Why Your Doctor Should Care About Social Justice

It seems we’ve all been thinking deeply about race and racism in the United States. My interest in public health stems from a desire to work towards equity and justice.

One of my favorite TEDTalks is by Mary Bassett: Why Your Doctor Should Care About Social Justice.  Dr Bassett is the Health Commissioner for NYC and a long time health activist.

As you may know, I worked for several years at Partners In Health (and am working there on the COVID response now) and so appreciated her nod to the work of Paul Farmer when she says:

“But I knew that epidemics emerge along the fissures of our society, reflecting not only biology, but more importantly patterns of marginalization, exclusion, discrimination related to race, gender, sexuality, class and more. It was true of AIDS. It was true just recently of Ebola. Medical anthropologists such as Paul Farmer, who worked on AIDS in Haiti, call this structural violence: structural because inequities are embedded in the political and economic organization of our social world, often in ways that are invisible to those with privilege and power; and violence because its impact — premature deaths, suffering, illness — is violent. We do little for our patients if we fail to recognize these social injustices. Sounding the alarm is the first step towards doing public health right, and it’s how we may rally support to break through and create real change together.”

She ends her talk with this statement:
“Our role as health professionals is not just to treat our patients but to sound the alarm and advocate for change. Rightfully or not, our societal position gives our voices great credibility, and we shouldn’t waste that.”

Videos like this can be great ways to spark ideas among your team members. What if you showed this video to your team and had a conversation about it?

Here are a few questions that may help to spark conversation:
  • What do you think your individual role is in addressing the social issues that accompany illness?
  • What do you think our collective role is in addressing the social issues that patients experience?
  • Have we pushed the envelope far enough as an organization to ensure that we are using our positions of power to advocate for patients and families?

Social Medicine

I am so excited for this year’s Social Medicine Consortium Third Annual Conference, Sharing Strategies for Health Equity. It is going to be held in Gallup and it is not too late to get tickets for next week’s’ events. You can find out more and register here

Photo of Camara Jones who discusses the allegory of race and social medicine.
Camara Jones

Folks, Camara Jones will be there! Camara Jones! If you haven’t seen her talk on the Allegory on Race and Racism, it is simply amazing and an even more amazing resource for communicating complex issues around the effects of racism. 

What is social medicine?

What IS social medicine, you may be asking…it is the “belief that inequity kills, and that together we can achieve health equity by constructing systems that demand justice, recognizing our global interconnectedness, and supporting the next generation of health professionals.” 

To help you share in my excitement–here is a wonderful talk that Joia Mukherjee, the Medical Director at Partners In Health, gave about a year ago at a Social Medicine Symposium at the University of Minnesota. 

Her impassioned talk is a great reminder to “reimagine” the social factors behind health and wellbeing and to examine the social inequality as a risk factor for disease. 

Social Medicine Discussion Questions:

Do you have time in the upcoming week in your team meeting to watch her talk with your team? Here are a few discussion questions that might spark an interesting conversation with your team and to push the social-justice-envelope:

How would you define social medicine and how it impacts health and health care?

Joia talks about how she dislikes the term “social determinants of health”. What are your thoughts on the term and on her distaste for it? 

How does your work “reimagine social medicine”?

What else could you do to ensure that we are considering the social issues that are behind our work?

Are there structural violence structures that are we actively fighting with our work? What structural violence should we consider more actively in our work?

The social justice elements behind our global health work motivates me tremendously.  At times, of course, the day-to-day tasks of our work can make it harder to give due diligence to our work as advocates and activists and as seekers of social justice. For me, this video is a nice reminder! 

Let’s stand together…

PS: If you are interested in learning more about how doctors can fight for social justice, read more here.

Book Report: Pathologies of Power

I read it so you don’t have to.

Picture of the cover of the book Pathologies of Power, by Paul Farmer, in which he writes about the "preferential option for the poor". The cover depicts two children, side-by-side, leaning on a wooden structure with a wooden beam between them.
Pathologies of Power
Pathologies of Power outlines what Partners In Health means when it talks about striving to create a “preferential option for the poor in healthcare.”
In its origins, the concept was connected with the the liberation theology movement of the mid-20th century. The option for the poor was first articulated by Father Gustavo Gutiérrez in his book A Theology of Liberation. Gutiérrez writes that the principle is rooted in both the Old and New Testaments. He claims that a preferential concern for the physical and spiritual welfare of the poor is an essential element of the Gospel. For Partners In Health, this principle translates into providing healthcare services to the most impoverished people and communities within a country. For example, when Partners In Health started working in Malawi, they chose to work in Neno. Neno, at that time, was a rural and fairly inaccessible community. Those who follow this principle work in solidarity with the most impoverished people to create social justice. Through the work of Partners In Health the community has begun to flourish.

Preferential Option for the Poor

For many years, PIH shared Pathologies of Power Chapter 5 with new employees as it calls upon public health practitioners to be community-based, patient-centered and open towards others: to “observe, judge, act.”

Reflection questions

Dr. Farmer borrows the social justice framework from liberation theology. The framework emphasizes our collective responsibility to fight alongside community partners for liberation from social, political, and economic oppression/structural violence.
What do you think of this approach?
Gutiérrez wrote his book in 1971. Are the principles still relevant?
Is there anything problematic about this framing?