A Spoke in the Wheel

Antony Sheehan, president of the Church Health Center, is here to talk about a key concept that helps keep our organization focused on changing the healthcare landscape.    

I’m a good Brit, but these days the words of a German pastor and theologian are what stick in my head. Dietrich Bonhoeffer wrote,

“We are not to simply bandage the wounds of victims beneath the wheels of injustice, we are to drive a spoke into the wheel itself.”  

I’ve spent my career in healthcare and have seen up close the effects of injustice in my own field. Many people with impressive clinical credentials are now poking at the true causes behind diseases and chronic conditions, and the realities are far more complex than anything a blood test will show.

The social and economic conditions people live in correlate both to access to healthcare and health outcomes, and one aspect is particularly important: education.  

The reality is that the number one predictor of length of life and quality of health is education. A large body of research consistently supports this truth.

The more formal education a person completes, the more likely the person is to live longer, to experience better health, to engage in behaviors that promote health, and to receive screenings that can catch disease in early stages.

Of course, multiple factors go into an individual’s ability to complete higher levels of schooling—the quality of the neighborhood school, time parents spend reading with children, family finances, the need to leave school to earn money, the truth that a weak start before age five may mean a student will not be prepared to study at a college level, or even complete high school.

The World Health Organization defines health inequities as inequalities that are avoidable—in other words, we can do something about them. So if health inequities are linked to educational inequities, where should we start?  

Michael Marmot, a British public health researcher, develops the notion of life chances versus life choices. He observes that our public health intervention is predicated largely on telling people that if they make different choices, they’ll have healthier lives. Choose to eat differently. Choose to have better relationships. Choose to have a meaningful career. Choose to get an education.

But can people who do not have life chances actually make life choices? Marmot doesn’t think so. Neither do I. People without socioeconomic chances are not in a position to make life choices.

Education is a spoke that we can drive into the wheel of health injustice before it crushes another generation. 

The Church Health Center already operates one of the best preschool programs in Memphis, giving many children from low-income households a head start on being ready for lifelong learning. Two years from now, when we are housed in the redeveloped Sears Crosstown building, we’ll be alongside a charter school. Young children cannot choose where they are born, what their environment is, or how much money their parents earn. Focusing on their education now creates decades of future life chances—in employment, in problem-solving, in a sense of self—that will result in life choices leading to health.


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