The California Endowment

Last week, Dr. Anthony Iton, Senior VP of The California Endowment, told me I was "irrelevant." More specifically, he said that physicians alone could not alter worsening public health trends across our country without stepping outside the "I'm-only-going-to-treat-patients-and-do-research" box. Doctors can make a very big impact in the lives of individual patients, but we won't make a dent in the poor health statistics of  many U.S. communities unless we get at the root causes of these disparities (poverty, access to fresh produce and clean water, housing, community empowerment, etc.). Otherwise, physicians will continue to lose the war on health. Dr. Iton was the first of two people who told me I was irrelevant (the second was a tech guy in Silicon Valley who believes iPods will replace the need for doctors in a few years - Star Trek style. Yikes.).

So I was immediately defensive. Of course we can make a difference. Helping one more person control his blood pressure or maintain a normal blood sugar, taking out an appendix or putting in a new liver, all these things are incredibly important (and what iPod is going to be able to do that, huh?!). Of course I am relevant. I better be; I'm going to be spending the next ten years in training...

But what I slowly began to realize was that Dr. Iton was just better at explaining some of the feelings I've tried to describe as a third-year medical student: the sense of helplessness, the need to do more, that inability to provide care outside of the clinic. He was simply putting these emotions into words. He asked us why medicine needed to continue researching "misery" in our country, just so it can describe that misery in a slightly different way (and publish it). Stop describing the misery, and do something about it!

A very good predictor of life expectancy is how much control individuals feel they have over their own lives and circumstances. There has been much work on this topic as of late (including a professor here at the Kennedy School - see below). It is clear that a heightened sense of control directly correlates to lower levels of stress and increased longevity. It appears that this is true for communities as well. So while it is imperative that we treat patients on an individual level, we must also treat the ills of communities if we want to reverse some of these trends. At The California Endowment, Dr. Iton and his colleagues are doing just that. With their "Building Healthy Communities" plan, they are moving beyond the clinic, infusing $1 billion into neighborhoods across California to improve the social and economic well-being of these communities (you should read the whole article in the second reference below!).

"[In Acosta Plaza]...there are half a dozen convenience and liquor stores within walking distance but the nearest traditional grocery store is nearly 2 miles away. There’s a public park in the neighborhood, but it’s not considered safe to use after dark. So, it should be no surprise that residents of Acosta Plaza would have higher rates of obesity and diabetes than in other communities, have less access to preventive medicine, and are less likely to graduate high school. No matter how diligent every resident of Acosta Plaza is about their own health and the health of their families, they live in an environment that contributes to poor health. These factors affect the amount of violence in the community, the economic success of the local economy, the strain on the hospital emergency rooms in the area, and of course the overall well-being of the families who live there."

I've had a number of discussions with other CPL fellows about these issues, but Dr. Iton was able to put it all together for me. If I am going to be active in state and national health policy and/or be a physician leader, then the most fundamental question I need to be able to answer is, "What policies are going to make Americans healthier?" Obviously the answer is uber-complex, otherwise we would've fixed this broken system long ago. But this is why I came to the Kennedy School. I wanted to understand how other industries (business, government, education, public health) interact with medicine, and what can these industries inform and teach us moving forward? I think an hour and a half with Dr. Iton taught me more than all of my classes last semester combined in this regard.

This was just one inspirational talk out of 18 different meetings on the San Francisco Field Experience, but I hope it gives you a sense of how special this trip was. It has easily been the highlight of my time here at HKS, and I am still digesting all of its content. Again, I owe a thank you to Brooke King and Jen Firneno for all their hard work in planning and coordinating this trip, and a very special thanks to Glenn Dubin, the fellowship's founder, for without his support, none of this would be possible.


References

• Sherman GD, Lee JJ, Cuddy AJ, Renshon J, Oveis C, Gross JJ, Lerner JS. Leadership is associated with lower levels of stress. Proc Natl Acad Sci U S A. 2012 Oct 30;109(44):17903-7.
• The California Endowment. Health Happening in 14 Places.