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.