Conversation with Dr. Leonard Syme

Recently, I had the good fortune of spending some time with Dr. Leonard Syme. Dr. Syme is Professor Emeritus at the UC Berkeley School of Public Health and for some time now has been decrying the traditional public health approach that would have experts descending upon stricken communities with “risk factor” based interventions. Indeed, he is quite fond of recounting the failure of his five-year project funded by the National Cancer Institute that attempted to reduce smoking rates in Richmond, California.

“Richmond is a poor city with high rates of unemployment, crime, and drug use. It also has heavy levels of air pollution from nearby oil refineries. At the time, there were few health facilities. And our research team descended on this trou­bled community with a brilliant plan to do a smoking cessation project! It is doubtful that smoking was high on the priority list of people in this community, but our team paid little attention to that.”

Dr. Syme emphatically states that these types of community interventions have not worked in the past and will not work in the future. However, one approach he believes has promise is to involve communities in addressing their own concerns.

“The evidence now shows that no matter how elegantly wrought a physical solution, no matter how efficiently designed a park, no matter how safe and sanitary a building, unless the people living in those neighborhoods can in some way participate in the creation and management of these facilities, the results will not be as beneficial as we might hope.”

In other words, assisting individuals and communities to develop a sense of control over their own destinies, he believes, is an important part of the equation of good health.

Those of us working to improve the health of communities would be wise to consider Dr. Syme’s insights. He has only come to these conclusions after a quarter of a century of study of risk factors and associated interventions. By the way, I don’t think Dr. Syme is necessarily advising us to drop a disease-based focus (e.g., breast cancer, smoking and hepatitis B), but it certainly seems advisable to acknowledge the interests of the communities and to ensure their maximal involvement in their own health.

- Doug Hirano, MPH, APCA Executive Director