Monday, May 12, 2014

“The sparrow is sorry for the peacock at the burden of his tail.”

One of the challenges of my job is the frequent opportunity to provide an opening welcome or keynote address at a health-related conference, participate in a panel discussion on some health topic, or attend an event highlighting the work of an individual or organization.  The challenge is that I’m often speaking to an audience that knows a lot more about the topic than I do.  The opportunity is the chance to broaden the horizons of a specialized audience by providing a broader public health context for an issue or challenging the attendees with an alternative narrative about what creates health.  
Last week typified those challenges and opportunities.  While monitoring and testifying at hearings related to therapeutic cannabis, I had the opportunity to:
  • provide opening remarks at the “Perinatal Hospital Leadership Summit” that was focused on supporting breast feeding,
  • speak on a panel at a “Forum on Science, Democracy and A Healthy Food Policy” convened by the Union of Concerned Scientists,
  • participate in a press conference on school-based and school-linked mental health services,
  • join in a panel interacting with Elmo at an event highlighting the work of Sesame Street in addressing the issues of children of incarcerated parents, and
  • attend the “150th Anniversary Celebration” of the founding of the Mayo Clinic.

In looking back at the week I recognized that the events that focused on some of our public health challenges (obesity, food insecurity, behavioral health, and Adverse Childhood Experiences) were bracketed and overshadowed by events celebrating the role of medical care in improving our health.  That’s when I recognized the insight of Rabindranath Tagore (born May 6, 1861), a Bengali poet, novelist, composer, and the first non-European to win the Nobel Prize in Literature, when he said, “The sparrow is sorry for the peacock at the burden of his tail.”
Minnesota is an overall healthy state.  We are ranked number 3 in the United Health Foundation’s State Health Rankings.  We have the lowest infant mortality rate and the highest male and second highest female longevity in the country.  The Commonwealth Fund just ranked Minnesota as number 1 in the country in “health care access, quality, cost, and outcomes.”  Our birth weight specific infant survival and many 5-year cancer survival rates are also among the best in the country.  On an overall population level Minnesota is doing well and the medical care provided in Minnesota is of the highest quality.  Minnesota has a lot to be proud of. 
But like the peacock, we are burdened by our visible successes.  While we focus on our noteworthy medical accomplishments, we often ignore the fact that most of Minnesota’s good health status is due to previous investments in public health.  Also overlooked are the health disparities in Minnesota that are some of the greatest in the country.  Disparities in infant mortality rates and in years of unhealthy life after age 65 are just two of the many disparities that are greater in Minnesota than in most other states.  As we are discovering, overall health and health disparities are not determined by just medical care but mostly by social, educational, and economic factors – the social determinants of health. 
To effectively address these determinants, we must move beyond the common narrative that health is created by good medical care and individual choices to a new narrative that health is created in communities by people in many sectors addressing the social determinants of health.  But creating that new narrative is difficult.  Our public health stories of preventing diseases don’t have the emotional impact of stories depicting daring surgeries or advanced technologies that bring people back from the brink of death.  Few of our stories about collaborative efforts to improve community health contain individual heroes who serve as role models for the next generation.  Seldom are our stories told by a person who can say, with tear-filled eyes, that he/she is alive today because of the work done to address social inequities.  We are burdened by the peacock’s medical care tail while we need the sparrow’s public health perspective. 
The peacock is a beautiful bird but its ability to fly is limited.  While it is charismatic in the space it occupies, its range of influence is restricted.  The sparrow is plain in comparison but has the ability to cover a great deal of space quickly and easily.  Medical care will continue to garner most of the attention and accolades in our society.  Yet, it is becoming increasingly clear that a broader and more inclusive public health approach will be necessary if we are to effectively create a healthy world for all.  As we work to create that healthy world, we shouldn’t feel sorry for the successes of our medical care system.  We should celebrate and support them because they are necessary.  However, we need to find ways to raise the visibility of our public health system that expands the horizons of what is needed to create a healthy and equitable world.  Despite the struggles that public health has endured over the last few decades, I have faith that public health’s future is bright because as Rabindranath Tagore also said:  “Faith is the bird that feels the light when the dawn is still dark.”  Do you feel the light?  I do.
Ed