In this episode, we speak to Daniel Dawes, Executive Director of the Satcher Health Leadership Institute at Morehouse School of Medicine. Daniel shares his public health story with us, how we was motivated to write his books: 100 Years of Obamacare and The Political Determinants of Health, and what public health as a field needs to do to effect equitable policy change in the United States.

Learn more about Daniel Dawes: https://satcherinstitute.org/about-us/leadership/

The Political Determinants of Health: https://www.press.jhu.edu/books/title/12075/political-determinants-health

100 Years of Obamacare: https://www.press.jhu.edu/books/title/11576/150-years-obamacare

April Moreno 0:04

Welcome to the public health network or the official podcast of the public health Podcast Network. I'm your host Dr. April Marino. Join us as we speak to public health professionals around the country and around the world, in Global Community and Environmental Health Topics. Join us also as we speak to podcasters in this field of public health. To learn more about us visit public health podcasters.com. And in the meantime, enjoy the episode.

Daniel Dawes 3:11

It is wonderful to join you, April, thank you for having me.

April Moreno 3:14

Thank you. So please tell us a little bit more about you and your public health story.

Daniel Dawes 3:20

April Moreno 9:44

Thank you so much for the work that you're doing. And a lot of the history you've been able to share with us on health policy and how we got to this point so far. There's a lot that I still don't know my story in public health actually begins at the implementation of Obamacare. Are the ACA? Oh, that's interesting. Yeah. So it's kind of a puzzle piece here. And this is a really interesting conversation because I'm also mixed, I'm Chinese and Mexican, but then on the Mexican side, we are also Mexican and Black and African American. We have commonality here.

I would love to hear your story one day. Yeah,well, meaning the ACA was worth my story and public health started. That's when I start to understand what is all of this. I'm just really grateful for the work that you've done. I'm sharing all the different ways beyond literal clinical health care, that affect different communities beyond genetics, right? Beyond genetics, absolutely, how far we have come in our thinking and understanding about these determinants, right, and how genetics plays a very small part, and overall health status. And these social and environmental determinants, as you mentioned, really have an outsized role they play an outsized role in our overall health and well being. So yeah, kudos to you.

Thank you. So tell us more about the book, the most recent book, how were you inspired to begin the second book on the political determinants of health?

Oh, my gosh, another great question. So, you know, as I guess, I can pick up then right from when the the social determinants of health framework and ensuing research really took off, at least in the United States back in 2008 2009. Right, again, after we had passed the ACA, you really saw an effort by our policymakers, you know, who were bold, I think, in their approaches to examine this some more. But as we were talking about that, I think, from my standpoint, I kept saying to myself, Okay, this is interesting, as we think about the structural conditions in which we're all born into we live in, we die in right? How did they come to be in the first place, and it just because of my legal training, I kept saying, wait a second, I know how frustrated I was in law school, right? Reading these laws, understanding the implications and the impact that they have in our society. And as I kept thinking about what the public health research was showing, around the social determinants of health, I kept saying to myself, my goodness, every time preceding every one of these social determinants of health, whether it is education, whether it is transportation, whether it is employment, or whatnot, there was always a pre seating policy, right? That instigated that structural condition or that social determinants of health. So whether it was a law or regulation, an ordinance, you name it, right, there was a preceding policy. And so as I started to think more about this, I kept saying, Oh, my gosh, every time someone raised an issue, again, I kept saying, we're not quite finished with the equation, because I still believe we are merely nibbling at the edges of the problem of health inequities and injustices in this country. Right. And, and I and I was thinking about at the time, the case law, right, especially Supreme Court precedents that were coming out. And this was now in the mid 2000s, right? Well, actually, I'm sorry, from 2010, all the way up on to about 2020. And I kept, I kept seeing, you know, the Supreme Court trying to erode the protections for underresourced for marginalized groups. I saw the recycling of dicta and holdings, you know, around this, again, chipping away and and making the argument that while you know, we acknowledge that the state the government right, has played a role in in in creating these inequities, essentially, they're so far removed today from the past, that it doesn't even matter anymore. And we know that is absolutely not true. When you look at public health research, we have seen through epigenetic research and others, that it still has significant impacts on our health, right. And as we're thinking about repairing the past, we really do need to focus on labeling it what it is, these are politically determined and driven

