Dr Maria Quinlan, Research Lead, Change Team, ARCH

As someone who lectures on the subjects of sociology, equality and how they intersect with patterns of health and illness in society, TEDMED talks have become a vital teaching resource, sharing fascinating insights on the changing landscape of healthcare globally…while also saving my voice and students ears![1]. A batch of talks that I find particularly fascinating all coalesce around the same theme – that in order to truly deliver an efficient, cost-effective health care system to society, we need to move healthcare ‘upstream’[2]. That is, we need to join the predictive dots and focus on preventative measures which are contextual – our living and working conditions, rather than merely focusing our resources on the diagnosis and treatment of illness.

In his TED Talk, entitled ‘What makes us get sick’ Dr Rishi Manchanda, a physician who has worked in some of LA’s poorest neighbourhoods,  makes the case for tackling these wider social issues (and gives some concrete examples of how to do this) – believing they are the only real way to address the root causes of illness. Dr Manchanda quotes startling statistics which suggest that living and working conditions have 60% more impact on our health and wellbeing  than any medical intervention we will ever have [3]. The need to move beyond the biomedical model of health care to incorporate the social model (i.e. to take into account issues such as class, culture, environmental-factors, race and gender) is nothing new, with the World Health Organisation defining health as “a complete state of physical, social and mental wellbeing, and not merely the absence of disease and infirmity” in 1948, close to seventy years ago [4]. Yet the majority of healthcare expenditure still goes on diagnosis and treatment rather than on prevention.  Why is this? Once we start to try to get to the root causes of illness, issues such as poverty, class, race and ethnicity, childhood trauma and neglect, the effect of toxic stress, and how much of it we experience in our day to day lives – all reveal a complex picture which often seems too big to tackle [5].

Beyoncé’s new music video highlights racial inequalities and discrimination in America, and at one point the graffiti image ‘Stop Shooting Us’ appears on the screen [6]. While high-profile  shootings of African American young men rightly grabs headlines, it is startling figures such as the fact that African Americans are 60% more likely to be diabetic, 40% more likely to die from stroke, and 40% more likely to die from breast cancer which are even more shocking – inequality in healthcare is a more silent killer [7]. If we look to class, we find that the relationship between socio-economic status and health is also ‘very large, very robust and very well-documented’ [8].

Digital healthcare can layer upon the existing patterns of inequality of race and income within our healthcare system, providing those who can pay for it with better care, while further marginalising those who can’t into a digital ghetto [9] –…or it can be a real force for change and equality. The HSE’s national eHealth strategy is attempting to provide our public healthcare system with the much needed digitisation that so many private healthcare organisations already take for granted here in Ireland. It’s exciting to be working beside the HSE’s eHealth team as they begin to make that vision a reality and to be part of what could really be a revolution within our healthcare system [10]. With the year that’s in it, that seems fitting, an féidir linn?…I truly hope so.



[1] www.tedmed.com/

[2] www.ted.com/talks/rebecca_onie_what_if_our_healthcare_system_kept_us_healthy?language=en#; https://www.ted.com/talks/nadine_burke_harris_how_childhood_trauma_affects_health_across_a_lifetime

[3] www.ted.com/talks/rishi_manchanda_what_makes_us_get_sick_look_upstream?language=en

[4] www.who.int/about/definition/en/print.html

[5] www.cdc.gov/violenceprevention/acestudy/

[6] www.youtube.com/watch?v=LrCHz1gwzTo

[7] http://familiesusa.org/product/african-american-health-disparities-compared-to-non-hispanic-whites

[8] Phelan et al (2010) ‘Social Conditions as Fundamental Causes of Health Inequalities: Theory, Evidence, and Policy Implications’, Journal of Health and Social Behavior 51(S) S28–S40

[9] www.kpihp.org/e-health-equality-for-all/#sthash.AqY5QKMK.dpbs

[10] www.ehealthireland.ie/Stakeholder-Engagement/Research/Research-into-eHealth-Implementation1.html

You can contact Maria on maria.quinlan@ucd.ie or call 01 716 5405. Check out our website for more information about Maria’s research interests.

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