Culture of Health Blog

Next year will mark 30 years since the Americans with Disabilities Act (ADA) became federal law—first of its kind legislation that outlawed discrimination against people living with physical or mental disabilities. It was a culmination of decades of challenging societal barriers that limited access and full participation of people with disabilities.

And yet in spite of the ADA’s passage, we still have a long way to go before society is fully inclusive of the 61 million people living in this country with some type of disability. Judy Heumann understands that while the ADA is important, in practice, “we’re not done yet." She is currently a leading advocate for disability inclusion and has been an advisor to institutions like the U.S. State Department, the World Bank, and the Ford Foundation. As a child, Judy was barred from going to school because she used a wheelchair. Years later, she was denied a teaching license for the same reason. These obstacles to education and employment are just two of many barriers that stand in the way of inclusion. Judy understood the need for strong advocacy in partnership with others experiencing continuous discrimination because of their disabilities. This discrimination is also often compounded by class, race, ethnicity, religion, gender, age, or sexual orientation among other characteristics.

I had the chance to personally meet Judy at the first convening of the Presidents’ Council on Disability Inclusion in Philanthropy this year. Darren Walker of the Ford Foundation and I are co-chairing this group of 13 other foundation executives to champion inclusion of people with disabilities in our own institutions and within philanthropy. We have a lot to learn from Judy and many others who have challenged systems and paved the way to making our nation more inclusive.

When I was a full-time pediatrician, I worked at a practice in the City of Philadelphia whose primary patients were teenage mothers and their children. Most of their parents were low-income with little to no outside support. Their lives were hard. Very hard. Many of the parents (grandparents to the newborns) were forced to choose between paying rent some weeks and having enough food to feed their children and grandchildren.  

I remember in particular one mother and her infant son who came to see me after he was born. She was scared because the baby was having trouble gaining weight, due in large part to the family not being able to afford much food. His grandmother was worried; given all the research showing how critical nutrition is to developing brains, I was concerned as well. Fortunately, the practice I worked in was a collaborative one, meaning that not only did we doctors work side-by-side with nurse practitioners, but also closely with social workers. And one of our social workers immediately went to work to get this family, in which the grandmother—who was the head of the household—worked full-time, enrolled in the Supplemental Nutrition Assistance Program (SNAP).

In the Boston Edison neighborhood of Detroit, black children raised in low-income households have grown up to have an average household income of $28,000/year as adults, and under 1 percent of that population has been incarcerated as adults. In contiguous Dexter-Linwood, just one census tract to the north, the average earnings for the same group is $17,000/year, with adult incarceration rates hovering close to 8 percent.

If some neighborhoods lift children out of poverty, and others trap them there, the obvious next step is to figure out how these communities differ. Travel to Charlotte, N.C., which has one of the highest job growth rates in America. But data reveals (surprisingly) that availability of jobs and a strong regional economy do not translate to upward mobility in this region. Children who grew up in low-income families in Charlotte have one of the lowest economic mobility rates in the nation. What does help, according to the The Opportunity Atlas (the Atlas), is growing up with less discrimination, around people who have jobs and higher incomes—but only when those factors are found in their immediate neighborhood. If they are present a mile away, it doesn’t seem to matter much according to the data.

As a child, the United States Surgeon General Jerome Adams, MD, MPH, suffered from asthma so severe that he spent months at time in the hospital, even once being airlifted to a children’s hospital in Washington, D.C. During these stays he was struck by the fact that he’d never encountered a black physician. That finally changed when as an undergraduate he met a prominent African-American doctor who had overcome his own significant life obstacles. Seeing another African-American making important contributions to the field of medicine inspired the young Jerome Adams to decide, “I can do that too.”

With that resolve, he embarked on a path that led to becoming an anesthesiologist and culminated in his appointment as the nation’s 20^th surgeon general.  

Reflecting on his journey, Dr. Adams notes, “that’s why your efforts at the Robert Wood Johnson Foundation (RWJF) are so important. You’re providing mentorship and leadership opportunities to those who wouldn’t otherwise know how to navigate the world of public health.”

For some, perhaps the mere mention of segregation suggests the past, a shameful historic moment we have moved beyond. But the truth is, residential segregation, especially the separation of whites and blacks or Hispanics in the same community, continues to have lasting implications for the well-being of people of color and the health of a community.

In many U.S. counties and cities, neighborhoods with little diversity are the daily reality. When neighborhoods are segregated, so too are schools, public services, jobs and other kinds of opportunities that affect health. We know that in communities where there are more opportunities for everyone, there is better health.

The 2016 County Health Rankings released today provide a chance for every community to take a hard look at whether everyone living there has opportunity for health and well-being. The Rankings look at many interconnected factors that influence community health including education, jobs, smoking, physical inactivity and access to health care. This year, we added a new measure on residential segregation to help communities see where disparities may cluster because some neighborhoods or areas have been cut off from opportunities and investments that fuel good health. 

Rich Besser was a fourth-year medical student when he found himself performing his first (and last!) solo emergency Cesarean section at a hospital tucked within a rural Himalayan village in Manali, India.

He had come to Lady Willingdon Hospital eager to learn about health problems facing people within the developing world, and worked under a gifted local surgeon, Dr. George “Laji” Varghese. Providing care for the underserved population there was no small feat. For instance, the power would often go out during surgeries, requiring someone to hold a flashlight over the operating table.

Dr. Laji one day left Rich in charge as he departed for a week-long meeting. Before leaving, as a precaution, he walked Rich through how to perform an emergency Cesarean section since they were high up in the mountains and hours away from the next health care facility.

Sure enough, a few days later a woman who’d struggled through labor for over a day arrived. A senior nurse noted that the baby’s heart didn’t sound good.

She was abruptly awakened by a phone call at 5:00 in the morning as Hurricane Katrina was ravaging New Orleans. Evacuees were fleeing the devastation and arriving in Houston by the tens of thousands to escape. Herminia Palacio was then the executive director of Houston’s Harris County Public Health and Environmental Services. She had until 11:00 p.m. to figure out how to care for them.