determinants of health, if you will, right. And so the Supreme Court, I think, is interesting, because they have said, well, these are socially derived, right, essentially, that's what they're saying. They're socially derived. They're not politically derived, right? And because of that, they make that case, then they're no constitutional implications or any legally enforceable remedies for the victims of these inequities, if you will. So for all of us who continue to stop there at the social right aspects and say that they're socially determined? Well, it does raise some significant legal implications, right, because you can't tie it to a legally enforceable remedy. And I have been really thinking about this that, you know, as we think about all of these policies that have been devised, the majority of which really are what I call the political determinants of health inequities, we have had some success in realizing more equity focused policies, right, but they're so rare and so far in between, right. So I do think that only policy can fix what policy is created, which is why, you know, for all of us that, you know, have come to understand that there are these upstream determinants and drivers, we cannot continue to put our heads in the sand, and ignore the fact that politics and policy plays a significant impact in determining how long we're going to live on this earth, and the quality of life, and the quality of our health moving forward.

Thank you for sharing that very important information. I mean, these are facts. These are things that we don't really think about, we talk about upstream, but then we leave it at the policy level, and we we hand it over, right? In public health, and we can't do that anymore.

Right, because of the the Supreme Court wanting to go that route of saying they, you know, they are socially derived, right. And the idea is that the idea they're making is that well, you know, black and brown and white people, they just don't like each other, essentially, right? We can't force them to like one another, we can force them to come together. We know that is absolutely not true. And so they don't think about those levers, political levers, legal levers that have been pushed and pulled over time, to ensure the status quo right over the 400 plus a year history. And we do know that the political determinants of health and equitably distribute social, medical and and other determinants, right. So I don't want folks to lose that idea because it is it is a critical aspect of our work in examining the creation and the perpetuation and exacerbation of racial and ethnic and other inequities in our society. So that is, that is absolutely critical. And and and, you know, April, when I think about the political determinants of health, whenever I am doing an analysis of an inequity that is observed in a community, I really frame it in this definition, right? That it is the political determinants of health involve the systematic process of structuring relationships, distributing resources, and administering power. And they operate simultaneously in ways that mutually reinforce or influence one another, to shape opportunities that will either advance or hinder health equity. So I do break it up into those three areas, looking at how, you know, we distribute resources, looking at how we structure relationships, and looking at how we administer power. And then I look at it in terms of what exactly then has fueled this? What are the factors from a pOH lens? And to your point, we can't we can't just look at policy, we have to look at it from the front end as well, right? So we have to look at voting, we have to look at government, we have to look at all of these aspects of the process, the political process, right? Because it does matter that we engage in every aspect of that process. It isn't simply not enough to go out and vote or simply not enough to think that a few you know are gifted in the policy arena and just let them handle that for us. We have to all be engaged, the community that is closest to the pain and the problem of these health inequities should be the ones who are leading the solutions. Right. So I do think it is absolutely clear Critical that, you know, everyone has a voice, right, and everyone has a seat at this table. And that voice is respected, and it is heard. And it is welcomed and incorporated, as the government is making decisions and so forth that impact virtually all of us, right and all of our health.

Thank you. And so, you know, that kind of leads me to my next question about a call to action. Is there a call to action that you share with your readers or, you know, listeners of this podcast episode? What can we do in the field of public health as students, professionals, community, people who may not have degrees in public health, but really care about a certain health condition or something that their communities are going through? What can we do? Is there a call to action? Is there something you would recommend?

