South Carolina's failure to reduce the state's deep, generational disparities in education and economic opportunity play out every day in the state's hospitals.
Health officials consider obesity the No. 1 health problem in a state were two thirds of adults are overweight or obese.
But the president of the state's premier hospital doesn't see it as an entirely medical issue.
To Ray Greenberg, it's a historical and social issue that manifests itself across South Carolina in “a complex web that leads to people getting sick.”
He motioned over his shoulder toward MUSC's Children's Hospital. He's proud of the hospital's skill in healing children. But, he says, that's the expensive way to fix health problems that could be prevented with better prenatal care and a healthy lifestyle.
“As a society we're willing to spend a fortune on saving a life. The irony of prevention is that the better it works, the less visible it is,” Greenberg says.
People have to be taught that unhealthy lifestyles lead directly to many of the state's ills and chronic medical problems. “You can't just go to the doctor and solve the problem, if they continue to live in a substandard environment.”
“A danger is in treating it as a purely medical phenomenon,” he says.
As a result, Greenberg has pushed MUSC to focus not just on treating people's illnesses, but also on changing the “social determinents of health ... to create a healthy population.”
Two such efforts by MUSC received a major booster shot in 2011 when Boeing gave the Children's Hospital a $1 million grant to combine and expand a program to reduce childhood obesity with one to improve heart health in children and young adults.
The combined program, called The Boeing Center for Children's Wellness, works extensively with the Charleston County School District, where a recent MUSC study found that 43 percent of the children were overweight or obese, along with 70 percent of their teachers.
Dr. Janice Key, a director with the center, says Type 2 diabetes in children can have devastating, lifelong consequences. “You see children with blood vessels equivalent with those of a 55-year-old.”
To help combat that, her program worked with the Charleston County School District to perform body-fat screenings and to incorporate anti-obesity and wellness awareness into daily school life.
In addition the MUSC team worked with the school district to make healthier school meals for children, especially those from poor families who don't eat balanced diets.
“They eat two meals a day at school, so if we change what they eat at school, we have changed their nutrition,” Key says.
Zachery Kronsberg gave the MUSC program credit for helping him lose weight. The 12-year-old attended exercise sessions at The Citadel supervised by Boeing Center trainers.
“Working out and being active makes me feel better than sitting on the couch,” Zachery says.
But he confessed that he needs the program to keep at it “because I'm very interested in staying on my couch.”
Coleen Martin, a program manager with the Boeing Center, says so many children, especially from poorer communities, have no idea they are overweight or obese, or that it poses a threat to their health.
They look like many, or most, of their friends and the adults they know.
“They think they are normal.”
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