Donald Berwick delivers Sargent’s 2019 Meredith E. Drench Lecture. Video by BU Productions

“If you want to improve health, you have to reduce inequity,” said Donald Berwick, a pediatrician and an expert on healthcare quality and improvement, who delivered Sargent’s 2019 Meredith E. Drench Lecture, “Start Here: Getting Real about Social Determinants of Health.” Using New York City’s subway map, Berwick highlighted how inequality affects health. On a D Line ride from the Upper East Side of Manhattan into the Bronx, average annual household income shrinks from $180,000 to $45,000 and the unemployment rate doubles. Life expectancy of the nearby residents drops 2.3 years for each mile the train travels. Berwick, president emeritus and senior fellow at the Institute for Healthcare Improvement and a former Massachusetts gubernatorial candidate, argued that health isn’t determined only by what happens in hospitals and doctors’ offices, but instead by the conditions of our early childhood, education, career, aging, community resilience, and fairness. How can we begin to address these gaps? Find the areas of greatest socioeconomic need, Berwick said. “You start where the causes of causes lie,” he said. “You start where a plague of inequality and social isolation and racism and its consequences hide and right their tragedies.”

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