Beyond healthcare, occupying for health

Certainly, there is a need to occupy healthcare. Healthcare is essential, and the prevention and treatment that happens in clinics and hospitals, emergency rooms and community health centers, is integral to improving and saving lives.

Yet, while medical care is essential, it accounts for only an estimated 10-15% of preventable mortality in the U.S. The true causes of our country’s poor health outcomes and health inequities – and thereby the real solutions to improving health – are not rooted in the provision of healthcare.

They are rooted in communities: in sidewalks and parks, in access to healthy food and adequate housing, in clean air and safe neighborhoods.

What does this mean? It means that to alter health outcomes and inequities, we must go beyond occupying healthcare.

We must occupy the junk food and fast food industries, whose marketing power and lobbying power (leading to the maintenance of skewed agricultural subsidies) impact what we eat and what is available for us to eat.

We must occupy the criminal justice system. The U.S., with less than 5% of the world’s population, has almost 25% of its prisoners, the majority of whom are people of color, people with mental health issues and drug addiction, and people with low levels of educational attainment. This exacerbates poor health outcomes related to substance abuse and mental health; worsens health inequities by race, ethnicity, and socioeconomic status; and to boot, has done little if anything to make neighborhoods safer.

We must occupy zoning policies and construction and planning industries to improve inequities in access to healthy food, enhance safety and walkability, reduce unintentional injuries (which are the leading cause of morbidity and mortality among children in the U.S.), and reduce the excessive energy use and pollution that stems from our homes and buildings, as well as long commutes in personal motor vehicles (of which we have more in this country than licensed drivers).

We must occupy the welfare system, which focuses on services that – despite what are often good intentions – do not empower citizens, tap into their problem solving capacity, or enhance their ability to take collective action to better their communities, as John McKnight argues in an article entitled “Services are Bad for People”.

We must occupy the news and entertainment media. Whether it is news stories that inaccurately and dangerously link bullying directly to suicide in a way that can elevate suicide contagion risk by suggesting suicide is a natural response to bullying; fictional TV characters eating hordes of junk food day in and day out, without any consequences; or music videos that normalize gender-based violence, the media play an enormous role in our perceptions of what is “normal”, shaping our behaviors in a way that has significant impact on health outcomes.

The list goes on. Our health is determined more by where we live, work, and play – our physical and social surroundings – than anything else. And the list of institutions, industries, policies, and laws that unjustly impact these places and environments extends many miles, and spans many fields.So, yes, we should occupy healthcare. But let’s not make the mistake of stopping there. There’s a lot more to be changed…revolutionized…occupied.

Vinu Ilakkuvan received her Masters of Science degree in Society, Human Development, and Health from the Harvard School of Public Health in May 2011. She currently works in youth violence prevention in Richmond, Virginia, and blogs about public health at

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  • Randall Reitz

    The work continues. The vision expands. Strong work Dr Miller.

  • Phil Lawson

    You are not talking about a healthcare issue, you are describing a mindset issue. Which leaves us with the questions; Where does the ‘mindset’ of a country come from? More importantly, how does the mindset of a country change?

    • miller7

      Great point, Phil. Changing the entire way we see health and creating a culture where health is viewed as not just the opposite of being sick requires time.

      Has this mindset come from years of expecting the same from our healthcare system? If we change the system will the public’s mindset also change? Take what is happening regarding polio in India. There has been a system change which in turn has lead to a mindset change about the virus. Granted there are only four countries who still deal with polio, the entire global mindset has shifted to a place where this is something we can prevent.

      A worth challenge – changing mindsets regarding health and healthcare.

      • Phil Lawson

        Does the system create the mindset, or does a mindset create the system? This was one of the primary subjects we addressed in the book Being Spherical – Reshaping Our Lives and Our World for the 21st Century. The biggest historical change in our collective ‘worldview’ happened during the Renaissance which allowed our current system to emerge leading to the prevailing mindset.

        In our just released book, It’s Going to be OK (but not like we thought) we add the element of momentum and its role in preventing change, even desired ‘good’ change.

        The question we are left with is: Will the momentum of the current system, of which healthcare is simply one element, allow for systemic change? Or is a ‘worldview’ change required first which will slow the systems momentum allowing for the desired and needed change?

        Momentum plays a much bigger role than realized. Just as a car can not successfully make a sharp turn at highway speeds, it must slow down to turn, our systems, healthcare and all others cannot make any significant change while traveling with great momentum. Ironically, an unexpected benefit of our financial crisis is that things have slowed.

        Now we are left with the small question of what is the new worldview required that will allow and facilitate the desired changes?

        I’ll bring you a copy of our new book this afternoon.

        • pursuitofPH

          Thanks so much for the comments! I agree completely that it’s a mindset issue – and a mindset issue in a couple ways. First, healthcare has become synonymous with health, and that’s a mindset that needs to change in order to take the kind of broader approaches to prevention and health promotion I tried to highlight. Second, health equity (and equity more broadly) needs to be more valued as an end goal. I think these are some (but certainly not the only!) components of the new world view you mention.

          I think your question about whether the system creates the mindset or vice versa is really interesting – it seems to be a vicious cycle where the mindset creates the system that perpetuates the mindset further, but to ask what comes first seems like a chicken-and-egg question to some degree…

          There are individuals and organizations that have this different world view that are working to change our systems (including health and healthcare) – the subject of my next post, hopefully! – and as these small changes happen, hopefully it will change more people’s mindsets, and help facilitate bigger systems changes moving forward.

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  • DrBeckerSchutte

    I so appreciate the passion in this post. And I think that we have to be willing to think outside the box, to push ourselves to act differently. So, thanks for the invitation. Thrilled to be on the same team!

    • pursuitofPH

      Thanks so much, I feel the same way! At a conference on positive youth development at the University of Virginia today and tomorrow, and am struck by just how many amazing people there are on this team of ours.

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