Public health expert Abdul El-Sayed visited Boston College on Tuesday to speak about public health in urban communities. Hosted by the Winston Center for Leadership and Ethics, Abdul’s presentation focused on his work as the Public Health Commissioner in Detroit and his approach to public health nationwide.
El-Sayed was Detroit’s health officer and executive director of the city’s health department from 2015 to 2017, when he resigned to run in Michigan’s 2018 Democratic gubernatorial primary.
First, El-Sayed defined public health as society-wide measures aimed at creating the conditions necessary for individuals’ health.
He illustrated this definition with an anecdote of a young boy he once met at a vaccine clinic. To El-Sayed, this experience with the little boy and his single mother taught him where, as the newly appointed public health commissioner, he ought to start.
“He was 3 years old and the fourth child of 21year-old mom. He had met his father maybe four times in his life, because his dad was in jail,” El-Sayed said.
Yet, this 3-year-old walked right up to El-Sayed and, maintaining eye contact, shook his hand. The little boy then, confident as ever, walked back to his mother. El-Sayed was struck with a crucial realization.
“I immediately started to appreciate that this kid’s confidence was completely undercut by the circumstances of his life,” he said. “And in that moment, I realized that the work that was in front of us was about building the kind of city that should empower that boy’s confidence. That for a child like him, the work of public health—the work with government, frankly—is about justifying the confidence that every 3-year-old should have in the life that he or she is going to lead.”
El-Sayed then spoke of his time at Columbia University’s medical school. He outlined the few square blocks where he, his fellow students, and other medical professionals lived and operated. They very rarely left this limited, condensed area.
The problem is, most of the people in New York don’t live within those few square blocks, if they even visit them at all, he said. El-Sayed realized that there was a disconnect between the work being done in that bubble and the realities of public health.
“They live in all the rest of New York City, and that’s where they spend 99.99 percent of their time,” he said. “If we’re not focused on improving health in [that] space, then we’re missing the point.”
El-Sayed went on to explain the definition of “social determinants of health.” These factors are the social features of a place, such as poverty and racism, that shape health asymmetrically for separate demographics, he said. Poverty will shape the well-being of a white individual in rural Alabama much differently than it would shape the well-being of a black individual on the South Side of Chicago, according to El-Sayed.
Public health, he emphasized, is all about context. To illustrate his point, he introduced a tale of two urban communities: the Bronx and Detroit. In studies performed at Harvard and Stanford, economists wondered where the poor lived the longest or shortest lives. They found that the urban poor of the Bronx lived significantly longer than the urban poor of Detroit, even when adjusted for household income, El-Sayed said.
“The difference here is whether or not you’re insulated by the context within which you live. Because in New York, things are accessible, and they’re usually affordable,” El-Sayed said. “There’s something about the fact that people literally live on top of each other that creates density, and density changes the experience of poverty.”
Detroit, he explained, can fit Manhattan, Boston, and San Francisco within its 138 square miles and still have room to spare. Additionally, Detroit’s population is declining. In effect, there’s a relatively poor population in a huge city that’s relatively empty. Less than half the population has regular access to a car. Unlike New York, things are not accessible, and this especially influences one’s experience of poverty.
“In particular, we said, ‘What are the health challenges that we can take on that have knock-on implications for intergenerational poverty?’” El-Sayed said. “So we wanted to leverage health to disrupt intergenerational poverty.”
The department created building programs to address these challenges. These include SisterFriends, a mentorship program for newly pregnant young moms; and Vision to Learn, which provides kids in Detroit public schools with vision tests and a free pair of glasses.
Even with such notable success, El-Sayed resigned in 2017 to run for governor of Michigan. He still wishes that society would address the various tensions in public health that rose to his consciousness over the course of his career, most specifically the assertion that public health, like every other aspect of life, is political.
“When there are scarce resources, what do we do to make sure those resources are allocated in equitable ways?” he said. “The fact is that health itself is a scarce resource. If not, everybody could still have a long, healthy life, right? Some people are systematically less likely to have long, healthy lives.”
El-Sayed ran his subsequent 2018 gubernatorial campaign relying solely on individual donations, with which he managed to raise $5 million. He lost in the primary to now-Governor Gretchen Whitmert, but the experience still taught him a lot, he said.
“I learned a lot about how we communicate and how we engage a system, about how a lot of those corporate entities communicate and engage that system, about the fact that kids like that the little boy I started with don’t have lobbyists,” El-Sayed explained. “And there’s something about that we take for granted, oftentimes, in upper middle
Featured Image by Bridget Clark / Heights Staff