Food Boxes or Grocery Stores? Take your Pick!

Demi Wilson reflects on the profound impact of health inequities in society.

When I think of the social determinants of health, I think back to my first week of classes at
Duke. In the Global Health FOCUS cluster, one of the classes I took was Global Health System
Development in Trent Hall, about a ten to fifteen minute walk from the chapel. I took this walk to
Trent Hall like a champ. To my left I passed the medical school, clinics, physical and
occupational therapy school, and the nursing school. I could envision myself in those buildings,
achieving my dreams, helping people in need. After daydreaming, I sat down in the classroom.
It’s Thursday, the second day of class. The topic of the day is the social determinants of health.
Little did I know that this class would spark my curiosity.

Almost eleven months later, my curiosity is still not satisfied. It seems like one thought just leads
to another, revealing new ideas. I sat down in Professor Thoumi’s seminar, expecting to leave
angry, frustrated with our health system, and bombarded with the challenges that minorities
face. To my surprise, I was hopeful. I left the seminar thinking that we have the power to truly
lessen the burden of the social determinants of health. We just have to be intelligent and
insightful with our decisions. The main topic of this seminar revolved around health equity. The 5
subtopics were the attainment of the highest level of health, lack of fair and just opportunity,
structural inequities of power and justice, according to need, and health justice. After teaching
about health equity, Professor Thoumi made a brilliant pivot to providing real life examples of
these subtopics and explained her projects that have combated these challenges.

“I looked at the world differently”

After speaking about the importance of deciding the best solution, acute care or long term care,
there were two examples that changed my perspective during this seminar. The first focused on
quality of care and how some patients rely on a translator to communicate with their healthcare
professional. This lessens the quality of care because time is devoted to translating instead of
treatment. The other example that blew my mind was the COVID-19 vaccine age cut off. This
cut off should technically be lower for Black people because there is a lower life expectancy
along with differences in risk for exposure. These two examples stuck with me and forced me to
acknowledge that there are so many challenges that are constantly overlooked.

Professor Thoumi also said a statement that challenged my way of thinking. To summarize, she
stated that we cannot have our mind wrapped around what happened in the past but we need to
pay attention to now, mainly in regard to mistrust of the healthcare system. This was a perfect
transition into two successful projects. Latin-19 at Duke started in 2020 and reached a greater
proportion of the Latinx population for COVID vaccinations. The goals were to elevate the
voices of community members, establish meaningful partnerships, and enable care delivery
models. Next, RadX Up provided opportunities to enhance health equity by integrating
community health workers into payment and care delivery reforms. I felt hopeful and excited
when hearing about these projects and for once I felt like there were solutions to the problems
at hand.

After my second class at Trent Hall, I looked at the world differently. I stepped out of the building
and began to walk back to the bus stop on chapel drive. Now, on my left I saw tired healthcare
professionals leaving work for the day and cars exiting the parking garage eager to get home.
What stuck out to me most was the bus stop near Duke hospital. There were many people
waiting on this bus which may be their only form of transportation. I felt that I was forced to
apply what I just learned on my fifteen minute walk and discuss with my peers. Certain groups
of people may not have reliable transportation to healthcare appointments, people may have to
work during the day in order to make a living, and insurance may not cover important
procedures that need to occur in order to save lives.

So, spare tires or brand new tires? Take a nap or fall into a deep slumber at night? Food boxes
or grocery stores? The acute care or the long term solution? With food boxes, people are
quickly fed and hunger is tamed. With affordable grocery stores with a great supply of food
options, the food is always available. There are pros and cons to both. You should not have to
make this choice but that is the basis of the social determinants of health. We get to make this
choice hypothetically, others don’t. The social determinants of health have opened my eyes. I
see situations that I never saw before, whether it is on a fifteen minute walk or on the everyday
news. Like Professor Thoumi mentioned, we need to pay attention to these big challenges but
there are also so many smaller challenges that don’t even come to mind initially, like the choice
between food boxes and grocery stores.

Diya Patel, Huang Fellow ’26

Vivian AppleDemi Wilson is a first-year student from Charlotte, North Carolina intending to major in Biology with minors in Evolutionary Anthropology and Chemistry on the pre-med track.