IHI Open School Short

Video Transcript: Why Does Health Equity Matter to You?: A Conversation Between Donald Berwick, MD, and David R. Williams, PhD, MPH

Donald Berwick, MD, Senior Fellow and President Emeritus of IHI
David R. Williams, PhD, MPH, Professor of Public Health, Harvard T.H. Chan School of Public Health

WILLIAMS: Well, Don, could you tell me why health equity is important to you? And what role you see health equity playing in the context of larger improvements in health care?

BERWICK: Health equity is important to me because it’s a piece of the larger problem of social justice. I think we have become, in the US and in many other countries, an unjust society, failing to attend to the needs of people who fall into positions of great disadvantage. And I just don’t like that. I don’t know why, maybe because I grew up in a small town where we kind of took care of each other. But I don’t want our society to be one in which we turn away. And to me, health equity is, it’s a symptom of a larger, crucial issue of the fabric of communities in our society.

I guess the other reason is that I’m a doctor. I don’t practice anymore, but when I did, about half of my patients were under conditions of enormous stress, on Medicaid, in poor families, in broken homes. And I could see the challenge, and frankly I felt helpless a lot, that the kid with asthma who came back and back and back, because there was no heat in their home, or because we couldn’t get the home clean, or the child failing at school who becomes depressed, because their self-image is hurt. And then the vicious cycle begins, poor sense of self, less effort, more failure. And you could see the cycle penetrated. I could give pills, or I could treat fevers. But that wasn’t creating healthy futures. And so it meant a lot to me.

There’s a kid I’ve written about quite a bit. It’s a real story. Some patients stick with you, you know, and this young guy was a 14-year-old when I met him, was in deep trouble. He had, he was drug addicted.

WILLIAMS: At 14.

BERWICK: At 14. He had his first gun when he was five. And he was in and out of trouble. But then he got leukemia. He got acute lymphoblastic leukemia. He was a 14-year-old black child, which, as you may know, is an extremely difficult disease. For some reason, acute lymphoblastic leukemia, which you can cure easily in a five-year-old white, behaves really badly in a 14-year-old black. But we went to the mat. This kid got everything. We got him a bone marrow transplant, a sophisticated chemotherapy, walked him through great difficulties. And he was cured. His leukemia went away at 17. There was no trace. And we remained in close touch until he died at age, I think he was 29, on the streets. He basically fell apart, and ended up having a seizure due to drug abuse. Cured of leukemia, and killed by poverty, killed by disparity. I mean, he wouldn’t have said that. This kid would never, ever blame anyone but himself. It was really interesting. He had internalized this, but I say that. I can’t forget that kid.

WILLIAMS: That is a really powerful story.