Guest guest Posted July 5, 2012 Report Share Posted July 5, 2012 Powerful . " Cured of leukemia. Killed by hopelessness. " Wow. Thanks for sharing. Pamela > > Group, > > This is the text of Dr. Don Berwick's address to the graduates of Harvard > Medical School and Dental School in May 2012 as printed in JAMA. It is > really a remarkable read. > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 6, 2012 Report Share Posted July 6, 2012 Hi Ben!I remember seeing the documentary “In Sickness and in Wealth†a few years back. In it, an epidemiologist from Louisville, KY stated that he could predict when someone would come down with diabetes and high blood pressure and subsequently their life expectancy based only on two factors—race and annual income. The most important factor was annual income. He said the reason he could do this was that if you make under a certain amount, there were only a couple of places in the city where you can live. Though these places have some fast food establishments, there are no grocery stores within 5 miles. There are no large employers in that area and the bus service is shoddy at best so you have to leave for work at least 90 minutes before your shift starts and even then you are not guaranteed to get to your job on time. Because you are on the lower end of the workforce, if you are late, you get fired. By the time you get home it is dark and there are no safe places to exercise—heck even staying in your home is not necessarily safe (and good luck getting the police to respond in a reasonable time frame). The people they followed were trying hard, but were all wearing down and becoming more hopeless. When asked what the solution to improving health in the country was, the epidemiologist said—economically integrated housing. We have to eliminate concentrated areas of poverty. You are correct in stating that meaningful work is key. The problem is finding meaningful work in neighborhoods where there is none. In my neck of the woods, there are numerous government incentive programs to try and get businesses to open in poorer areas—and yet very few businesses are interested. Why? The workforce is poorly educated and unskilled and the crime rate is high. Also, the surrounding population does not have the money necessary to keep the business open. Government plays a role by deciding issues like where to place low income housing, where to place police stations, how much money to put into public education, how much money to put into public transportation, etc. We all make mistakes. However, in most places, if you are poor, the mistakes are far more difficult to overcome. The question in our society is can we or should we do anything about it.Just my thoughts. From: [mailto: ] On Behalf Of Ben BrewerSent: Thursday, July 05, 2012 2:58 PMTo: Subject: Re: Berwick Address I enjoyed reading this piece by Dr. Berwick. He makes a lot of great points. But, he loses me with the suggestion that his patient was failed by society or government or anything other than a group of continuing bad life choices. Poverty drives bad health outcomes. It seems to me that meaningful work is key to progress with medical and social problems. This hasn't received enough attention. I would say that goverment policies have made it hard and expensive for small businesses to grow and employ people in their communities. Anti-business policies that foster chronic joblessness and people waiting on someone else to fix their problems seem to me to be near the root of the problems that Dr. Berwick details. Ben To: Sent: Wednesday, July 4, 2012 8:16 PMSubject: RE: Berwick Address WOW! It does put things in perspective, doesn’t it! Izquierdo-Porrera MD PhDExecutive Director & Co-founderCare for Your Health, IncPhone Fax http://www.care4yourhealth.org/ " Don't ever let injustice go by unchallenged. " Help us make our community healthy -> http://www.care4yourhealth.org/wanttohelp.php From: [mailto: ] On Behalf Of Dr. BradySent: Wednesday, July 04, 2012 7:40 PMTo: Subject: Berwick Address [1 Attachment] [Attachment(s) from Dr. Brady included below] Group,This is the text of Dr. Don Berwick’s address to the graduates of Harvard Medical School and Dental School in May 2012 as printed in JAMA. It is really a remarkable read.No virus found in this message.Checked by AVG - http://www.avg.com/Version: 2012.0.2193 / Virus Database: 2437/5111 - Release Date: 07/04/12 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 6, 2012 Report Share Posted July 6, 2012 Ben, I echo your sentiments. I think that many of us (primary care especially) see tragic situations similar to this all the time, and we feel somewhat powerless in the face of such despair. However, I've often thought that too much expectation has been placed on us in our role as physicians/medical doctors, to create change. Our relationships and the trust we cultivate with patients gives us a great position to influence people's lives for the good, but our instruments are limited. We are the hammer, but the problem to be fixed requires an entire toolbox. Still, it's good to remind us to invest ourselves in our patients' well-being-- and it makes for a nice graduation speech! Breen, MD I enjoyed reading this piece by Dr. Berwick. He makes a lot of great points. But, he loses me with the suggestion that his patient was failed by society or government or anything other than a group of continuing bad life choices. Poverty drives bad health outcomes. It seems to me that meaningful work is key to progress with medical and social problems. This hasn't received enough attention. I would say that goverment policies have made it hard and expensive for small businesses to grow and employ people in their communities. Anti-business policies that foster chronic joblessness and people waiting on someone else to fix their problems seem to me to be near the root of the problems that Dr. Berwick details. Ben To: Sent: Wednesday, July 4, 2012 8:16 PMSubject: RE: Berwick Address WOW! It does put things in perspective, doesn’t it! Izquierdo-Porrera MD PhD Executive Director & Co-founder Care for Your Health, Inc Phone Fax http://www.care4yourhealth.org/ " Don't ever let injustice go by unchallenged. " Help us make our community healthy -> http://www.care4yourhealth.org/wanttohelp.php From: [mailto: ] On Behalf Of Dr. Brady Sent: Wednesday, July 04, 2012 7:40 PMTo: Subject: Berwick Address [1 Attachment] [Attachment(s) from Dr. Brady included below] Group, This is the text of Dr. Don Berwick’s address to the graduates of Harvard Medical School and Dental School in May 2012 as printed in JAMA. It is really a remarkable read. No virus found in this message.Checked by AVG - http://www.avg.com/Version: 2012.0.2193 / Virus Database: 2437/5111 - Release Date: 07/04/12 Quote Link to comment Share on other sites More sharing options...
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