In 1999, then-U.S. Surgeon General David Satcher issued a groundbreaking report that gave prominent attention to mental health and emotional well-being as cornerstones of health. Yet nearly 20 years later, our health-care system is still struggling to address the impact of mental health on overall health, particularly for those living in distressed communities.
Meet Janice, a 40-year-old woman with chronically unstable diabetes who lives in a neighborhood rife with violence and poverty. Each time she is taken to the hospital, her doctor explains — thoroughly and with great compassion — the correlation between her fainting episodes and overconsumption of cakes and sweets. Each time, Janice replies, “Thanks, doctor. I’ll try to do better.”
Janice genuinely wants to get better. She understands her doctor’s advice, but she struggles to follow it. Why would Janice continue to engage in such unhealthy behavior? The answer is simple: it makes her feel better.
Science is increasingly revealing that the lifestyle choices we make today — and the lifestyle diseases so many Americans suffer from — are often driven by much earlier life events and childhood experiences.
A landmark 1997 study found that Adverse Childhood Experiences (ACEs), such as physical, sexual and emotional abuse, an incarcerated household member — or even divorce — contributed significantly to health problems decades later.
We also know that the social determinants of health — the conditions in which people are born, grow, live, work and age — factor into health disparity for individuals facing economic instability, lack of education and family challenges often present in distressed communities.
East New York, Brooklyn is a textbook case of such a community with stark health disparities and no way to break from the horrific impact. One-third of East New York residents live in poverty. They face higher incarceration rates, poor housing conditions, school absenteeism and assault rates that far exceed most of the city. Given what we know about ACEs and social determinants of health, it should come as no surprise that residents of East New York also have higher rates of obesity, diabetes and stroke.
Psychiatric hospitalizations are much higher than average as are asthma-related hospitalizations for children and adults. While infant mortality rates throughout the city have declined, East New York continues to rank higher than New York City and Brooklyn averages. Overall, East New York ranks among the worst in the city for premature deaths and other factors showing the ravages of poverty.
A toxic level of stress permeates distressed communities riddled with the problems associated with social determinants of health. We know that people have an innate need to feel bette and they develop compensatory behaviors in an effort to do just that. Often they manage stress and anxiety in ways that are familiar to them based on their life experience.
What we need is a “whole health” approach to care that makes the connection between emotional well-being and real-life experiences, supports individuals in developing healthier coping strategies that achieve greater health and addresses both the individual behavior and the social and economic conditions that drive 60 percent of a person’s health outcomes.
This includes providing individuals, particularly in distressed communities, access to a full array of services, including mental health, care coordination, housing services, nutritional support, job placement and youth and parent advocacy (including school support).
Let’s return to Janice. The question we need to ask is: What happened to cause her to become a diabetic who could not seem to stop eating the sweets that seriously aggravate her condition? We must recognize that traumatic experiences early in life combine with the social determinants of health to lead to poor health outcomes later in life.
Coping behaviors continue into adulthood leading to ever more serious health and behavioral health challenges. Embracing the whole health approach by lifting the stigma of mental health, identifying social determinants of health and providing access to resources will improve health outcomes for Americans living in our most distressed communities.
Bringing together government, health and mental health providers and philanthropy to support this integrated approach to care in local communities is a critical step toward effectively addressing all the factors that contribute to a person’s well-being, so Janice and millions of others like her can lead healthier, happier and more productive lives.
