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Public health expert Abdul El-Sayed visited Boston College to speak about public health in urban communities. His presentation focused on his work as the public health commissioner in Detroit and his approach to public health nationwide.聽

El-Sayed was Detroit鈥檚 health officer and executive director of the city鈥檚 health department from 2015 to 2017, when he resigned to run in Michigan鈥檚 2018 Democratic gubernatorial primary.

First, El-Sayed defined public health as society-wide measures aimed at creating the conditions necessary for individuals鈥� health. He illustrated this definition with an anecdote of a young boy he once met at a vaccination 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.聽

鈥淗e was 3 years old and the fourth child of a 21-year-old mom. He had met his father maybe four times in his life, because his dad was in jail,鈥� 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.

鈥淚 immediately started to appreciate that this kid鈥檚 confidence was completely undercut by the circumstances of his life,鈥� he said. 鈥淎nd 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鈥檚 confidence. That for a child like him, the work of public health鈥攖he work with government, frankly鈥攊s about justifying the confidence that every 3-year-old should have in the life that he or she is going to lead.鈥澛�

El-Sayed went on to explain the definition of 鈥渟ocial determinants of health.鈥� 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.聽

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.

鈥淭he difference here is whether or not you鈥檙e insulated by the context within which you live. Because in New York, things are accessible, and they鈥檙e usually affordable,鈥� El-Sayed said. 鈥淭here鈥檚 something about the fact that people literally live on top of each other that creates density, and density changes the experience of poverty.鈥�

Detroit, he explained, can fit Manhattan, Boston, and San Francisco within its 138 square miles and still have room to spare. Additionally, Detroit鈥檚 population is declining. In effect, there鈥檚 a relatively poor population in a huge city that鈥檚 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鈥檚 experience of poverty.

鈥淚n particular, we said, 鈥榃hat are the health challenges that we can take on that have knock-on implications for intergenerational poverty?鈥欌�� El-Sayed said. 鈥淪o we wanted to leverage health to disrupt intergenerational poverty.鈥澛犅�

The health department created building programs to address these challenges. These included 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.聽

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.聽

鈥淲hen there are scarce resources, what do we do to make sure those resources are allocated in equitable ways?鈥� he asked. 鈥淭he 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.鈥�

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.

鈥淚 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 little boy I started with don鈥檛 have lobbyists,鈥� El-Sayed explained. 鈥淎nd there鈥檚 something about that we take for granted, oftentimes, in upper-middle-income communities鈥攖hat the government will be responsive to you. Imagine a reality for you where the government will always fail, and it will not only fail you but it will also fail to show up after it fails you.鈥�

Adapted from an article by Megan Kelly in聽The Heights,聽October 1, 2019