Sixty-eight years ago when the World Health Organization was formed, they defined health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” The WHO has never changed that definition, and a growing attention to the social determinants of health – “the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life” – is reinforcing the notion that health is, indeed, so much more than how we feel physically. Whether it’s housing, clean water, fair and safe employment, or basic health care, the ability for all members of a community – and of the nation more broadly – to enjoy these basic human rights is an essential component of creating a healthier society.
As the WHO clearly states, “access to quality housing and shelter and clean water” are basic human rights required for people to live a healthy life. They are also important social determinants of health that many Americans lack. On a given night in January, 564,708 Americans were homeless – defined as someone sleeping outside or in an emergency shelter or transitional housing program – and of those individuals, 15%, or 83,170 people, are chronically homeless, meaning they have been homeless for at least a year, or have experienced four or more episodes of homelessness over the course of the past 3 years, and have a disability, often a severe mental illness and/or physical illness. Addressing and ending homelessness and chronic homelessness is a difficult endeavor; one approach is the Housing First model that prioritizes getting the homeless and chronically homeless in permanent housing first and then providing supportive services on a voluntary basis. When Lloyd Pendleton, a former manager at the Ford Motor Company and the Church of Jesus Christ of Latter-day Saints, became the Director of Utah’s Homeless Task Force in 2006, Utah became the first state to adopt a statewide Housing First model, and the number of chronically homeless individuals dropped from 1,932 in 2005 to 168 in 2016. This drastic drop is a huge success and a continued commitment is essential to keep it on track. While the number of people who are chronically homeless in Utah has declined, the number of homeless people in Utah has grown over the past decade, from 11,275 to 12,685 – a 12.5% increase. Although Lloyd has recently retired from the Utah Homelessness Task Force, his commitment to ending chronic homelessness and decreasing homelessness remains strong as he consults with cities on their efforts to decrease homelessness and chronic homelessness.
Like access to quality housing, the basic human right to clean water is a social determinant of health that will be discussed on the TEDMED stage this year. Being able to turn on the faucet in our kitchen sink, fill a glass with water, and drink it is something many Americans do without much thought or worry. Indeed, it is what many families did in Flint, Michigan, until Dr. Mona Hanna-Attisha, a Detroit-raised pediatrician, exposed the dangerous levels of lead in the drinking water after testing the blood lead levels in the children she treated. The levels of lead in the water were nothing short of shocking – 5 times as high as the level of concern outlined by the Environmental Protection Agency. The impact of this lack of access to clean water is significant – children exposed to lead are at an increased risk for damage to cognition and behavior, while high exposure can lead to irreversible damage to the nervous system. Also shocking is that, in a town just 45 minutes away from Flint, the levels of lead in the water barely registered and were of no cause for concern. This is a stark example of how social determinants – where you are born and where you live and grow – significantly impact your health. But these determinants do not only impact health on the individual level; research suggests that lead exposure in women can lead to DNA changes in their grandchildren. The social determinants that affect our health have implications for generations.
Fair employment and decent work are also important social determinant of health, and as the WHO points out, when working conditions are good, individuals receive financial security and benefit from personal development, social relations and self-esteem, and are protected from many physical and psychosocial hazards. Susie Baldwin knows all too well what can happen when people are victims of unfair and dangerous working conditions. A Public Health and Preventive Medicine physician, Susie’s career has focused on sexual and reproductive health, and supporting survivors of human trafficking through clinical care, research, and advocacy. Fewer than 1% of trafficking victims in the US are are identified, and Susie, who co-founded HEAL Trafficking, works closely with physicians and health care providers to educate them on signs of trafficking to improve victim identification. Once victims have been identified, Susie and her colleagues at HEAL also help to train health providers to properly respond to and work with patients that are survivors of trafficking by creating environments where people feel safe and secure discussing their situation with their health care provider. By using public health interventions, Susie is heroically working to provide the essential support and care necessary to those whose basic human rights have been egregiously violated, while also working to build the systems necessary to support survivors once they have been identified.
So much of our health is determined by forces outside of our immediate control, and individuals like Lloyd, Mona, and Susie play an important part in ensuring that those forces – the social determinants of our health like housing, water, and labor – allow us to live better, healthier lives and not deter us from reaching our fullest potential. We are excited to hear their TEDMED talks in Palm Springs this year, and we hope to see you there!