PBS Series on Health Disparities to Air with Major HSPH Contributions

The PBS-viewing public will have the opportunity to learn more about what HSPH faculty have long documented: racial and economic inequities may help explain why the United States — one of the richest countries in the world — ranks among the least healthy industrialized nations. Eating right, staying active, and having "good genes" are only part of the prescription for a healthy life. Social policies that contribute to a good education, affordable housing, a clean environment, freedom from discrimination, and other factors also matter.

These dimensions and their links to health will be investigated in a four-hour PBS series that begins on March 27 at 10 p.m. called "Unnatural Causes: Is Inequality Making Us Sick?" The other three installments will air April 3, 10, and 17. The series is produced by California Newsreel with Vital Pictures.

See information below about local early screenings.

HSPH faculty and alumni served as advisors to the series. Many appear on camera. "We're world leaders in the area of health disparities research," noted Lisa Berkman, who chairs the HSPH Department of Society, Human Development, and Health. She added, "The PBS people were incredibly good at bringing out the best of the science behind our work and were terrific at framing it through stories about people's lives."

The School has long been involved in health disparities research. A sampling: Just this month, the journal Health Affairs dedicated its March/April issue to the subject and published four papers from HSPH faculty; the journal chose one of those papers, "Toward a Policy-Relevant Analysis of Geographic and Racial/Ethnic Disparities in Child Health," as a lead paper. The paper was co-authored by HSPH faculty members Dolores Acevedo-Garcia, and David Williams, and colleagues. Williams has just been named staff director of a Robert Wood Johnson Foundation commission to look at social, economic, and other non-medical strategies to improve Americans' health; HSPH Professor Katherine Baicker sits on the same commission. Three years ago, the School convened top international experts for a three-part symposia, organized by HSPH faculty member Nancy Krieger, called "Health Disparities & the Body Politic."

"In a world where socioeconomic status is a powerful predictor of health, our question is, what can we do to ensure people don't get sick in the first place?" said Williams, Florence Sprague Norman and Laura Smart Norman Professor of Public Health at HSPH. He added that the PBS series "is a unique opportunity to change the national conversation about the factors outside of the medical system that are key to health."

Also serving as a nexus for the series' producers in tapping HSPH expertise on the subject was Krieger, Professor of Society, Human Development, and Health. Much of Krieger's career has focused on researching the associations between social inequities and health. Some of her most recent research has found that U.S. socioeconomic inequities in premature mortality (death before age 65) and infant death rates shrank between 1966 and 1980, with reductions in rates sharpest among people of color in the lowest income quintiles. This was during a time when social programs such as Medicare, Medicaid, "War on Poverty" initiatives, and civil rights legislation began. The disparities started to widen again in the 1980s, coinciding with cutbacks in funding public health and antipoverty programs, and the stagnation of the minimum wage. Hear a podcast about this research.

"Disparities are not inevitable and can be addressed," Krieger said. She served as a scientific advisor to the PBS film producers — was interviewed, viewed and commented on rough cuts of the filming, as well as organized screenings of the series both at HSPH and at the American Public Health Association — because she believes the series will help the public understand the magnitude of the problem. Krieger will participate in upcoming panel discussions about the series. See information below for details.

Acevedo-Garcia, HSPH Associate Professor of Society, Human Development, and Health, was interviewed for the series about research on immigrant health and the structural inequalities that affect Latino health and well-being. "There was an amazing amount of careful consultation with the top experts in the field that went into making this documentary," she said.

"It is not only a powerful summary of health disparities and how serious and damaging they are," Acevedo-Garcia added. "It is also an account of the state of our field at this point in time — where there is consensus, and where work remains to be done."

Laura Kubzansky, HSPH Associate Professor of Society, Human Development, and Health, noted that the PBS series vividly portrays how stress sustained over time is associated with heart attacks. This is a focus of Kubzansky's research. Hear a podcast about Kubzansky's work.

The effects of poverty — along with other potential sources of toxic stress such as abuse or neglect — can disrupt the development of the brain early in life and lead to lifelong effects on physical and mental health, added Jack Shonkoff, Julius B. Richmond FAMRI Professor of Child Health and Development and director of the Harvard Center on the Developing Child. The extent to which the PBS project goes beyond simply documenting disparities in health status and begins to elucidate potential causal mechanisms is critically important, said Shonkoff. In other words, he noted, by studying the biology and psychology of early life adversity, the Center's researchers believe that it is possible to identify and alleviate the roots of many disparities in adult physical and mental health.

Jim Yong Kim, François-Xavier Bagnoud Professor of Health and Human Rights at HSPH, appears in an installment in Unnatural Causes called "Collateral Damage." The episode describes the lives of Marshall Islanders, some of whom live impoverished lives in areas of high rates of tuberculosis.

Health disparities are not just a matter of unequal access to health care, said Ichiro Kawachi, HSPH Professor of Social Epidemiology and director of the Harvard Center for Society and Health. "If we want to reduce and ultimately eliminate health disparities in this nation, we can't stop at strategizing about improving health insurance coverage. We must also discuss how to improve our education system, attack poverty, and improve access to affordable housing, and secure jobs."

Unnatural Causes has four episodes:

• Hour One: In Sickness and Wealth
• Hour Two: When the Bough Breaks/Becoming American
• Hour Three: Bad Sugar/Place Matters
• Hour Four: Collateral Damage/Not Just a Paycheck

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Local Events for PBS Series

• Screening and Panel Discussion at JFK Library

Thursday, March 27, 2008
Reception: 5:30 p.m. to 6:15 p.m.
Program and screening: 6:30 p.m.
The John F. Kennedy Library, Columbia Point, Boston, MA
Register online or call 617-534-2622 by March 20, 2008.

Join Mayor Thomas M. Menino, the filmmakers, local officials, and community leaders for a screening of the series and a panel discussion.

Howard Koh, Harvey V. Fineberg Professor of the Practice of Public Health at HSPH, will moderate a panel discussion at the event.

Event is free and open to the public.

Panelists include: Dr. Barbara Ferrer (Executive Director, Boston Public Health Commission), John Auerbach (Commissioner, Massachusetts Department of Public Health), Llew Smith (California Newsreel film producer), Dr. Nancy Norman (Medical Director, Boston Public Health Commission), Dr. Joseph Betancourt (Director, MGH Disparities Solution Center), and Dr. Nancy Krieger (Harvard School of Public Health).

Hosted by: Boston Public Health Commission, Massachusetts Department of Public Health, California Newsreel, and WGBH

• Screening and Discussion at HSPH

Thursday, April 3
8:30 p.m. to 11 p.m.
Kresge cafeteria
A DVD of Episode 1 will be shown. Then, Episode 2 will be viewed live.
Dr. Nancy Krieger will lead a discussion.
Co-sponsored by the HSPH student group Public Health Intersections with Politics and the Harvard Center for Society and Health

— Ellen Barlow. Photo by Mark Henle/Courtesy of California Newsreel with Vital Pictures.