Oh, my goodness, absolutely. I know that when I speak today, with a lot of health equity and health justice champions, they really are despairing, right? They've lost hope, in recent times, especially with what we have seen coming out of the Supreme Court and in other governmental bodies at the state level, and maybe municipal level as well. But I'm here today to say, April that I'm actually quite optimistic. And here's why. Because we are in the fourth period of this nation's history for in terms of a great awakening, of health equity, right, we've had four periods. The first was when President Abraham Lincoln freed black slaves, and actually worked to create the nation's first major health policy addressing the social determinants of health needs of these free newly freed people, and poor whites and others in this country, right. But we saw how racism and hatred works in this country, it does not sleep, right, hate never takes a break. And so seven years after that major policy was passed, we saw the dismantling of that program. And then it would take about 100 years almost, for us during the Second Great Awakening for health equity. And that was during the Civil Rights Movement. Two years into that movement, health equity champions like you and I and others, right, listening to this podcast, recognize, wait a second, we need to get moving, right? There's so many people who are dying prematurely, and who are sicker, right, what are we doing to address those issues. And so we saw that movement in the 1960s, to address the more overt forms of discrimination in public health and health care. Right? Then the third one happened a few decades after that, when we started addressing the more subtle forms of discrimination, right? In public health and health status, the neck disparities, right? If you will, and and, and that, again, was building up on previous pieces. And then this fourth one now has really opened up right. For disparities. We are talking about health equity, we're talking about breaking down the structures and and systems that have perpetuated harm and oppression on communities of color and other vulnerable populations. So it is, I think, such a rare opportunity for us right now. To to stand up courageously, and be bold and say, Wait a second, now is the time to do something that is going to be transformational, right and address these political determinants of health because what I am afraid of, and here's where there may be a little pessimism, if we are not careful. What we have seen in this country is that every time we've realized these, these three preceding periods of health equity, there was always a period of retrenchment that follow right or backlash to undo the gains that had been made from that policy standpoint. We see that happening right now in this country with white nationalists and Christian nationalists and others who are trying to spew their message of hate in this country who are trying to stir up dissension and division in this country who are trying to undermine our democracy. And so people need to wake up and recognize the period that we're in and and actually get up and start doing something about it because we can we have that power right? The Constitution begins with we the people right? So we have the power we need to exercise it we need to be both and I will leave with this final thought from my dear friend and mentor Dr. David Satcher. You know, where he reminds me more than ever before. That what we need today, especially today, our public health leaders who care enough about these communities right? But caring we know is not only enough, you got to know enough, you got to avail yourself of these political determinants of health. Right, as contentious as they may see, right, or complicated or complex as they may seem, we have to know enough. We also need to recognize that we have to be courageous to do enough, right? This is not a movement, for the faint of heart, we have to be courageous. And we have got to persevere until the job is done. Right? Because throughout history, where we had made gains, guess what? April, I'm sure you and I are both exhausted. And many of the listeners to this podcast are extremely exhausted. I know I am tired. But But again, because hate never takes a break, and racism never sleeps in this country, we have to be careful that yes, we take time to rest. But we have got to be vigilant. And we have got to continue to push and spearhead this health equity movement forward,

we have got to do all that we can to move that dial forward right, to a meaningful degree, because I am hopeful that, you know, with all that we see going on right with all of the trends that we see happening in this country, with the fact that we're becoming a more racially pluralistic society, I believe that we now have the attention of the nation, right? Where people are saying, Whoa, wait a second, I didn't realize that these inequities and injustices were happening, right, I thought we were in a post racial world - But we have their attention. We all know that that is not always for too long, we have no idea when that door will slam, but it will. And so we have got to be vigilant and really mobilize into action and ensure that as we are looking at opportunities for everyone to vote, we know voting can be the difference between life and death, as we are looking for opportunities to engage in the political process, and to inform the government and then of course, help develop policy that we are involved in every step of the process. It is absolutely critical. So again, I want to thank you, April, so very much for this opportunity today.

Thank you so much. How can we learn more about your department, your program, your institute? How can we connect? How can we reach out?

So we you know, at the Satcher Leadership Institute, we have a website, it's Satcher institute.org. Folks can go to the website, they can sign up for our newsletters, sign up for our fellowship programs. You know, however they want to get involved, just contact us, let us know, we we welcome you into this work. Because we know that health, health equity is a multi dimensional issue. And it takes a transdisciplinary and collaborative group of leaders and scholars and community activists and advocates and so forth coming together and working together to realize the vision that we are setting out to do and our vision really is to create systemic change at the intersection of equity and PDA. So again, I want to thank you for that. That opportunity to really showcase the institute's work and and how your your listeners can get involved. And thank you so laborers in this movement. Right?

We are all interconnected. We are all part of this community national amd global community. So thank you so much for joining us today, Daniel.

My pleasure. Thanks again.

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