Addressing Wellness, Not Illness, in Community Health
Sickness is more a product of social forces than biological ones. Like any good idealistic college senior (especially one with a sociology degree), I left Williams in the spring of 2012 with convictions such as these, borne out of long classroom and office hours discussions with my mentors and friends. My thesis that year had to do with rural community health volunteers around the world, and how they were motivated to volunteer through the social prestige of their work in the context of their communities, and not through extrinsic “incentives” given by the large, bureaucratic NGOs that supposedly controlled them. Eager to get some real world experience, I, perhaps ironically, signed up with a large, bureaucratic organization to get the chance to experience community health on the ground in the US. Community HealthCorps, the largest health-focused AmeriCorps program in the country, works with local community health centers to place young, health service focused graduates in a variety of positions that address public health and health disparities.
I applied to a few different areas, and finally settled on a school-based health program in Oakland, CA. I had been to the Bay Area a couple of years earlier to intern at another health-related organization, but, as it turns out, downtown Berkeley and the neighborhood in East Oakland that I work in are about as far apart as possible socially and economically. Oakland has consistently been rated as one of the most violent and crime-filled cities in the nation. It is also the most ethnically diverse city in California (and that’s saying something) and has a rich history and culture. Oakland was where the Black Panther Party got its start back in the 1960s, and where the Occupy movement had the most support, and, in various iterations, is still going strong. In many respects, Oakland is today what people thought Berkeley was back in the ‘70s.
The neighborhood that I work in, Elmhurst, is on the far east side of the city, butting up against the more well-to-do suburb of San Leandro. Demographically, it’s about two-thirds Latino and one-third African-American, with the vast majority of the population the working poor. Unsurprisingly (since I studied it in school), the rates of chronic, preventable health conditions like type-2 diabetes, obesity and cardiovascular disease are more than double the national average. At the middle school where I worked my first year I was tasked (or, rather, I tasked myself) with developing an afterschool gardening and nutrition class for the students there. Doing this with little experience in garden education, I met with mostly failure (and a few notable successes), but also learned some things that I wouldn’t have thought of in a classroom. Most importantly, that the reverse of that first conviction is also true: Wellness can be a product of social forces as well as biological ones, and these two forces can also feed into each other positively. Kids that have eaten a nutritious breakfast and have gotten 8 hours of sleep the previous night are more likely to sit through class in the morning and succeed; kids that have social and emotional support in the classroom and outside of it are much more likely to not make poor choices that could affect their health. This focus on the wellness of the whole child is a large movement in education as a whole; the school-based health clinic that I worked out of was part of a new paradigm launched by Oakland’s school district to make schools a one-stop-shop for whatever the child needs.
I think this is a great direction for education and schools in general to go towards, and recognizing the interrelatedness of social and physical condition comes right out of the sociologist’s playbook. But what about health care? If you’ve been tracking the national health care debate, you’ve probably heard the buzzwords: preventative care, primary care, “sick care” versus “health care.” I decided to stay on with my program for a second year, in order to stay in a community that I have come to care about, and also deepen my understanding of the social systems that encourage both sickness and wellness.
This year, I am working in a community health center up the road from my school, where I am helping to develop a “wellness program.” Run by a health center organization called LifeLong Medical Care, this clinic provides health care for much of the Elmhurst community, through regular primary care checkups. Its health care providers and staff know only too well the intersection between social status and physical health, but, due to the method of revenue accrual, are unable to give their complicated patients the time they need. A patient may come in complaining of back pain, while at the same time her urine analysis comes up positive for cocaine, and her chronic diabetes is out of control. A provider must try to address all of these concerns in the 15 minutes allotted to the patient, due to the federal Medicaid guidelines that pay for the amount of patients seen, not taking into account the level of complication of the problems that the patient has. A regular checkup is usually more like a triage of the problems that can be dealt with at present.
And, as any good sociologist would suspect, these problems are even more complicated and enmeshed than they seem on the surface. A history of diabetes can stem from eating unhealthy food (due to a lack of healthy food availability, price, and lack of education), stress (from historical poverty and oppression, domestic violence, lack of safety), and lack of exercise (from no gyms in the area and a lack of safe running and walking routes). A fifteen-minute visit with a primary care provider, no matter how kind and understanding, cannot possibly scratch the surface of these problems.
Wellness programs, like the one that I’m a part of, aim to make up this difference and provide actual opportunities for people to address their health positively, and in a way that acknowledge the social underpinnings of those problems. We employ a group-based care model that brings people with the same common problem (chronic pain, obesity, diabetes, etc) together with a provider to teach a curriculum and provide a forum for discussing their condition. Though the length of the visit with a doctor is the selling point, some of the most powerful moments that I’ve witnessed in the program have come from interactions between patients. Sharing a common background, they are often the best educators and supporters for each other, breaking down the vertical hierarchy of doctor-patient. The wellness groups allow patients to give voice to the deep problems behind the problems, and in that way to form solidarity and address them.
I’m contemplating applying to medical school in the next year, but I know that to be happy as a health care provider, I’m going to have to find something like the programs I’ve worked with over the past couple of years. Human health is an incredibly complicated field, and I know that in order to address it in a way that people deserve in terms of social justice, we need to change the conversation. Instead of playing catch-up in terms of sickness with our most poor and oppressed populations, we need to champion wellness. Sickness is biological—a problem that needs to be fixed. Wellness is social, physical, and emotional—a state that allows nothing to fall through the cracks, something to strive for.
Matthew Crimp ’12 currently lives and works in the Bay Area