ATLANTA - "Why are some people healthy and others not?"

Dr. Linda Rae Murray posed this fundamental question during her presentation at the annual meeting here of the Association for Community Health Improvement.

Murray, chief medical officer for the Cook County Department of Public Health, an area that includes Chicago and environs, said that many people mistakenly believe that differences in lifestyle choices are the most significant determinant of an individual's health status. "In reality, socioeconomic, cultural and environmental factors play the dominant role in health inequities," she said. "You have got to talk about the true nature of the problem before you can fix it."

The March 5-7 meeting where Murray spoke drew over 450 participants. The Association for Community Health Improvement, which is made up of leaders from the health care, public health, community and philanthropic sectors, is a program of the Health Research and Educational Trust. CHA was a sponsor of the Atlanta meeting.

Murray noted that as the income gap in the United States continues to grow, so will health inequities. To illustrate her point, she cited research showing that the U.S., despite being the second wealthiest nation in the world (based on per capita GDP), has one of the worst population health profiles among wealthy - and some not so wealthy - developed nations.

Murray said there is a need for government-funded research into the social determinants of health and the health impacts of public policy. She said that health researchers should routinely collect income and class data.

Conferees got an advance screening of the PBS series, "Unnatural Causes: Is Inequality Making Us Sick?" The four part documentary series was slated to air in many markets in late March. It presents the growing body of research that points to the dominant impact of race and socioeconomic status on health outcomes.

The series questions whether conventional health strategies that focus on lifestyle choices, improving poor medical care and identifying genetic predispositions to illness are the most effective ways to improve public health. With its companion website, the series is part of an outreach and public awareness campaign to help reframe the debate over U.S. health policy.

The series does not dismiss the role healthy behaviors play in health outcomes; however, as Harvard University epidemiologist David Williams pointed out in one segment, "increasing opportunities, providing education and training for better jobs, investing in our schools, improving housing, integrating neighborhoods, giving people more control over their work - these are as much health strategies as diet, smoking (cessation) and exercise."

The website describes outreach activities that community organizations can undertake to help citizens understand the issue and take action to address health inequities. DVDs of the series, for use in community meetings, can be ordered through the site.

Many of the breakout sessions at the March meeting featured Catholic health care organizations. For example, St. Louis-based Ascension Health gave a presentation on its Access Leadership Planning Program; St. Joseph Health System of Orange, Calif., described its approach for using self-reported health to identify and help vulnerable populations; and Bon Secours Richmond Health System reported on its efforts to manage childhood asthma and reduce disparities. CHA, with Bon Secours, presented ways organizations can evaluate their community benefit programs.