Friday, March 25, 2016

World TB Day and Health Equity Postulates

Today is World TB Day – an event that occurs every March 24th to commemorate the day in 1882 when Prussian Physician Robert Heinrich Herman Koch discovered the bacillus that causes TB. For this discovery he won the 1905 Nobel Prize.
Probably as important as his work on tuberculosis are Koch's Postulates, four criteria used to establish a causative relationship between a micro-organism and a disease. The postulates embody the four criteria required to establish that an organism is the cause of a disease. According to the Koch Postulates, to be determined as the cause of a disease, an organism must be:
  • Found in all cases of the disease examined.
  • Isolated from a diseased host and prepared and maintained in a pure culture.
  • Capable of producing the original infection, even after several generations in culture.
  • Retrievable from an inoculated diseased experimental host and identified in culture as being identical to the original causative agent.
By using his postulates, Koch's pupils found the organisms responsible for diphtheria, typhoid, pneumonia, gonorrhea, meningitis, leprosy, bubonic plague, tetanus, and syphilis, among others. Koch’s Postulates have had a huge impact on health care and society.
As I thought about Koch’s Postulates and how they verified links between an infectious agents and diseases, I realized that we lack similar postulates for verifying links between some of our current health issues and their causative agents. Specifically, we lack the consensus criteria that could be used to evaluate the policies, systems, and activities that lead to health disparities and inequities.
To correct that deficiency, I will riff off of Robert Koch’s ideas and posit some Health Inequity Postulates. To establish that a policy, system, or activity is the cause of a health inequity, it must be:
  • Found to systematically disadvantage some populations while advantaging others.
  • Present in an affected/disadvantaged community and maintained by the political, social, and economic culture.
  • Capable of producing inequities generation after generation.
  • Identified as associated with disparate and negative outcomes in community after community regardless of time or geography.
In creating this list of postulates it became obvious that health inequities are much more complex than infectious diseases and require more than four postulates to determine causal links. I also realized that unlike infectious agents that cause disease, policies, systems, and activities can have both positive and negative impacts on factors related to health equity.
Given that our departmental efforts have focused on Advancing Health Equity, here are some Health Equity Postulates for consideration. To establish that a policy, system, or activity is advancing health equity it must:
  • Use the improvement of the health of everyone within a population or community as the ultimate measure of success.
  • Focus on the health of communities.
  • Embrace community engagement and ownership.
  • Be built on partnerships and shared power.
  • Recognize individual rights and responsibilities and societal responsibilities.
  • Include recognition of historical and cultural backgrounds and influences.
  • Be based on sound science not ideology.
  • Incorporate the physical, emotional, spiritual, environmental, social, and economic determinants of health.
  • Have both a short-term and long-term perspective.
  • Be socially responsible.
  • Be socially just – it must help meet the basic needs of everyone and no one benefits at the expense of others.

In accepting his Nobel Prize, Robert Koch stated: “If my efforts have led to greater success than usual, this is due, I believe, to the fact that during my wanderings in the field of medicine, I have strayed onto paths where the gold was still lying by the wayside. It takes a little luck to be able to distinguish gold from dross, but that is all.”
What I’ve outlined is just a start to what needs to be a more comprehensive list of Health Equity Postulates. I’d be interested in any postulates that you might add to that list. What gold is lying for us to discover along our path to health equity?

Ed