neighborhoods and what ya want

One of the away rotations I did this year was a clinic with a few different sites in Appalachia. The mountains were gorgeous! After clinic I'd take my host's punctilious terrier for a walk in the park and catch the sun setting over the pond. The sky is a bit clearer than where I am in Philly, which meant an early morning run allowed for some brighter stars than I usually see. (I also learned that the morning-star is actually Venus, which means it oughta be called the "morning-planet", but maybe that's counting bullets.)

One of the physician-assistants I worked with was a woman who has lived and worked in the area for several decades. One of the things she said was, "I don't have too much medical expertise I like to teach students, but I like telling about the family part of practicing in a small-town." She knows many of her patients in settings other than just at an office-visit, so she understands why a man is having trouble paying for medical expenses - because he is out of a job. And since she lives in the town, she knows when jobs are available, like a custodian position at a local school, and can recommend that man for a job. Employment is one of the social determinants of health.

Social determinants of health (SDH) are a burgeoning field of study in primary care. Things like the zip code show wide differences in lifespan. In Philadelphia for example, a zip code in Lower North Philly has a life-expectancy of 68 years. Three miles away, a zip code in Center City has a life-expectancy of 88 years. Why is that? SDH like education level, income, or transportation access to go to a grocery store instead of a corner-market are an obvious factor in longevity. But even as resources do become available, or people are educated on how healthy lifestyle decisions can improve their well-being, actual changes and improvements don't often follow. Why? Because the cultural norm of what is desirable hasn't changed. Philadelphia can and has taxed sodas to impede their consumption and contribution to early-onset diabetes. As one person put it, "All it's doing is taking my money. I still like soda and I'm still going to drink soda."

One of my professors said, "Knowledge alone is insufficient for change." Motivation is key. What do you want? This is a question Jesus repeated in his public ministry (Mark 10:51). God decided to personally enter into humanity not just to provide people with information, but to converse with us individually. He asks us questions so we can understand what we really want, and if we will bring that desire to him. Besides prosaic conversations about what we want out of our day, he also came to destroy the power of death (Hebrews 2:14-18). Death is a fact of life. We are all born, and we all die. The discrepancy of early-death between zip codes so close together has launched many helpful initiatives that are tackling the various SDH involved. Perhaps the most important factor are the cultural norms of what is considered desirable. How do those change? Changing cultural norms happens in relationships, as we see what we used to consider good or bad in another light. This is what Jesus did, he provided a different way, a much more practical way, to understand our life and death (John 11:17-27). The downstream effect of Jesus on people is that norms change as groups of connected people no longer desire to do things that are harmful and instead desire things that are beneficial for human beings to excel at living.

I don't know my neighbors much. Excepting sheltering-at-home situations, I'm often gone for 12 hours, which doesn't leave a large amount of time to pill around on the front stoop with neighbors. But one day I do want to know my neighbors and understand the values making my zip code's life-expectancy what it is.

What about you? Have you heard about social determinants of health? How do you think cultural norms change?