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To provide good health care for a community, you can’t just treat people for rat bites, you have to get rid of the rats. That’s what Georges C. Benjamin, executive director of the American Public Health Association, told University of Maryland University College health care administration graduates gathered for the university’s Upsilon Phi Delta Honor Society induction ceremony May 9.

“You can take care of a person with a rat bite,” Benjamin said. “But if you have 10 people come in with rat bites, unless you do something to get rid of the rats, you haven’t done much.”

Benjamin’s career had taken him from the Army to emergency medicine and then into health care policy.  A former secretary of Maryland’s Department of Public Health and Mental Hygiene, Benjamin is known for speaking passionately about the underlying causes of health problems in the nation’s struggling communities.

“If it hurt people, if it killed people, it was mine,” he said.

The ceremony recognized the accomplishments of more than 2,600 graduates who are earning UMUC bachelor’s and master’s degrees in health care administration. Benjamin was chosen to give the Distinguished Leader Lecture.

While he loved being a one-on-one emergency health doctor, he said, he soon understood that the best way to care for people’s health was to remove the factors in their communities that were causing people to suffer.

“Health is a very complex process,” he said. “It’s the interaction of your genes, your environment and your behavior.  One of the painful revelations that I had to come to grips with is that 80 percent of what makes you healthy happens outside of the [doctor's] office.  It is more than an insurance card. It’s about quality housing, it’s about access to safe and affordable food. It’s about air quality and clean water, and it’s about education.”

He drew a correlation between the education of the mother and whether her child will survive its first year of life, between graduation from high school and health, between poor transportation and the ability to get care.

Health care also is about where trash is dumped, he said. As health commissioner in Washington, D.C., he saw that illegal trash haulers would cross into the city from Virginia at night and dump trash into vacant lots in poor neighborhoods, causing health problems.  He convinced the district police to patrol the bridge and stop the trucks.

Zoning is a health issue because it congregates low-income housing on unhealthy land, he said. Playgrounds are a health care issue. If children can’t get enough exercise in safe, supervised places, they will do worse in school, have shorter attention spans, and more trouble with the criminal justice system. Racial discrimination is a health care issue because it causes stress and leads to violence.

“We know that it is difficult to improve your nutrition and exercise regularly if the streets are not safe, if the sidewalks are broken and the stores don’t offer affordable fresh fruits and vegetables,” he said.

In many low-income communities, grocery stores have high-caloric, high-fat, non-nutritious foods displayed on the front row, he said. Store owners say that if they have fruits and vegetables people wouldn’t buy them. The business community says it can’t make a profit on those items, Benjamin said.

The challenge, he told graduates, is for physicians who enjoy the art of individual healing to take on leadership roles in pushing for community changes to promote health. The challenge is for physicians to realize that their patients include hundreds of thousands of people who need healthier communities if they are to live as well and as long as people in wealthier neighborhoods do, he said.

“That means you have a primary responsibility to be your neighbor’s keeper. I encourage you all to take the responsibility to help get rid of the rats.”