I think we need to talk.
Over the last 20 years we've had a wonderful, although at times challenging relationship. I'm not saying that I want to break up, but I do think we have some things to work on. I know that I'm partly responsible for the state of our relationship so I decided to write this letter because sometimes when I talk, I don't feel like you really listen.
Not long after we got together, you decided that everything in this relationship was going to be about the social determinants of health (SDOH), the big picture. You were always talking about policies, systems, institutions, and communities—housing, education, transportation, structural racism, and employment. While I understood why, I had some concerns and I think I even voiced them at the time but that didn’t make a difference. I could have openly disagreed with your focus but I followed your lead because I thought that within a few years, you'd open up and find ways to connect personal health behaviors to those systems and institutions.
Now don't get me wrong, you definitely bring up the role of individual health behaviors and choices every now and then--but let's be honest, I'm just not feeling a strong enough connection based on the things you say and do. Personally, I can get people to understand the relationship, but what happens when I’m not around? Too many times, I’ve walked in on conversations about us and the people talking (who think they know us or are our friends) either don't really understand what we do or they immediately point to what's missing between us. They’ll even go so far as to say that we’ll never last if you won’t open up and make space for lifestyle and personal behavior in the relationship-- not just when you’re talking about health education and direct services, but also when you’re developing models, designing programs, and evaluating impact.
So here’s the good news… I’m still invested in this relationship and I know that you are too because recently, I’ve seen some important changes in the things you say and do. You’ve started to open up and talk about the connection between lifestyle and determinants of health in more specific ways; the relationships between employee wellness and community conditions; the importance of developing cultures of health everywhere people live, work, and play; and that while all roads lead to health, one of those roads is paved by the choices people make every single day. I’ve decided to be patient with you Public Health. I know that change takes time and that perspective transformation requires changes to the head and heart. When you know and believe something different, you will decide and act differently. I believe you just might be transforming.
No relationship can be one-dimensional and successful over the long haul. Every good relationship requires balance. Yin has Yang, Abbott had Costello, Beyoncé has Jay-Z, and social determinants of health have personal health behaviors. For all of them, talking about one without the other just doesn’t seem right and communicating their connections and roles validates them both.
So Public Health, while things between us might not be perfect, I am hopeful. I believe that if we continuously communicate the connections between SDOH and health behaviors, strive for authenticity and transparency during your transformation, and seek balance in all that we do, we’ll be together for a long, long time.