I still beg to differ with Heather Welford Neil's comment that the health
care system cannot overcome inequities in the health care system. I have
seen many health care systems that do have an impact on very low
Socioeconomic Status individuals AND improve their nutrition.  This in it of
itself can improve SES as the health of these populations improve.

To give you a marvelous example of how social networks can be built through
a health care system - just look at the wonderful work done in Tanzania as a
collaboration between the Swedes and Tanzanians.  They did growthing
monitoring right.  They put into place community groups that worked through
the problems themselves.  AND this not only improved nutrition, it improved
the social networked in that area.

Many many nutrition projects have had success in raising women's income.  To
give an example of a project to improve vitamin A deficiency, mothers were
helped to grow varieties of sweet potatoes that were richer in vitamin A.
Again, this project was done properly.  The women were consulted and picked
the varieties that were less susceptible to disease.  They then increased
their income because they got into groups and discussed marketing and began
selling sweet potato pancakes, a big hit.

Another nutrition project was conducted on a large scale in Bangladesh with
many many local NGOs.  These NGOs worked on gardening for low income women.
 These women became leaders and worked with other women in their villages.
They increased the variety, quantity and quality of the vegetables they
grew.  They increased their income AND also vitamin A deficiency rates declined.

Finally, just take a look at Paula Meier's work. Which where the women that
actually had the biggest increase in breast milk doses to their premie
infants?  The African American women.  The same group that supposedly cannot
be touched by our health care system.

Also, there have been studies that show that race alone (not just SES) has
an impact on the type of care provided by health care practitioners.

I'm sorry, but the research does not support the fact that health care
systems can only have minimal impact, by themselves on health outcomes.  It
is the very fact that there is no effort in some places to reach the poor
that they have worse health.  For over 20 years I've worked in developing
countries and I can assure you, when it is done right, health care systmes
can have a huge impact on the very poorest of the poor and improve their SES.

Susan E. Burger, MHS, PhD, IBCLC

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