“I’m sick and tired of being sick and tired” (Fannie Lou Hamer, 1964) – Why we work to create pathways to health equity

Fannie Lou Hamer – voting rights activist, civil rights leader, and humanitarian, captured the nation’s attention during the 1964 Democratic National Convention, when she described the injustices she and others in her community had endured in their fight for the right to vote. She had been jailed, beaten, and threatened for her advocacy, but didn’t back down. The cumulative impact of these and other stressful life experiences negatively impacted her health, but she remained committed to securing her civil rights, because in her now famous words “All my life I’ve been sick and tired. Now I’m sick and tired of being sick and tired.” ¹

The legacy of Fannie Lou Hamer is an example of personal empowerment and resilience, and how social factors, broadly considered, contribute to the health status of individuals and communities. Over the past 50 years, the United States has made significant progress in improving health outcomes for the nation as a whole. “People are living longer, healthier, and more productive lives. However, this upward trend is neither as rapid as it should be – we lag behind dozens of other nations – nor is it uniformly experienced by people in the United States.” ²

This is why we work every day at the Centers for Disease Control and Prevention (CDC) to identify concrete and actionable steps toward achieving health equity. We never lose sight of the “faces” and families behind the data. Consider June, for example. “Every time I hear you talk about health, it seems that poor people don’t have a chance [to be healthy]. Everyone can’t go to college, or eat the way you say we should eat. I wish you could see my grocery bill every time I go to the supermarket! And, the costs of medicines! Who can afford it? On any given day, it’s all I can do to just get to the end of the day without breaking down!” This was one side of the conversation I overheard between my neighbor – a public health nurse, and June. A single mother of 4 adult children, June worked for the past 30 years in a factory that made cardboard boxes. Before passage of the Affordable Care Act, she had little access to the healthcare system, and only very recently has she been able to successfully manage her diabetes. After so many years of having to neglect her health, she is now experiencing a number of serious complications of diabetes. June is highly motivated, though, to change her diet, exercise regularly, and take her medications as prescribed. Why? Because the most important aspects of her life are threatened.

June values “the life in her years” as much as she values living a long life. At CDC, we have a health-related quality of life program that assesses health-related quality of life and wellbeing outcomes in the U.S. using state and national surveys. “Well-being is a positive outcome that is meaningful for people and for many sectors of society, because it tells us that people perceive that their lives are going well. Good living conditions (e.g., housing, employment) are fundamental to well-being. Tracking these conditions is important for public policy. However, many indicators that measure living conditions fail to measure what people think and feel about their lives, such as the quality of their relationships, their positive emotions and resilience, the realization of their potential, or their overall satisfaction with life.” ³

Research has demonstrated that “higher levels of well-being are associated with decreased risk of disease, illness, and injury; better immune functioning; speedier recovery; and increased longevity.” ⁴

As we celebrate 30 years since the release of the landmark Secretary’s Task Force Report on Black and Minority Health, how might we enhance the health-related quality of life of persons and communities at risk for health disparities? Promoting wellbeing is consistent with the goals of health promotion programs that seek to help people thrive and not just prevent them from getting sick. If we understand health as a resource that people use 1) to live full, productive, and satisfying lives and 2) to cope with or change unhealthful environments ⁵, then we can develop and implement population health strategies that enhance quality of life and reduce health disparities. We can end the cycle of being “sick and tired of being sick and tired.”

Visit CDC’s Healthy Communities Program (HCP) for community health promotion program ideas.

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¹ Browne-Marshall, G.J. (2007).
Race, Law, and American Society: 1607 to Present – (foreword by Derrick Bell).
Routledge: New York, NY. p.131.

² MMWR Surveill Summ. 2013 Nov 22:62 Suppl 3:1.
Forward: CDC Health Disparities and Inequalities Report, United States, 2013.
Frieden, TR.

³ CDC, Health-Related Quality of Life (HRQOL) website (March 6, 2013).
Well-being Concepts, Introduction.
Division of Population Health, National Center for Chronic Disease Prevention & Health Promotion, CDC.

⁴ CDC, Health-Related Quality of Life (HRQOL) website (March 6, 2013).
Well-being Concepts, Why is well-being useful to public health?
Division of Population Health, National Center for Chronic Disease Prevention & Health Promotion, CDC.

⁵ Prev Chronic Dis. 2007 Jul;4(3):A73. Epub 2007 Jun 15.
Changing times: new possibilities for community health and well-being.
Liburd LC, Sniezek JE.

Cross-posted on HHS, Office of Minority Health’s Blog for Health Equity.