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

Posted on by Leandris C. Liburd, PhD, MPH, MA

Sick and Tired of being Sick and Tired

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

Fannie Lou Hamer, Mississippi Freedom Democratic Party delegate, at the Democratic National Convention, Atlantic City, New Jersey, August 1964.

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! Diverse Women chatting while tending fresh vegetables in their shared, inner city, organic garden 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.

Well being, a happy, loving, family enjoying their time together outside

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

Healthy Community, a happy, supportive, diverse group of people, gathered together at a community event, encouraging one another

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
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Posted on by Leandris C. Liburd, PhD, MPH, MA

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

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    Great article and a positive step in bringing the gap between the “haves ” and “have nots ” by creating understanding.

    So often women are left behind in all aspect, work, education, and health care. It is surprising that an African American women would be quoted, then again maybe not. We as women are all “…sick and tired of being sick and tired.”
    All gaps were made through color not gender, and now that females are standing together and making their voice heard things will change. Due to heart disease and misdiagnose, I started, Hearts of Color, Inc., an organization focused on women and heart disease as well as other chronic diseases.
    The closing of the gaps or stopping them from widening will take the hands, actions, and voices of many.

    Unfortunately, I have to agree with the statement “it seems that poor people don’t have a chance [to be healthy]”. It isn’t just the fact that they have “poor living conditions”. Many lower-income families cannot afford basic health insurance to protect them when they get sick or have an emergency. Growing up in a poverty-stricken neighborhood, I witnessed too many families with parents who are too busy worrying about working and making money in order to make ends meet and survive that they completely disregard their health. They don’t have time to worry about maintaining their health until things get really severe and they end up in the hospital. Even then, they can’t afford to pay for any medicines to get better. I believe that a huge factor contributing to the fact that “poor people don’t have a chance to be healthy” is due to the fact that they are too busy overworking themselves in order to no longer be “poor” that they are forced to neglect their health. Their current hardships cast a shadow over the importance of maintaining their long-term health.
    On the other hand, I believe that we can make a difference and enhance the health-related quality of life of people at risk of health disparities by making health a priority and promoting preventative measures. I strongly believe that can end the cycle of being “sick and tired of being sick and tired”. This would mean that our country has to completely restructure in order to actually be able to take care of its people. This starts with addressing the fact that there is an absolutely ridiculous and growing gap between the extremely wealthy upper class and the poverty stricken middle in America. There are too many Americans that simply aren’t able to afford to live and too many “middle class” Americans that cannot afford health coverage. As a strong advocate for universal healthcare, I think the amount of money people have to pay to see a doctor, buy necessary medicines, etc. is absolutely ridiculous in America. The first step in creating a country of healthy and satisfied people is providing them with basic and essential needs for living, which starts with a healthcare system that works to take care of its people instead of working towards increasing profits.

    Un gran artículo y un paso adelante en lo que la diferencia entre los ricos y los pobres mediante la creación de conocimiento. Por desgracia, tengo que estar de acuerdo con la afirmación “parece que los pobres no tienen la oportunidad para estar sanos. No es sólo el hecho de que tienen malas condiciones de vida. Muchas familias de bajos ingresos que no pueden pagar un seguro básico de salud para proteger a ellos cuando se enferma o tiene una emergencia.

    The poor you will have with you always is a quote that has been used frequently to begin or end a debate on the responsibility or lack thereof individuals, groups, or society as a whole, to provide healthcare or other assistance and support for the poor and underserved. Various individuals and groups have debated if assistance is provided, who should be delegated the task or financial responsibility. Many organizations offer occasional health screenings or other one time or intermittent assistance but very few offer longer term health care. Health care and health care coverage in its present state cannot meet the healthcare needs of the underserved and remain financially solid. Intermittent offerings are a positive effort but they do not meet the populations needs for long term primary care. The benefits of receiving routine primary care and early intervention during acute illness are paramount in the effects on long term health and longevity. These attempts at providing care do not meet the overwhelming burden of bridging the gap associated with geographic access to care, the ability to maintain insurance coverage, and race/ethnicity and socioeconomic status (VanderWielen, 2015).
    According to VanderWielen, there are more than 57 million people who live in areas that have shortages of providers. The total number of areas at time of article print was 5, 864 designated areas. As with nurses, it is anticipated that the healthcare provider pool will continue to diminish in the near future and further exacerbate the disparities in healthcare if changes are not made. The solution VanderWielen and her team posed was having an increase in the number of students in local medical school’s staff clinics and offer free health care. This would have a twofold purpose. According to Tavernier, students who are exposed to underserved communities are more likely to serve them after completing their education. The goal would be to increase opportunities for healthcare professionals to provide care and gain experience while immersing them in a setting they may not otherwise experience. Long range the goal would be for many of the students who trained in these areas to return to them or similar settings thereby improving the geographical access to health care.

    I think that with the subjects of the courses of occupational psychology it is possible to create new trends on innovation in equity, which is essential for a society to have a balance Of power between both genders, something detestable is the internal racism between little different social classes.

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