The Schroeder Center and the W&M Health Policy Journal Club recently welcomed David Limbrick, MD, PhD., to speak about “Social Determinants of Health: A Clinical Perspective.” Dr. Limbrick, who sits on W&M’s Public Policy Board of Advisors, is the Executive Vice-Chair of the Department of Neurosurgery; Chief of the Division of Pediatric Neurosurgery; T.S. Park, MD Chair of Pediatric Neurosurgery; Professor of Neurological Surgery and Pediatrics; and the Neurosurgeon-in-Chief at the St. Louis Children’s Hospital. Dr. Limbrick spoke about how his experience working in pediatric neurosurgery in Ireland, Uganda, Haiti, and St. Louis has informed his understanding of social determinants of health and the role they should play in health policy discussions.
Dr. Limbrick shared that his path to becoming a neurosurgeon was not a straight line. As a W&M undergraduate, for example, Dr. Limbrick spent some time as an environmental science major before discovering biology. Later, he attended medical school at Virginia Commonwealth University before completing a seven year residency in neurosurgery at Washington University in St. Louis. He traveled the world to study neurosurgery in a global context, and he spoke about his time in Dublin, Ireland and Mbala, Uganda, where he became more aware of inequities in healthcare delivery.
Dr. Limbrick spoke extensively about his time working as a neurosurgeon in Haiti immediately before and after the massive 2010 earthquake. In Haiti, Dr. Limbrick saw how crumbling infrastructure and crowded conditions made getting Haitians the care that they needed more difficult. He said that this experience made him think about social determinants of health in his own community.
Dr. Limbrick then turned his attention to St. Louis. He discussed the infamous Delmar Boulevard, which he explained runs through two very different neighborhoods in St. Louis, with homes averaging $73,000 sitting across the street from homes averaging $335,000. Dr. Limbrick said that Delmar Boulevard illustrates a much larger issue of racial and economic inequality that plagues St. Louis and makes it much harder for healthcare to be distributed in an equitable way.
Dr. Limbrick gave a short history of the healthcare crisis in St. Louis and described the closing of the city’s safety net hospitals, which further worsened social inequities across the city. Still, he thought that the situation was beginning to look up in the St. Louis healthcare system. In 2001, as an example, the St. Louis Regional Health Commission was founded as a strategic alliance focused on providing uninsured residents with healthcare. In addition, last year, Missouri voters approved Medicaid expansion through the Affordable Care Act which would grant health insurance coverage to 275,000 Missourians who were not previously eligible. The expansion goes into effect on July 1.
Following his presentation, Dr. Limbrick answered questions from the audience. He noted that clinicians can be a part of policy discussions by providing a unique perspective on the limitations of existing health policies as they care for patients daily. He explained that clinicians see the human element of health-related social problems and used the gun violence epidemic as an example. In discussing the Missouri Medicaid expansion, he acknowledged that some people may see the cost of the expansion as an issue, but as someone who cares for the most vulnerable members of the St. Louis community daily, he noted that any expansion of healthcare services in Missouri would be a positive.
Dr. Limbrick’s perspective as a clinician provided the students and faculty in attendance with a new way to understand problems of health policy and social determinants of health. His captivating life experiences and candor about social inequality were a welcome addition to the Health Policy Journal Club’s ongoing discussions and debates.