Social Determinants Of Health: Seminar Will Investigate Non-Medical Causes Of Illness Mike Field ------------------- Staff Writer In England, a team of researchers discovers that rates of illness and even disease among civil servants bear a striking inverse relationship to employment grade: the higher up an individual progresses, the less likely he or she is to suffer from a number of maladies, including lung and other cancers, coronary heart disease, respiratory diseases, gastrointestinal disease, chronic bronchitis, accidents and violence. In the East Baltimore neighborhood adjacent to the world-renowned Wilmer Eye Clinic, a series of studies shows the leading cause of preventable blindness is unoperated cataracts, even when victims have the means and access to corrective surgery. One study estimates that fully half of all blindness among this urban population is preventable or reversible, yet is occurring nonetheless. These are just two examples of the kinds of issues a new interdivisional seminar, Social Determinants of Health and Illness, began to address at its first meeting Feb. 8. Organized by third year medical students Bruce Baird, Anita Ung and Anh Tran, the seminar is open to all, particularly faculty and students from the schools of Medicine, Nursing, Public Health and the graduate departments of Anthropology and Sociology. Their hope, say the students, is to generate an interdisciplinary discussion about the social, cultural, economic, gender, ethical and psychosocial aspects of health and illness both here and abroad. The seminars are scheduled to occur twice monthly on an ongoing basis. Physicians and public health experts have long suspected that rates of morbidity and mortality are, at least in part, socially determined. Yet finding the exact nature of those social factors has proved extremely problematic. Take, for instance, the strange case of life expectancy in Japan. In 1965 both Great Britain and Japan had a life expectancy of 68 years. Twenty-five years later, Japan had leapfrogged its way to the top of the world charts, with an average life expectancy of 76 years, while Great Britain lagged behind with an improved--but far less spectacular--73 years. Both nations have systems of national health care, but Japan spends far less than most developed countries on medical care, eschewing the kinds of superheroic medical miracles that are so prevalent in the United States (where the average life expectancy is far lower). At the same time that their life expectancy was growing, the dietary fat intake among Japanese increased significantly and smoking remained prevalent. Why then did the Japanese numbers increase so markedly? While there are many theories, no one knows for sure. "One of the issues we will be looking at is how economics encourages people to get sick or helps them stay healthy," Baird said. "In Brazil, for instance, poor women who stand in the rivers washing their clothes often contract leishmaniasis, a parasitic disease that affects a large number of the world's population in the tropic zones. In medical school we learn how this disease works and how it is treated, but we don't tend to look at who gets this illness and how they are exposed to the pathogens. There is a lot of talk about treatment, but nobody is talking about getting people out of the river." One of the aims of the new medical school curriculum introduced four years ago was to take a more holistic approach to medicine and examine not only the progression but the etiology of disease as well. The new seminar, Baird said, will be an extension of that focus. "The Physician and Society, which is the name of the new curriculum, has made an effort to address these issues and serves as a good introduction," he said. "We want to use this seminar to delve further." Each seminar will focus on two or more papers related to the topic of health, illness and the possible social determinants that affect populations identified by class, gender, race, economic status or some other category. In the initial seminar, for instance, the group considered the Whitehall study of British civil servants that seems to indicate that employment classification among civil servants has a direct relationship to the incidence of many diseases, including several types of cancer. Two other papers looked at the incidence and causes of blindness among populations surrounding the Wilmer Eye Clinic. "The purpose of the seminar is to use these papers as a sort of jumping-off point," Baird said. "We are not going to focus on critiquing the papers so much as using the information presented to look at the broader issues of disease, health and social variables that might play a role in the numbers." In future meetings, organizers hope to invite researchers from the Hopkins community and beyond to present their papers and discuss their work. "We are really hoping that we'll bring together faculty and students from across East Baltimore," said faculty participant Robert Lawrence, associate dean for professional education and programs at the School of Public Health. "I think there is tremendous interest in these subjects and in this approach to the health sciences. This seminar presents a tremendous opportunity for constructive dialogue with doctors, nurses and public health specialists each bringing their own unique perspective to the issues." For further information about the Social Determinants of Health and Illness seminar, contact (410)614-4590.
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