Letter from the Dean
Health inequity is one of the most urgent challenges we face in health care and biomedicine.
We see evidence of it everywhere, from infant mortality to life expectancy.
We see it in disease prevalence and in how well conditions are managed. We see it in clinical trials that lack diversity and in the uneven distribution of resources, with COVID-19 vaccines serving as a recent example.
Despite widespread advances in prevention and numerous breakthroughs in therapies and drugs, for millions of people, a wide gap persists in realizing lifelong health.
While the underlying reasons for this gap are complex and deeply structural, the lived reality is this: The color of your skin, the community you belong to, and the place you call home remain the largest predictors of health and longevity. Far more than your doctor or what’s written in your DNA.
These social and environmental factors are appropriately called determinants of health because their influence is so profound. And perhaps at no other time have they been so vividly and painfully on display, from the health effects of climate change to the devastating impact of structural racism during a global pandemic. As our latest issue of Stanford Medicine magazine uncovers, effectively engaging these issues demands that we view a patient’s health in a completely different light.
There is a wealth of data on how structural racism has created neighborhoods that lock in health disparities. Communities of color, often burdened with substandard housing, are typically located far from the best schools, good jobs and quality hospitals or clinics. They lack access to nutritious food, clean air and green spaces. The barriers to good health are often literal: railroad lines and highways that cut off disadvantaged urban neighborhoods, or miles and hours of travel that isolate rural areas.
These are the realities that too many Americans, particularly people of color, must navigate every day.
Far too often, physicians treat patients and then send them back into the same environment that caused their illnesses. I’m encouraged that researchers and health care providers are broadening their scope to better identify the most acute factors impacting human health. Further research is vital to fully understand the complex relationships between non-medical factors and their impact on outcomes and, importantly, to identify solutions — in partnership with communities — to begin to correct generations of inequality.
Social determinants are integral to Stanford Medicine’s vision of precision health. By embracing a holistic approach, precision health treats the individual and focuses on predicting and preventing disease before it strikes, and curing it — precisely — if it does. And to be precise, we must appreciate the full context of a patient’s environment and all of the factors that shape the patient’s health and well-being.
I am proud of the many Stanford Medicine community members who are pioneering ways to address social determinants, and I encourage you to learn more in these pages. I believe the insights and experience gained represent a critical opportunity to eliminate the unconscionable health disparities that plague our nation. Through concerted efforts across research, education, policy and patient care, we can build a more equitable health care system for all.
Lloyd Minor, MD
Carl and Elizabeth Naumann Dean of the School of Medicine
Professor of Otolaryngology-Head & Neck Surgery