Approximately six years ago next month, I was teaching in Winslow
Auditorium at the Yale School of Public Health. It was the second day of my
class on the Social and Behavioral Foundations of Health, and we were
discussing the impact of race and social class on health. There were nearly 120 students present – and
it was only the second day of class – so I didn’t have much credibility yet.
About one-third of the way through my lecture, an African American woman
sitting in the third row, fourth seat from the right, raised her hand – and
with a good deal of contempt in her voice – asked me what I knew of these
things as “a white woman of privilege”?
At that time, after almost two decades of teaching, no one had ever
confronted me like that. And for the
first – and only – time in my life, I had a full sympathetic nervous system
response – my heart rate and blood pressure accelerated, I got tunnel vision,
and I thought I was going to pass out.
I took a deep breath, and steadied myself on the podium. Then I replied – totally unprepared: “You are right, I am privileged. And so are all of you – having the
opportunity to be graduate students at one of the finest universities in the
world. … But I didn’t come from
privilege.”
And for the first time professionally and publically, I revealed to this
class of 120 students, whom I didn’t know, that I was a child of Holocaust
survivors.
It was a defining moment for me professionally. It was very personal and emotional. And it opened up an opportunity for me to
discuss with the class – the tragic impact of stigma, discrimination and
persecution on health and mental health.
It opened up an opportunity to discuss assumptions we make all too
quickly – and as burgeoning professionals, how important it is to be
non-judgmental to best promote the health of the public. And it opened up an
opportunity to discuss public health as social justice. The idea here is that
health is a moral imperative. According to the World Health Organization,
while there are no guarantees for good health, society can and should design
and build effective institutions and social systems to support all citizens in
the fundamental pursuit of health and well-being.
And for me, it was an opportunity to redouble my commitment to this health
and social justice approach.
Around the same time, my mother was dying of melanoma. So I was acutely aware of the legacy that I
needed to carry forth as the daughter of Holocaust survivors – not just for me,
but for Tyler and our children: Ethan and Sam.
A legacy of not just surviving,
but thriving. And a legacy of tikkun olam – repairing or healing
the world. I knew that I could not be a
bystander to the injustices I witnessed daily in health and public health. To the social inequities that I saw in race
and social class – and about which this student had confronted me.
Now some of you
may even be wondering, what exactly is Public Health. [I get that question a lot.] Public health
refers to organized measures to prevent disease, promote health, and prolong
life among the population as a whole. We are concerned with the total system
and not only the health of an individual or the eradication of a particular
disease. Public health functions to
monitor health of communities, formulate public policies to address health
priorities, and assure that populations have access to appropriate and
cost-effective care.
My own research
is in two main areas, spanning the developmental lifespan: maternal and child health and chronic disease
prevention.
First, for nearly
my entire career (I arrived at Yale in 1989), I have worked in maternal and
child health – particularly with urban teens and young women. Over the last decade, I have been running
large randomized controlled trials on a model of group prenatal care that
results in better birth outcomes for women and their babies: for example, we have documented a 33% reduction
in preterm delivery (the leading cause of infant morbidity and mortality) and a
50% reduction in rapid repeat pregnancy (I say with full respect to the young
women I work with, that the only thing more challenging than a 15 year old with
one child, is a 16 year old with two). We are now conducting a study with United
Health Foundation in Detroit, Nashville and McAllen TX in advance of a planned
national scale up of this model of group prenatal care in 2016.
Second, six years
ago, on the heels of that confrontation in the classroom, I started CARE: Community Alliance for Research and
Engagement. Our goal is to improve
health in New Haven with a specific focus on the prevention of chronic diseases
– such as obesity, diabetes, heart disease and cancers – which account for 75%
of our nation’s $2.5 trillion dollar healthcare expenditures – and have
tremendous human costs in terms of illness and premature death. Our work in New
Haven is deep in the neighborhoods and schools and we use a community
organizing approach with a strong social justice foundation.
What these two
seemingly disparate areas of research have in common are the inclusion of those
traditionally vulnerable and underserved, dedication to scientific rigor and
community engagement principles, and a commitment to tikkun olam – healing the world, in whatever small ways we are
able.
Finally,
I’d like to close with some connection of my work to this week’s Torah portion and
the impending High Holy Days.
When you enter the land that the Eternal your God is giving you as a
heritage, and you possess it and settle in it, you shall take some of every
first fruit of the soil, which you harvest from the land that the Eternal your
God is giving to you, put it in a basket and go to the place where the Eternal
your God will choose to establish the divine name. [Deuteronomy 26:1-2]
The Israelites are instructed to express their gratitude to God for their
bountiful harvests and freedom from slavery by tithing 10% of their crops for the Levite, the stranger, the orphan, and
the widow (verse 26) (ReformJudaism.org).
In this parsha, we are
told to tithe crops. But one may also
tithe other things of value to help the
Levite, the stranger, the orphan and the widow – notably our time and our
money. Of course, the upcoming High
Holidays are a time of personal reflection and repentance, when together with
Jews throughout the world, we examine the year past and envision the year
ahead. For me – and for us -- this
provides an opportunity to reflect on our privilege, while reaffirming our
Jewish tradition’s longstanding commitment to tikkun olam – healing the
world.
I will continue to
redouble my efforts in the hospitals, health centers, neighborhoods and schools
where my team and I work. And I hope
that you, too, will make your own commitment to health and healing personally,
for your family, our congregation, and the broader community in which we live. If we move forward with passion and
compassion, courage, integrity and excellence – then I believe that we can face
confrontation with strength, we can stand up to injustice (don’t be a
bystander, be an “upstander”), we can learn from our history and leave a legacy
for our children, we can be generous in our tithing – and we can indeed begin to heal the world.
