Moral Determinants of Wellbeing

2020 was by any measure a bad year for humanity. In the United States, we bore witness to intense disruption to the social fabric of our nation. And then, during the first full week of 2021, the citadel of American democracy, the U.S. Capitol, was invaded by U.S. Citizens during an active session of Congress.

We are in the middle of what will continue to be a long period of reckoning. 

Collectively, we are troubled and unhealthy. We the People, no longer seem to share a singular North Star for the civil society. 

Earlier this summer, following the killing of George Floyd, Dr. Donald Berwick published a commentary in JAMA, titled, The Moral Determinants of Health.

If you read this newsletter long enough, you will see the term social determinants of health often. Our health is implicated by many factors, one of which involves our social engagements, such as employment, education, transportation, and relationships. 

As Dr. Berwick notes, below the social determinants in a community or society are the moral determinants of our health. 

[S]ome form of moral compact, implicit or explicit, should be the basis of a just society. Without a common sense of what is “right,” groups fracture and the fragments wander.

Our society is fragmented. Ill health and incredible socioeconomic disparities has created a tension that manifest in an insurgence of the U.S. Capitol.  

Our healthcare, economic, and political systems are in triage mode. We cannot thrive if all we’re doing is repairing massive hemorrhages. We must seek solidarity in the general welfare. And we cannot solve the social determinants of health if we ignore the moral components of our society.