me.

And I have made my way
from those streets

to standing in front of you today,

and I learned a lot on those streets.

And that's why I care about the underlying
social determinants of health.

I made my way from those streets
to a local teen counseling center,

and I made my way into
the foster care system.

Now, my first placement
was an emergency placement.

And, when I was there,
the people were – they were kind,

but I didn't trust them.

And so, I just couldn't
let them help me.

And, just as I was starting to trust,

I was reassigned to another home.

My next placement was with
an African American family.

And they were great.

They were generous,
they were kind,

and maybe they didn't
quite know what to do

with this blonde,
blue-eyed white girl.

But I always felt like an interloper.

And then, one day,
I was doing the family laundry,

and I accidentally threw
a red T-shirt in with the whites.

And I was petrified.

What kind of punishment
would there be?

What kind of retribution
would be exacted?

And, instead, they said,
"Don't worry! It's Ok."

And, suddenly, we were united
by a common color:

pink.
(Laughter)

And my final foster placement
was with a couple

who became foster parents just
to give me a home.

And they made me feel
safe and trusting.

They gave me confidence
in my abilities and myself.

Being a foster child taught me a lot.

It taught me how life traumas
have long lasting impacts.

It taught me about race, and equality,
and social justice,

and it taught me that
reaching out in kindness

can literally save a life.

Having experienced great cruelty,

I knew what it was like
to feel unvalued.

And having experienced great kindness,

I know the importance of caring
for the most vulnerable.

But, you know what –

In a lot of ways, I was lucky.

I was white, I was educated,

I got placed in good foster homes,

and, when I was there, I saw a lot
of kids that weren't that lucky.

And I saw them lose hope,

and I saw what it did to their health.

So, I embraced this life perspective.

As Franklin Delano Roosevelt said,

"The test of our progress
is not whether we add more

to the abundance
of those who have much.

It is weather we provide enough
for those who have too little."

And that's what addressing the social
determinants of health is about.

With those lessons,
I went on to medical school.

I trained as an infectious
disease physician,

and I finished just as the HIV/AIDS
epidemic was unfolding.

And in that clinic,
that HIV clinic that I started,

I saw veterans — it was at the V.A.
— coming in,

young veterans coming in,
looking like old men.

Their bodies falling apart,
catastrophically,

from this devastating fatal illness,

because, remember, back then,
there were no treatments.

And I saw them lose their jobs,

and their homes, and their friends,

as they lost their health.

And the worst sadness —

was I watched them
be rejected by their families

as they were dying,
just because they were gay.

And what do you think
that did to their health?

And through fighting for
and supporting those brave men

against all those unfair judgements
and the abandonment,

that's where I found my inspiration.

By caring for others who experienced
cruelty and adversity,

I was given the opportunity
to repay the kindness

that had been shown to me.

Those patients taught me
powerful lessons:

lessons of acceptance,
and courage, and love.

And they taught me what
a physician can be

and what Medicine must be.

But today, tragically,
Medicine is failing in our country.

The fact is that the system
that I work in, here in the US,

spends more than twice the amount
of healthcare dollars per capita

compared to any other
developed country,

and we have worse health outcomes.

We spend 18% of our GDP

and we have dismal health
status in this country.

The fact is, in this country
we don't even...

too many don't even have access
to this failing system.

We've got 51 million uninsured
and many more underinsured,

and this lack of coverage
translates directly

into worse health outcomes.

You know, I was one of those uninsured,
when I was a teenager,

and I didn't have a doctor,

and the only place I could go
when I got sick

was the local emergency room,

and that's not the right place
for a teenager to get help.

And the fact is that
our healthcare system today

is characterized
by unconscionable disparities:

disparities in health on the basis
of race and ethnicity,

geography, orientation
and socioeconomic status.

It's shameful.

And I know.
Look at these numbers.

Blacks on average live
about 4 to 7 years fewer than whites.

And I know, because I heard those
stories of "why",

from the African American
HIV patients

I took care of in that HIV clinic.

And it's because of the social
determinants of health.

Martin Luther King said,
"Of all the forms of inequality,

injustice in healthcare
is the most shocking and inhumane."

And my message today

is a call to action for each one of you.

