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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A Clinic and a Community

I am pleased to have Antony Sheehan on the blog today. Antony came to the Church Health Center last year after holding senior positions in the British health system and a fellowship at the Institute for Healthcare Improvement in Boston. I value Antony’s leadership and partnership as the Church Health Center moves into its future.    

For all of its history the Church Health Center has valued collaborations within Memphis, Tennessee. We are concerned not only for our own stability as an organization, but for also seeing results in the wider community’s effort to improve the health of the city.

Now we stand on the brink of our most complex collaboration to date as part of a coalition of business and community leaders committed to redeveloping a massive vacant structure that once housed a Sears catalog order distribution center. Unquestionably it would have been less expensive to implode the building and start over, and the owners could have embarked on any number of commercial schemes sure to earn a profit.

And while the Church Health Center could raise money and erect our own campus to solve some of the challenges that come with our continuing growth, we’ve chosen to lean into our mission alongside educators, artists, small businesses, and residential space by moving our operations to Sears Crosstown as an anchoring partner.

Why? Because we’ve learned a few things in our first quarter of a century.

When the Church Health Center opened its doors to the first 12 patients in 1987, we stood in the gap. Some people had access and means to receive the best healthcare in the region, largely because they had good insurance offered through employers. But thousands and thousands of other people worked hard in low-income jobs without health benefits. They could afford neither insurance premiums in the open market nor the typical fees of healthcare providers.

The Church Health Center has stood in this gap for a long time, and every year we understand it better. Making sure people can see doctors is important, but every person who visits our clinics comes with a life context and personal narrative that often contribute to illness or pain, and the Church Health Center has worked to address those issues. Our 80,000-square-foot wellness facility is a testament to our effort to treat not just the pain or illness, but also the causes of pain or illness by helping people achieve better balance in the various dimensions of their lives.

But it’s not enough. We’ve seen that we have to peel yet another layer away from the health issues of our patients. We have to get to the causes of the causes of pain and illness. The circumstances people live in, work in, and relate to others in affect their health—but they often have no ability to control or change these circumstances, or even to express how they feel about their lives.

Where you live affects health. Whether you can express yourself affects health. Whether you perceive that you have choice—even about what you eat—affects health. Too often low levels of education, income, and health are bound together in a multigenerational cycle that is hard to break out of.  

And that’s where Crosstown comes in.

Rather than being torn down, the old Sears building will be transformed into a thriving community. By moving all our operations into Crosstown, the Church Health Center will contribute to creating a health-giving community and health-promoting environment. We’ll be participating in “village life” with teachers and painters and writers and musicians and store owners and residents. A tilt toward issues of health and wellness will not be accidental. Rather, all the elements of Crosstown will intentionally seek to support the health of individuals who live and work at Crosstown, those in the surrounding neighborhood, and those who come to the Church Health Center for care. The wellness benefits of these dimensions of life will not depend on income brackets.

A community is as essential as a clinic to better health. People cannot make a choice for a richer more fulfilling—and healthier—life if they do not first see the possibility of such a life. By offering such a vision, we will crack the causes of the causes of the pain and illness of our patients.

Antony Sheehan is president of the Church Health Center, Memphis, TN.