Dr. Mark DeHaven is Professor and Executive Director of the Texas Prevention Institute at UNT Health Science Center in Fort Worth, Texas. He is a community-based health improvement researcher and activist, who has collaborated with others to improve health in underserved communities throughout the United States and on several continents for more than two decades. As a Christian medical and public health professor he has dedicated his personal and professional life to recombining faith and health principles, which he believes, are a foundational component of Christian life, tradition and theology.
He was interviewed by Dr. Teresa Cutts, PhD, Methodist Le Bonheur Healthcare.
How can organizations working to address health disparity better identify assets in a community and help build stronger connections between the assets and healthcare providers?
I’ve had the same answer for 20 years, but it’s evolved over the last year. Our GoodNEWS team is now moving the discussion away from places and to the people. We focused for the last decade on the community-based, participatory integrated model, with the traditional assets-based analysis, seeing what’s there and integrating. Increasingly, after all of that, we’ve built structures, identified the strengths of the community, the things we can build on, gap analyses. We worked with our community partners to build a senior living center to integrate the health principles of GoodNEWS and developed our own community gardening network in churches and local community centers. We’ve come to the point where we have discovered that the only real primary assets are the people and the community they form.
One way of thinking about it is the assets are the people. If we are able to work with people and give them the tools they need to change, stimulate the desire to be healthy, that is the real asset. I believe that is what Jesus was looking for, that it’s scripturally sound and it transcends denominations and religions.
Health services researchers are now talking about animation, patient activation. You’ve got have that internal motivation. You can’t just bring a program to people if they don’t have that desire.
If you go into rich communities that have all the assets we’re looking for, they are still extremely unhealthy. When we look at it from the from the physical health indicators, people may be worse off in the high-risk communities; that is the function of the poverty. But even when we are in materially rich communities the obesity rates are high, cancer rates are high, heart disease, stroke, all the cardiovascular complications. It’s all still there. Until we begin to recognize that the people are the assets and work within that framework, we’re not going to see change in health outcomes.
Instead of people, what did you think the assets were 20 years ago?
We were looking at physical things: churches, parks, all the tangible assets related to underutilized potential resources we could partner with to engage and promote healthier lifestyle. How do we now awaken a collaborative approach where we bring health into the thinking, the thought equation about how to integrate existing physical resources in a way that’s going to improve health outcomes?
So you found that focusing on those tangible assets was not as useful.
Absolutely not. We work with many groups and we still believe that improving the physical assets is important. From a social justice perspective, we believe in equity across those resource bases. When there are unsafe streets, inadequate lighting, packs of dogs running around so people can’t be safely outside, or no access to healthy food—for all of those things yes, we still have to work together in partnership and throw our resources behind, in any way we can, the primary actors who are engaged in addressing those social determinants.
However, even when we do that, we’ve found that’s no guarantee that people are going to be healthy or buy in to that model. We still believe in the importance of that from a social justice/inequity perspective. However we don’t think it’s nearly enough. That’s why the dialogue is important.
Can you talk about GoodNEWs’s theology?
GoodNEWS stands for genes, nutrition, exercise, wellness and spiritual growth. We’ve been upfront about our theology when working with pastors and congregations. Even though our GoodNEWS research is rigorous and we have received funding from the CDC and the NIH, a lot of pastors still think it is a ministry. We’ve approached this by saying all we want to do is walk along side you. Our theology is to love God and to love your neighbor. And, we value your partnership in doing very high quality community-based participatory research.
We’re gathering data at a granular level, down to lipids and HDLs, LDLs, other clinical indicators, and starting to move to the area of the human genome. The groups that come to us are those drawn to our theology. We use, not exactly a liberation theology, but it’s real scripture based in that we feel that health is inseparable from faith.
Our approach to health is based on the theories that were developed by and are still being developed by Dr. Jenny Lee. We work with Christian churches. We read in scripture, starting in Genesis, that God formed man from the dust of the ground and breathed into his nostrils the breath of life, and man became a living being. Lee is the first to unwrap it from a scriptural basis. She’s been an innovator, collaborator, and co-investigator on the GoodNEWS research and community work from the beginning of forming the model.
For years I was at a leading medical institution where cutting edge gene research was being performed, looking at how can we manipulate the gene so that we can continue living the way we live and find interventional remedies to compensate, usually through pharmacological interventions and treatments, to try to reverse or at least disguise the effects of our toxic way of living, on our health.
