Although this is the healthiest time in human history and medicine is quickly evolving, the rift between those with the highest life expectancy and those with the lowest continues to widen. “Health has no choice but to enter the political arena,” said Sandro Galea, MD, MPH, professor and dean of the Boston University School of Public Health, during the Massachusetts General Hospital Executive Committee on Community Health symposium June 4.

In fact, said Galea, in the last 30 years the life expectancy gap has widened despite advances in technology and medicine, and in the past 10 years the slope of the relationship between wealth and life expectancy has gotten steeper. “Health is not caused by medicine, rather, it is caused by a full range of factors,” he said. In his presentation, “Achieving Health Equity: Addressing Social Determinants of Health” he detailed what he calls the “'actual actual' causes of health.”

These include geography, economic status and social conditions. The safer a person’s living environment, the more financially stable they are and the more highly educated they are, leading to a higher life expectancy. When asked what the best way to ensure good health, Galea responded, “Choose to be born to wealthy, well-educated parents.” With the widening of the wealth gap in the United States, the poor is no longer “the other.” In fact, nearly 50 percent of the U.S. population faces at least one of the “five evils of poverty”—low income, lack of education, no health insurance, living in a poor area and joblessness—which greatly impact health.

During the presentation, Galea joined panelists Eric Weil, MD, chief medical officer of Primary Care in Partners Center for Population Health; Katharine Rushfirth, CNM, associate chief nurse midwife at Mass General; and Ana Cabral, manager of Complex Patient Populations community health workers at Mass General Chelsea HealthCare Center in a discussion moderated by Guardia Banister, RN, PhD, NEA-BC, FAAN, executive director of the Institute for Patient Care and director of the Yvonne L. Munn Center for Nursing Research. The symposium was co-sponsored by the Executive Committee on Teaching and Education and the Institute of Health Professions School of Nursing.

Know of a Great Community Health Project?

The Mass General Executive Committee on Community Health is now accepting proposals for community health and health equity funding from clinical departments engaging in community health efforts – such as following community health improvement guidelines, community champions, creating a committee, or developing a community health strategic plan. For more information about this opportunity, contact Nicte Mejia, MD, MPH at