I hope that future readers of this blog will scratch their heads and wonder why this is news. However, for the time being, it still is, and I hope all of you take the time to read this elegant declaration from Tim Cook echoing John Acton, the 19TH century British historian,

The most certain test by which we judge whether a country is really free is the amount of security enjoyed by minorities

Health is a complex multidimensional construct. We focus, perhaps simplistically, on biological issues, but health in its most important sense is tied to the dignity of our relationships. Here is Tim Cook, as reported by Bloomberg Business Week October 30, 2014.

Throughout my professional life, I’ve tried to maintain a basic level of privacy. I come from humble roots, and I don’t seek to draw attention to myself. Apple is already one of the most closely watched companies in the world, and I like keeping the focus on our products and the incredible things our customers achieve with them.

At the same time, I believe deeply in the words of Dr. Martin Luther King, who said: “Life’s most persistent and urgent question is, ‘What are you doing for others?’ ” I often challenge myself with that question, and I’ve come to realize that my desire for personal privacy has been holding me back from doing something more important. That’s what has led me to today.

For years, I’ve been open with many people about my sexual orientation. Plenty of colleagues at Apple know I’m gay, and it doesn’t seem to make a difference in the way they treat me. Of course, I’ve had the good fortune to work at a company that loves creativity and innovation and knows it can only flourish when you embrace people’s differences. Not everyone is so lucky.

While I have never denied my sexuality, I haven’t publicly acknowledged it either, until now. So let me be clear: I’m proud to be gay, and I consider being gay among the greatest gifts God has given me.

Being gay has given me a deeper understanding of what it means to be in the minority and provided a window into the challenges that people in other minority groups deal with every day. It’s made me more empathetic, which has led to a richer life. It’s been tough and uncomfortable at times, but it has given me the confidence to be myself, to follow my own path, and to rise above adversity and bigotry. It’s also given me the skin of a rhinoceros, which comes in handy when you’re the CEO of Apple.

The world has changed so much since I was a kid. America is moving toward marriage equality, and the public figures who have bravely come out have helped change perceptions and made our culture more tolerant. Still, there are laws on the books in a majority of states that allow employers to fire people based solely on their sexual orientation. There are many places where landlords can evict tenants for being gay, or where we can be barred from visiting sick partners and sharing in their legacies. Countless people, particularly kids, face fear and abuse every day because of their sexual orientation.

I don’t consider myself an activist, but I realize how much I’ve benefited from the sacrifice of others. So if hearing that the CEO of Apple is gay can help someone struggling to come to terms with who he or she is, or bring comfort to anyone who feels alone, or inspire people to insist on their equality, then it’s worth the trade-off with my own privacy.

I’ll admit that this wasn’t an easy choice. Privacy remains important to me, and I’d like to hold on to a small amount of it. I’ve made Apple my life’s work, and I will continue to spend virtually all of my waking time focused on being the best CEO I can be. That’s what our employees deserve—and our customers, developers, shareholders, and supplier partners deserve it, too. Part of social progress is understanding that a person is not defined only by one’s sexuality, race, or gender. I’m an engineer, an uncle, a nature lover, a fitness nut, a son of the South, a sports fanatic, and many other things. I hope that people will respect my desire to focus on the things I’m best suited for and the work that brings me joy.

The company I am so fortunate to lead has long advocated for human rights and equality for all. We’ve taken a strong stand in support of a workplace equality bill before Congress, just as we stood for marriage equality in our home state of California. And we spoke up in Arizona when that state’s legislature passed a discriminatory bill targeting the gay community. We’ll continue to fight for our values, and I believe that any CEO of this incredible company, regardless of race, gender, or sexual orientation, would do the same. And I will personally continue to advocate for equality for all people until my toes point up.

When I arrive in my office each morning, I’m greeted by framed photos of Dr. King and Robert F. Kennedy. I don’t pretend that writing this puts me in their league. All it does is allow me to look at those pictures and know that I’m doing my part, however small, to help others. We pave the sunlit path toward justice together, brick by brick. This is my brick.

Is your city healthy? Ask your MD!

Screenshot 2014-02-09 23.41.09The Feb edition of The Lancet, ran an editorial calling on physicians and architects to lay the foundation for improved health in the urban setting. The complete article is available freely HERE

This is one more link in the chain of argument started by Michael Marmot who looked at civil servants in the UK starting in the 70’s. His work in this area, now collectively known as the White Hall Studies clearly and elegantly documented the relationships between social status and health. His famous 10 year study of British civil service workers found that the lowest class workers (doormen, messengers etc.) had mortality rates three times that of the highest social class of administrators. Unsurprisingly, smoking, obesity, sedentarism, and high blood pressure were more common in the lower classes, but even when accounting for these risk factors, the lowest class developed complications of CHD over 2 times more than the highest class over the decade of the study.

Many theories were postulated to explain this finding, and in the ensuing decades the picture of what determines health has become even more fuzzy. It turns out that pollution, noise, social inequality, your neighbourhood, unemployment, and a host of other factors impact on our health. This too would not surprise too many MDs. However, what is surprising to all of us, is just how “off the radar” such issues are, and how man made they are at the same time.

The UK is the birthplace of population models of health, and of social determinants of health; and It is not surprising that they set the pace in promoting healthier populations through better urban design. What I find most compelling though is that the article was a lead editorial in one to the leading medical journals of the land, and it will be interesting to see the response of the medical community. This is, after all a lateral attack on the health industry: a domain that was, once upon a time, all biomedical, and has only in recent years  flirted uncomfortably with behavioural issues (cigarettes, obesity, diet, exercise, etc.). As a group, us docs have had a hard time figuring out how to deal with behavioural issues, but perhaps that struggle will prepare us all the more to accept urban design as yet another important determinant of our patient’s health.

There is a silver lining hidden in this story, and the editorialist underscores this  by calling on architects and physicians to mobilize together for healthier communities. Health is so complex that great success requires that it become a priority for professionals, and bureaucrats at all levels of the society.

Ahhh …  (hugh sigh of relief). Health promotion is not our job after all – it is everybody’s job. Thanks to the the UK and the Lancet for reminding us to think outside our box.