Brian D. Smedley

Director, Health Policy Institute, Joint Center for Political and Economic Studies

By Carol Harrison

With health disparities generating new interest from journalists, Brian D. Smedley is called upon increasingly to explain their roots in where people live, work and play - what public health professionals call the social determinants of health.

Smedley may well be among the most knowledgeable source in America on the subject. Director of the Health Policy Institute for the Joint Center for Political and Economic Studies since September 2008,he previously oversaw publication of the influential 2002 Institute of Medicine report, "Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care." That work earned him the Congressional Black Caucus' "Healthcare Hero" award in April 2002.

The Institute of Medicine study awakened the interest of many journalists for the first time in how a person's race and ethnicity contribute to both his health risks and to the medical care he is likely to receive. "By stripping away the pretense that the difference can be explained by minority lack of access to timely care, the report should spur doctors and patients to question why racial disparities are tolerated in medicine," USA Today noted. "A disturbing new study," the New York Times declared. "A picture that cannot be ignored," wrote the Washington Post.

Smedley was pleased by the initial attention, but he has been frustrated by the lack of action in the years since. "That report put the issue of health care disparities on the map, but it didn't create the kind of policy change we need," says Smedley, a member of the advisory board of the USC/California Endowment Health Journalism Fellowships and a frequent and popular speaker at its seminars. He called the inaction at the federal, state and local levels one of his major disappointments in a career dedicated to social justice.

A Detroit native, Smedley graduated magna cum laude from Harvard University with a degree in psychology and social relations. After earning a doctorate in psychology from UCLA, he did a postdoctoral stint as a research fellow at the Educational Testing Service.

He served as a Congressional Science Fellow in the office of Rep. Robert C. Scott, a Democrat from Virginia, and director for public interest policy for the American Psychological Association before going to work for the Institute of Medicine.

Smedley's work on the study motivated him to become a co-founder and research director in 2005 for The Opportunity Agenda, a communication, research and advocacy organization in Washington, which focuses exclusively on issues of concern to minorities.

At the Joint Center for Political and Economic Studies, Smedley was charged with refocusing its Health Policy Institute. Since his arrival, the Institute has redesigned its Web site by making as its centerpiece the Place Matters Initiative, which has involved two dozen communities across the country in a long-term effort to identify the complex underlying causes of health disparities and define and implement strategies to reduce them.

In Washington, D.C., for instance, Place Matters teams are creating "wellness opportunity zones." In California, the eight health departments in the Bay Area are examining transportation, access to food and liquor stores, air quality, and other social and health inequities to explain why life expectancy can vary by as much as a decade from one census tract to another.

"Bicycle paths, walkways, better land use policies so we are not sitting people's homes next to sources of industrial waste - even something as simple as a farmers market can improve nutritional options," Smedley explains.

Although there's been an upsurge in journalists' interest in health disparities since the Institute of Medicine report, Smedley says they're not paying enough attention to why or how place matters. "The preponderance of the health reporting is about innovations, medical devices, the latest breakthrough, whoever wins the Nobel Prize," he says. "It's hard to get public attention for health disparities."

One reason, he notes, is the "American emphasis on individual determinism: that you get what you deserve."

"If you work hard, play by the rules, eat right and exercise, you should be healthy," Smedley says. "There is an overwhelming amount of reporting that reinforces that frame. But research shows that the contexts in which we live are just as important."

Although expecting people to take responsibility is good, Smedley says individual determinism "only gets us so far in understanding why disparities exist and what we can do about them. The idea that there's a larger social inequality rubs against the grain of individual determinism and is very difficult to report on."