Getting to a Place Where Zip Codes Don’t Matter
Mass. health commissioner to SPH grads: focus on real but treatable problem
The 290 graduates of the School of Public Health heard a pointed appeal at their Convocation Saturday: Get us to a place where zip codes don’t matter.
Speaking was Monica Bharel (MED’94), Massachusetts public health commissioner, who was appointed commissioner earlier this year after more than a decade as chief medical officer of the Boston Health Care for the Homeless Program.
“Let me be clear,” Bharel told the SPH grads last Saturday at Agganis Arena, “the biggest public health risk facing our society today is endemic health disparities…The neighborhood you were born in, the school you go to, your parents’ health—all of these things directly and dramatically influence whether you develop asthma, diabetes, or heart disease or die young.”
Bharel said reducing economic and racial health disparities was her primary priority as public health commissioner. She noted that her department has a proud history of leadership in tackling cholera and smallpox and ensuring that schoolchildren were vaccinated, and she touted Boston as having the best medical care in the world.
But, she added, “lost in that remarkable narrative are the often invisible pockets of people who, in a very real way, live in a different Massachusetts.”
She illustrated the wide disparities among Boston neighborhoods by comparing health indicators of residents living near MBTA stations, using data gathered by Sandro Galea, new dean of SPH. The rate of diabetes at the Dudley Square T stop is four times as high as at the Arlington stop, she said, while the premature death rate is more than twice as high. The two stops are about two miles apart.
“These numbers don’t reflect the proximity to medical care,” she said. “This is something else—something that is much deeper and much more disturbing.”
Income, education, and other personal circumstances have a direct impact on the health of families and subsequent generations. As an example, she said, research has shown that people with high rates of childhood trauma have triple the risk of lung cancer and three and a half times the risk of heart disease.
“We must ensure that vulnerable populations receive better integrated and destigmatized care,” she said. “From the bedside to the halls of bureaucracy, we need to focus our effort on this real but treatable problem.”
Bharel, who earned a medical degree from the School of Medicine and completed a residency and chief residency in internal medicine at Boston Medical Center, recalled her early interest in the social determinants of health as a teenager visiting relatives in New Delhi, India. On frequent walks to the market, she noticed a frail elderly man who lived by the roadside. As she passed by one day, he lay dead, covered by a sheet. As others walked past, she remembered wondering not what he died from, but why he was there in the first place.
“What can be done so that that person, or his children, never ends up on that roadside to begin with?” she asked.
She urged the graduates to become “relentless” activists for health equity: “Identify the currents of injustice, harness that current, empower the change you believe in to reach a place of fairness and equity where zip codes don’t matter.”
Overseeing a 3,000-employee department with a $540 million budget, Bharel said Massachusetts has the ability to become a leader in addressing disparities by using data to target interventions. She is committed to collecting detailed population-level risk and outcome data, which can help to inform policy.
Galea, who took over as dean in January, said Bharel’s message resonated at SPH. “We see ourselves as leading the effort to improve the health of the public, now into the future. Dr. Bharel is at the forefront of those who can make change happen,” he told the crowd of graduates and their families.
Student speaker Pawandeep Kaur (SPH’15), with a concentration in social and behavioral sciences, also urged the graduates to advocate for fairness and equity. The first member of her family to attend college, she told her classmates that “our circumstances and sometimes sheer luck” determine opportunities.
“Not everyone is this lucky. There continues to exist systemic oppression” on the basis of race, gender, and sexual identity, the native of Oman said. “We have a moral obligation to make the best of this…Whatever direction we choose, we must remember that it is our duty to advocate for those who cannot advocate for themselves.”
Two faculty members were honored at the SPH Convocation for their teaching and scholarship. Infectious disease specialist Christopher Gill, an associate professor of global health, who directs the SPH Pharmaceuticals Program, received the Norman A. Scotch Award for Excellence in Teaching, and Josée Dupuis, a professor and acting chair of biostatistics, received the Faculty Career Award in Research and Scholarship.
Sami Hamdan (SPH’15) was awarded the Leonard H. Glantz Award for Academic Excellence.
Lisa Chedekel can be reached at chedekel@bu.edu.
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