This article is about a panel at Health Journalism 2008.
The Science Supporting the Social Determinants of Health, presentation from A.H. Strelnick, director, Institute for Community & Collaborative Health, Montefiore Medical Center
Panelists:
• Christine Herbes-Sommers, senior series producer, PBS series Unnatural Causes: Is Inequality Making Us Sick?
• Llewellyn Smith, co-executive producer Unnatural Causes
• A.H. Strelnick, director, Institute for Community & Collaborative Health, Montefiore Medical Center
• Moderator: Andrew Holtz, M.P.H., independent journalist, Portland, Ore.
Sandy Kleffman
Contra Costa Times
Some people enjoy longer and healthier lives than others.
When trying to understand why, people often focus on genes, access to medical care and behaviors such as diet, smoking and sedentary lifestyles.
But social factors also can play a crucial role in adding or subtracting years from someone's life, including the community they live in, how empowered they feel at work, and their social status.
Such disparities help explain why Americans often live shorter, sicker lives than residents of other industrialized countries despite the huge sums we spend in this country on health care, said speakers at a "Community … the Health Story" forum on Friday morning.
The panelists discussed how to tell this story in a compelling way, or as moderator and independent journalist Andrew Holtz put it, "so that even our editors will understand it."
Experts refer to the concept as the "social determinants of health," but Holtz suggested using an easier-to-understand term such as "community."
Research reveals that education levels, disadvantages in life, social isolation, discrimination, income and stress can influence life expectancy and the likelihood of getting certain diseases, said Dr. A.H. Strelnick, director of the Institute for Community & Collaborative Health at Montefiore Medical Center.
We need "to look under the surface for the true roots of our health problems," he said. Strelnick used a series of graphics to illustrate what he called "the social gradient," or how people tend to become sicker and die sooner as they move down in socioeconomic status.
Years ago, people assumed that high-powered executives had the most stress, Strelnick said. But studies comparing health with how much control or powerlessness people have at work tell a different story.
"The person most likely to have a heart attack was the janitor," Strelnick said.
In an example of how to put a compelling human angle on the story, the panel showed segments of a four-hour documentary series called "Unnatural causes: Is inequality making us sick?" The program will air on PBS over four consecutive Thursdays from March 27 to April 17.
The producers focus on people living in four communities. Using maps to illustrate their point, they reveal that conditions such as heart disease, stroke, diabetes and cancer are much more prevalent in some neighborhoods than in others. Poorer areas that lack supermarkets, safe streets and decent housing have more health problems than wealthier communities.
People in some well-to-do neighborhoods live seven to 10 years longer than others, said Llewellyn Smith, co-executive producer of the series and the founder of Vital Pictures Inc.
"If it isn't a fact of nature, that means we can do something about this," Smith said.
Many cities have data and maps that can help reporters show in a powerful way the clustering of diseases in certain communities, said Christine Herbes-Sommers, senior producer of the series.
One episode of the series focuses on Greenville, Mich., after a factory moves to Mexico for cheaper labor, Herbes-Sommers said. The show explores how hospital visits rose and people's health suffered after they lost their jobs and their finances spiraled downward.
For more information on the series, go to www.unnaturalcauses.org.
