Daniel Dawes has been thinking about health equity for a long time.
Growing up in Lincoln, Nebraska, he noticed the disparities in health care access and the disparities in health status among his own family. The child of a white mother and a Black father, he saw how the white side of his family living in rural Nebraska lacked access to hospitals and clinics while the Black side of his family had many family members dying early in their 60s.
"The premature deaths and lower life expectancy that we see in certain communities really propelled me forward to dedicate my career to examining them, to understanding them, and to building awareness," Dawes said. "Whether you're white, Black, Asian, Latino, or Indigenous, we want to make sure that you're given a fair shot at reaching your full potential."
Today, Daniel Dawes is an internationally recognized leader in the health equity movement and scholar on the political determinants of health, a framework for understanding the forces behind racial and socioeconomic health disparities. Over the past year he served as a Presidential Visiting Fellow at Yale School of Nursing (YSN) where he helped integrate his work on the political determinants of health into the YSN curriculum.
Dawes is the founding dean of the School of Global Health and senior vice president of global health at Meharry Medical College in Nashville, Tennessee. Among his many achievements, he was an instrumental figure in developing and negotiating the Mental Health Parity Act, the Genetic Information Nondiscrimination Act, and the Americans with Disabilities Act Amendments Act. He was also an architect of the health equity-focused provisions of the Affordable Care Act.
Yale News sat down with Dawes to talk in more detail about the political determinants of health - and how brought his scholarship to YSN. Here are five key takeaways.
1. Political decisions, not just social ones, can cause health inequity.
In his book "The Political Determinants of Health" Dawes argues that the political determinants of health create the social conditions, like inadequate transportation, housing instability, and lack of healthy food options, that ultimately affect our health.
"It's a systematic process of structuring relationships," he said. "It's distributing resources and administering power, and they operate simultaneously to impact your health outcomes."
At its core, this framework helps us understand how policies and politics shape health inequities. By understanding the root causes, Dawes says, we can better develop and implement actionable solutions to address health disparities. For example, he cites the ratification of the 19th amendment and the passage of the Civil Rights Act of 1964 and how health outcomes for both women and Black people, respectively, improved after their establishment.
"You see improvements when you pass a law that is inclusive, that is equitable, and that is fair," Dawes said. "It also does not hurt the group that has benefited the most in that community over generations. In fact, it does quite the opposite because everyone is seeing an increase in their longevity and in their health outcomes."
2. Health care providers play a critical role in addressing the political and social drivers of health inequities.
There are many people, Dawes says, who think physicians, nurses, and other health care professionals shouldn't work to address inequities within the health care system. That it's not their duty or their role. But Dawes pushes back against this argument.
"We know that when the white coats speak, our society inherently listens to them," he said. "They have tremendous respect, and they have tremendous power and influence. With that power comes responsibility."
If the role of a clinician is to "do no harm," Dawes thinks it's not enough for health care providers to stabilize a patient in the hospital or clinic and then release them back into environments where they're being harmed.
For example, if a patient has respiratory issues and lives in a community where there's rampant air pollution due to discriminatory policies like redlining, a clinician should advocate for their patients at city council or state legislative meetings.
3. YSN is advancing academic program development and research centered on the political determinants of health.
In the past, Dawes has developed certificate programs for medical students and public health students but not for nursing students. However, at YSN, he helped in the development of the nation's first certificate program on the political determinants of health geared toward nurses. The program will have several components, but Dawes is especially excited about the experiential component.
"It's not enough to sit in a seat and be lectured to all day long," he said. "You're going to be given the theory, but you need to be able to apply that theory in a practical way."
That could look like attending a hearing at the Connecticut General Assembly or meeting with leaders at the United Nations. Students will learn about the art of policymaking at the local, state, national, and even international level.
"When the situation arises where we can advance more inclusive policies that will positively impact individuals, students will be ready to go at all levels," Dawes said.
4. An interdisciplinary approach is essential within health equity.
Dawes was interested in working at Yale, and with YSN in particular, because providers like nurses can play a critical role in addressing health inequities. But he says nurses often haven't had a seat at the table.
"Whenever I'm speaking about political determinants of health, the majority of people who I'm speaking to are in medicine," Dawes said. "I'm always thinking to myself, but where are the nurses? Where are the physician assistants? The physical therapists? The pharmacists?"
Dawes thinks it's important to create a more inclusive table that allows for people across different disciplines to come together to tackle some of the more pressing inequities in health care. In his role at Yale, Dawes helped to establish collaborative initiatives that extend across the health sciences, from nursing to medicine to public health.
His work will not only enhance nursing education but also foster interdisciplinary partnerships with other schools such as Yale School of Medicine and Yale School of Public Health. The goal is to integrate the political determinants of health into health science curricula and establish collaborative initiatives that extend across these disciplines.
"When we come together and work collaboratively, that's when the magic is made," Dawes said. "That's when we see egalitarian policies move over the finish line."
5. YSN will co-host global summit to develop actionable strategies for promoting health equity.
While at Yale, Dawes helped plan a global summit that he says will convene thought leaders, health care professionals, and policymakers to develop actionable strategies for promoting health equity.
A partnership between YSN, Meharry Medical College, and University of Global Health Equity in Rwanda, the summit will explore issues including "blue zones," mental health, and artificial intelligence (AI). With AI, for example, Dawes says attendees will think through both the opportunities but also the harms of this technology.
"AI feeds on data that isn't necessarily inclusive of a lot of population groups, and it's more extractive and maybe harmful to one group versus another," he said. "We need to get our heads around this to figure out what kind of AI tools are appropriate. How can we ensure that our students and our faculty are utilizing tools in their own research and in their own practice that will benefit the community?"
Overall, the goal of the summit is to prepare future health leaders with the expertise to drive systemic change, address the root causes of inequities, and build a more equitable global health system so all population groups can benefit.
