SPA Annual Meeting Reviews
Session I: Where Do We Go From Here - Chaos or Community?
Presented by Edward M. Barksdale, Jr., MD
Reviewed by Erin Williams, MD, FAAP
Texas Children’s Hospital
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Dr. Williams |
The Saturday morning Session I began with Edward M. Barksdale, Jr., MD, Surgeon-in-Chief, Professor of Surgery of Rainbow Babies and Children’s Hospital, Case Western Reserve School of Medicine in Cleveland, Ohio who gave a magnificent talk entitled, “Where Do We Go From Here - Chaos or Community?” In this presentation Dr. Barksdale ensured the audience would be proficient in the following objectives:
- Defining and discussing population health along with the limitations imposed by biomedical health models and healthcare.
- Reviewing the impact of childhood toxic stress and negative experiences on long-term health.
- Embracing the responsibility of advocacy for our patients beyond the four walls of the hospital.
- Collaborating with others to improve the health of communities in need.
This lecture was timely given the extreme happenings of 2020. Dr. Barksdale pointed to the presence of the coronavirus, the troubled economy, and the social unrest in our country that we must work beyond in order to help at-risk and under resourced communities.
After his arrival in Cleveland, Ohio in 2007, Dr, Barksdale took note of the very disheartening statistics seen in the annual Cuyahoga County Child Fatality Report. He noted the very high rate of gun violence, suicide rates, and crime in the community where he practiced. After becoming aware of such negative outcomes, Dr. Barksdale noted that many of the people who were suffering from these situations all seemed to be connected to two consistent concepts - poverty and race. That is when he said, “Enough is enough,” and decided to get involved.
The revolving door of teenagers in and out of the trauma center operating rooms due to gun violence was appalling. Thus, Dr. Barksdale stated that he developed a mission to be involved both academically and socially, in order to hopefully deal with the true problem rather than just place a Band-Aid on an open wound. It was then that Operation Focus came about. This was a community-based violence intervention program. This anti-violence initiative for former gang members focused on decreasing gun violence in the community.
This program was one that involved leaving the comfort zone of the hospital and going into the community. Dr. Barksdale described visiting churches, recreation centers, being at the neighborhood parks in order to reach and better serve the community. He did not do this alone; he had to collaborate beyond medicine, and work with city officials such as the mayor of Cleveland, the Chief of Police, and a group of community advocates. The program was successful in that two years after its start the county had its lowest homicide rate in 50 years.
This successful program led to the successful $2 million Defending Childhood Initiative grant which worked to decrease and prevent violence experienced by children in Cuyahoga County by going deep into the community and actually talking with and getting to know the children and hearing their stories in order to adequately deal with the root of the problem.
Throughout this process he learned that violence and social disadvantage led to poor health outcomes such as premature death, disease, disability and despair. Dr. Barksdale reminded us that the social determinants of health are where we live, work and play. Thus, a community filled with negative social determinants will only lend itself to poor health.
This experience taught Dr. Barksdale seven main lessons regarding the social determinants of health that he thought beneficial to share with SPA.
First, with regard to health, he recommended a new definition. Rather than the absence of disease, we should consider the overall wellness and processes involved to maintain health. He stated that, “Health is a part of a dynamic framework of our environment.” Second, when considering health equity, we must think about equity rather than equality and remove barriers in order to practice health justice to allow everyone what they need to ensure success.
Third, the concept that geography is destiny simply means you are a product of where you live.
Fourth, Dr. Barksdale emphasized that toxic stress is a barrier and early stress and adversity have negative health effects. Fifth, antifragility, a term used by Nassim Taleb, pertains to what one does in adversity. This concept is what it takes to make it despite negative happenings and perhaps this antifragile nature is something we should seek to better understand. Sixth, we must develop a culture of health, and deal with the negative social determinants one at a time in order to accomplish the goal of good health. Finally, the concept of shalom or peace is achieved when one develops social determinants of well-being or wellness rather than the social determinants of health.
This outstanding talk left the audience with the inspiration and the challenge to go forward and work to help all of our patients not just medically but also socially.
Sources:
Taleb, Nassim N. Antifragile: Things That gain from Disorder. Random House; 2012.