Starting from there, Dr. Lee said that while scientists can tell us everything about the gene, but one area is a big black hole: They won’t tell you who created the gene. So you start with, what is a living being? In medicine we call this being from scripture the human living organism. If you take what is this living being that is talked about in the Bible, it is comprised of organ systems and organs. They are comprised of 170 trillion cells. These cells each have 23 pairs of chromosomes. On those chromosomes are written the 24,000 genes. The 24,000 genes break down into three billion DNA-based pairs. When we get that small, we are talking about particles, about the dust of the ground. So it’s not make believe that the dust of the ground was put together and we’re a living being, something real and tangible, the same material, the DNA basis of all creation.
I was meeting with a pastor recently who was overweight by at least 100 pounds. He said, “Look, my wife lectures me all the time about my health; when I’m ready I’ll change. Right now, I don’t want’ to change.” I said that’s fine I don’t need a change; I’m just here to talk about the human gene and how it functions. And I described what I just said about the 24,000 genes. I said therefore, when we look at scriptures, it’s inseparable from the requirements for health because God created the gene. And it works in a certain way. It is a chemical structure that functions according to messages.
So the messages we give someone matter. If you feed someone healthy food, give him or her healthy water, will that person necessarily be healthy? No. If you maintain that sound chemical structure, but then surround it with prejudice, hatred, mistrust and lack of forgiveness, all the stress that goes with those negative messages will compromise the integrity of that living structure God created. But if you surround it with love, kindness, generosity, forgiveness and caring, that structure now vibrates, in what Dr. Lee calls “happy genes.”
We structured the entire program in epigenes, meaning above the gene. Our folks resonate with this. We’ve come to learn that DNA is not destiny. There is a mechanism of an epigene. It is possible to switch genetic predispositions on and off. When scientists started publishing books like Genie in your Genes and Ghost in your Genes, it didn’t take long for that pastor to say to me the other day, you mean the Holy Spirit in your Genes.
By drawing a strong relationship between science and scripture we end up engaging these churches and faith leaders in our programs. For them it makes theological sense. That pastor, by the way, after 10 minutes, said, “I’m on board, this makes sense.”
If you had a magic wand, and were in charge, how would you design health exchanges or systems to promote better equity and eliminate disparity at the population health level?
I am a supporter of the president. He’s had a really hard time that first four years. He was forced to compromise so much, when we look at these healthcare exchanges and affordable care, to me it is still insurance system that is still going to leave about half of the uninsured still uninsured. For me, if there’s a magic wand and I’m in charge, I’m moving the whole thing out of medicine and putting it in public health, moving away from treatment to prevention of disease.
The model we use in the community is this: if you take a community health problem—in this case our entire country is plagued with chronic diseases—there are three different component pieces that are addressing our community health needs. The first is medicine through clinical science. The second is public health through actions taken collectively—population health perspective. And the third anchor of the triangle is mediating institutions: nongovernmental organizations, community-based organizations, faith-based organizations, business, government, policy. So we have these three kinds of actors working together. And here, once again, we are putting all of the resources into medicine.
The work we’ve done indicates that the smart money is on how you integrate clinical science with actions taken collectively and in order to produce informed social action, to produce health and not just treat disease. If you isolate out constantly focusing on this clinical part you’ll constantly be inside trying to fight your way out of this box. Until we move our perspective outside of that box and recognize that, in the communities where we have the pockets of risk, we need to embrace a social determinants of health approach. I know we have to do the exchanges, I know it’s a step; I know it’s a compromise. The real area from my perspective is moving out into the public health frame, moving to preventing disease and promoting real health for people and communities.
Photo: Mark DeHaven in Peru.
I like the work Mark De-Haven is doing. The elemination of adverse social determinants is the hardest part of population health, but also the most important in creating equity in health care delivery and wellness. For that reason, Physicians for a National Health Program support a national health insurance program as the best means to cover everyone in America, improve quality of both preventive and treatment care, and control long term costs. We believe that health care is a human right- a right that Jesus demonstrated in the most visible parts of his ministry- healing. We need to love our neighbors and work for social justice in many areas to eliminate these social determinants . We are just now developing the research and the language to talk about population health- next we will have to change the unjust systems.