Since its debut in 2009, millions of people have viewed the seven-part documentary series, Unnatural Causes. Created to “reframe our national debate about how inequality impacts health,” according to series producer Larry Adelman, Unnatural Causes features physicians, researchers and people from cultures and communities around the United States, telling their stories about the impact of income, race, environment, class and other social determinants on health. While the award-winning series was created as a primer for the public, Robert Wood Johnson Foundation (RWJF) Health & Society Scholar 2005-2007 Lisa Bates, Ph.D., saw it as something else—a powerful teaching tool for students of public health.
“Last year, I developed a new course in social epidemiology,” said Bates, an assistant professor in the Department of Epidemiology at the Mailman School of Public Health at Columbia University. “I wanted the students to be able to view and discuss the Unnatural Causes series because of how the stories told in the film inform and humanize the data we discuss in class.” Students enrolled in 2009 and 2010 were required to view the series, but the documentary was also screened in a school-wide venue and open to all students and faculty under the auspices of the Center for the Study of Social Inequalities and Health where Bates is a core faculty member.
“When we show students Unnatural Causes, we are training them to go after research results the same way we do,” adds Bruce Link, Ph.D., co-director of the RWJF Health & Society Scholars program at Columbia and co-director of the Inequalities Center. “The documentary blends qualitative and quantitative data and emphasizes the fact that any research finding that has real utility has a significant story behind it. We, in turn, try to teach students to tell a story about how things affect health, then use data to see where those stories touch down—the documentary helps with that process,” explains Link, a professor of epidemiology and 1995 RWJF Investigator.
“The series also helps with a struggle many students new to social epidemiology experience,” Bates said. “Which is what do we, as public health practitioners, do with all of the study results on the social determinants of health? Students sometimes feel stuck and wonder: how can they influence housing, education, policy or the other factors that contribute to health outcomes but lie outside the traditional domain of public health. The series shows that a key role of the epidemiologist is to speak with an authoritative voice and challenge biological essentialism,” she continued, “and to help explain the effects of social factors on health to those making policy in other sectors. The compelling presentations of stark and avoidable social disparities in health in the series also help motivate students and keep them grounded in what public health is all about,” she said.
Health Beyond the Numbers
To Bates’ students, the Unnatural Causes segments on immigrant life; racial disparities in health; wealth and health; neighborhood context and health status and other topics, have greatly broadened their view of how to be most effective in their careers. “I’ve been working in liver transplant research, investigating living donor transplants,” explains Columbia M.P.H. student Scott Heese. “I work primarily in patient care and the stories in Unnatural Causes helped me understand what might contribute to people being unwilling to be donors. Being a donor can cost $5,000 to $10,000 dollars because people are often out of work for three months or more and they might not have full insurance coverage,” Heese added. “Considering income disparities helped me take a closer look at the social side of donation. Viewing the series also confirmed my view that we ought to spend more time trying to fix health problems before they happen. We should look for more upstream solutions to the many things that contribute to disparities,” Heese said.
Even students with first-hand knowledge of the relationship between disparities and health were enlightened by the series. “I’ve worked in health care and I taught health education in the South Bronx last year,” said Julen Harris, a first year M.P.H. student. “I also thought I knew something about the immigrant experience because my parents are from Jamaica and England. But the segment about immigrant health showed a different perspective. It focused on a group from Mexico and how hard organizations were working to help them integrate, overcome language barriers and other obstacles. They discussed the health problems of industrial workers and the impact of immigrant parents having to work long hours and be away from their families. It expanded my knowledge and now I’m thinking about how to put it into practice in my work.”
For Felix Muchomba, an M.P.H. student who first came to the United States from Kenya to attend college, Unnatural Causes convinced him that he was right to choose a career in public health. “I came out of college and went to work on Wall Street for four years,” Muchomba said. “I liked my work, but in the city you see a lot of homelessness and poverty. I grew up around a lot of poverty in Kenya and it affected me,” said Muchomba whose first view of the United States was his college campus in Middlebury, VT. “I decided I wanted to find a way to make a difference, so Unnatural Causes was very relevant to me.”
“More than anything, the series was an example of what people in public health can do with knowledge. How we can educate the public, target the right people and work to improve things. It was a model of what I could do with all that I am learning,” Muchomba said.
As of this year, nearly 30 students, many RWJF Scholars and several members of the Mailman faculty have joined the lively, post-documentary discussions at Bates’ Unnatural Causes seminars. Going forward, “the students also have access to a monthly journal club that involves RWJF Scholars. They are given the opportunity to select and discuss work with the Scholars. Overall, the Health & Society Scholars program has created connections from around the school that have been instrumental in doing this work and planning for the future,” Bates said.
The Robert Wood Johnson Foundation Health & Society Scholars program supports multidisciplinary collaboration in the field of population health. Scholars are trained to rigorously investigate the connections among the social determinants of health and act on their discoveries in ways that will improve public health.