social determinants of health

On a melancholy Saturday this past February, Shalon Irving's "village" — the friends and family she had assembled to support her as a single mother — gathered at a funeral home in a prosperous black neighborhood in southwest Atlanta to say goodbye.

To understand why teen pregnancy rates are so high in Texas, meet Jessica Chester. When Chester was in high school in Garland, she decided to attend the University of Texas at Dallas. She wanted to become a doctor.

"I was top of the class," she says. "I had a GPA of 4.5, a full-tuition scholarship to UTD. I was not the stereotypical girl someone would look at and say, 'Oh, she's going to get pregnant and drop out of school.' "

A man sobbed in a New York emergency room. His elderly wife, who suffered from advanced dementia, had just had a breathing tube stuck down her throat. He knew she never would have wanted that. Now he had to decide whether to reverse the life-sustaining treatment that medics had begun.

American Indian and Alaska Native families are much more likely to have an infant die suddenly and unexpectedly, and that risk has remained higher than in other ethnic groups since public health efforts were launched to prevent sudden infant death syndrome in the 1990s. African-American babies also face a higher risk, a study finds.

Poor people who reside in expensive, well-educated cities such as San Francisco tend to live longer than low-income people in less affluent places, according to a study of more than a billion Social Security and tax records.

At her home studio in Westwood, Kansas, yoga instructor Marilyn Pace leads a class of 5-to-8-year olds. With the help of songs, games and other kid-friendly teaching methods, she guides her small students through poses like the cobra, the triangle and the downward-facing dog.

Tatjana Alvegard takes her daughter, Kaya, to Pace’s classes regularly.

It's T minus four days until exam day, and Travis Driscoll is practically living at his desk.

"Each day, I'm easily here for five hours," he says. "I haven't done much of anything else but studying for the last two months."

Driscoll is one of 13,000 medical school applicants across the U.S. taking the new Medical College Admissions Test, or MCAT. He's got stacks of science books on his desk to help him prepare and a rainbow of biochemistry charts pasted to the walls: glycolysis, citric acid cycle, electron transport chain, mitosis, meiosis and DNA replication.

Poor old Dr. Krebs. His painstaking Nobel-winning work on cellular metabolism, called the Krebs cycle, has made him the symbol for what's ailing medical education.

"Why do I need to know this stuff?" medical students ask me.

"How many times have you used the Krebs Cycle lately?" senior doctors jokingly reminisce.

When I was just beginning my third year as a medical student, I learned an important lesson about what matters most in health.

It was a typical summer afternoon in St. Louis, with the temperature and humidity both approaching 100. My patient was a woman in her 40s who was being admitted to the hospital because her lungs were filling with fluid, a complication of kidney failure. She had missed all three dialysis appointments that week.