In May, during our 22nd Annual Meeting of state health department HIV and hepatitis program leaders in Washington, D.C., we hosted a discussion on addressing the social determinants of health to improve health outcomes. The following is an interview with Dr. Mindy Fullilove, professor of clinical psychiatry and sociomedical sciences at Columbia University, who shared highlights from her presentation.
NASTAD: Thank you for taking the time to speak with us, Dr. Fullilove. Could you share with us the key highlights from your talk on the social determinants of health?
Dr. Mindy Fullilove (MF): The main point of my talk was to highlight that there are no “magic bullets” for ending the HIV and viral hepatitis epidemics. It’s not like I can give you a drug. There is no drug we have that wipes out disease. Magic bullets don’t work. However, “magic strategies” do work, because they work on multiple levels of scale. So, if we put together what we’re doing with people, with communities, with a new level of scale, then we can really get ahead of these epidemics and start to see progress.
NASTAD: You spoke specifically about how the make-up of our communities contributes to epidemics like HIV and viral hepatitis. What do you mean and how can health department leaders help?
MF: Social conditions, specifically socioeconomic status, are the fundamental causes of disease. And since our neighborhoods are becoming more and more “sorted” by race, class, sexual orientation, age, religion, lifestyle, and numerous other factors, these separate neighborhoods are inherently unequal in terms of access to resources. That is, where one lives determines one’s access to resources and exposure to many risks such as HIV or hepatitis infection. So, the sorted out city is a good way to think about one of the levels that’s missing from our conversation. It has to be a part of every conversation. It’s not enough to be an AIDS director talking about increasing numbers of people who get into care. We have to think about the communities in which they live as well. We have to have a more holistic view of what it means to address health disparities.
NASTAD: Where can public health leaders go to learn more about the “magic strategies” and “sorted” cities?
MF: To learn more about “magic strategies,” read the article Magic Strategies: The Basic Biology of Multilevel, Multiscale, Health Promotion, by Rodrick Wallace and Deborah Wallace. My latest book, Urban Alchemy: Restoring the Joy in America’s Sorted-Out Cities, and handout, examine “sorted” cities and describe approaches we can take to revitalize communities and begin to really address inequalities such as health disparities.
NASTAD: Thank you for your time.
How do you think the make-up of your community has contributed to the HIV and viral hepatitis epidemics? Tell us what you think by leaving a comment below.