Remember I was going to recruit you

in the health professions,
but here's the important point:

far beyond!

Because you have a way
to correct this injustice.

I submit to you that one reason
we spend so much on health

and see so little in return

is that we're spending
money on the wrong things!

We have a system of "sick care",
not healthcare.

We treat patients after they get sick,

but we don't provide the services
and opportunities they need

to keep them from ever becoming
patients in the first place.

We need a new paradigm!

One that's reactive.

I mean, proactive! Not reactive.

One that is primary-care-based,
not acute-intervention-based.

One that coordinates care,
rather than fragments care.

One that is population
and community-based,

rather than hospital
and physician-based.

And we, most importantly,

need to move from the traditional
medical model

to a model that embraces the social
determinants of health.

And we now understand
that the health of a population

is predominantly determined
by factors other than clinical care,

and hospitals and physician offices.

In fact, that's only 10% of what
determines a community's health.

The other 90% is behavioral
and social factors.

And what do I mean
by social determinants of health?

I mean factors like
socioeconomic status,

education opportunities,

occupation and job security,

housing, safe neighborhoods,

social status

and one that is particularly
important to me:

the feeling that you have
a place in society,

the feeling that you have
a social support system,

the feeling that you are valued.

And we know that those
who feel unvalued have poor health.

So, I saw kids,
when I was in foster care,

with no chance for an education,

and I now know that, if they didn't
get a high school diploma,

they were more than five times
as likely to have poor health,

compared to me,
getting a college education.

And I saw kids who had experienced
nothing but poverty,

and I now know that they're eight times
as likely to be in poor health

as their more fortunate counterparts.

My experiences
have shown me the link

between these social
determinants of health

and status of health in a community
and in a person.

And so these realities demand

that we address the social
determinants of health.

And here's the message:

health cannot be the sole
responsibility of physicians.

We must all come together
in new partnerships —

government and community groups,

academia and business —

to ensure that everyone
has access to education,

to job opportunities,
to safe neighborhoods.

So, you don't need to go
to medical school to improve health.

You need to care.

And health must not be limited
to a single domain.

We need to talk about health
in all policies,

and understand that every
social policy in our country

should consider the impact on health.

Now, it's been said that we can't afford
for the healthcare system

to take care of all
these social problems.

Well, I'm here to tell you today —
We have the money to do this.

We're just spending it
on the wrong things.

So, if you look at this chart,

you will see the United States
right here in red, in the middle.

We spend a lot more
on traditional healthcare,

but a lot less on social services.

Add those poverty reduction programs
together with healthcare

and we're right in the middle.

We're just spending money
on the wrong things.

We need to reduce poverty,

we need to give
education opportunities,

we need to create job opportunities,

because if we do,
people will be healthier

and we won't have these huge
expenses in medical care.

My call to action today,
I believe, is urgent.

We all need to come together

to address the social
determinants of health,

to challenge the inequalities
and disparities

that are so deeply ingrained
in our country,

create social policies that
will ensure a better health for all.

As President Obama said,

"Every once in a while,

a moment comes where you'll have
a chance to vindicate

all those best hopes
that you had about yourself

and about your country..."

I would submit to you.

It's a challenge.
Look inside yourself.

Examine your life experiences.

Define your core values.

What are you going to do?

Ask yourself:

What country do you want to live in?

One in which social deprivation
defines your health status?

One in which the circumstances
into which you were born

determines your life expectancy?

Or do you want to live in a country
in which we all come together

to address the social determinants
of health?

A place in which we come together

to bring all our diverse perspectives
and experiences

to ensure a better health for all?

Our life experiences define
what we'll prioritize;

how we use the opportunities
that we've been given.

For me, my life experiences bring me
powerfully and inevitably

to helping the vulnerable,

to ensuring social justice
in our society,

to taking care of those who have been
forgotten by society.

So, I ask you:

How will we treat
our most vulnerable?

Will we have the political will
to address poverty,

to develop national policies
that address education,

job opportunities,
neighborhood safety?

Will we have the courage

to change the way that we spend
our healthcare dollars

and use them to address
the social determinants of health?

And, most importantly:

Will you join me?

Will you lead this change?

Because now is the time.

Thank you very much.

(Applause)