Addressing Social Justice Through Healthcare

by Wyatt Bensken

In the past few years, the United States’ problem of pervasive racism has been exposed in some of the most tragic ways possible: police brutality resulting in the loss of life of young African Americans. This issue has been pressed to the forefront of the news, and individuals everywhere are having to step-up and respond to these social justice issues. The medical and public health communities are no exception, and while public health is a discipline known to serve all communities, medical care is often polarizing — with the rich white receiving the best care and poor minorities receiving little to no care, resulting in far worse health outcomes. In one case, residents in poor areas of Baltimore are reported to have a life expectancy that is 20 years lower than residents living within wealthier neighborhoods. It becomes clear that all of these social justice issues are linked, and that the incidents of gun-violence and institutional racial inequality we see on the news are the tragic representation of a society of disparities, which extends into our healthcare system.

An article in The New England Journal of Medicine published on November 19th of this year details how the medical community is responding. The team of physicians from Johns Hopkins Bayview Medical Center explains how, since 2011, their medical residents (students who have graduated from medical school and are training in their discipline) have been studying and developing curriculum for a program they have termed Medicine for the Greater Good (MGG). This curriculum comprises 12 one-hour workshops focused on key social justice issues. The idea for these lesson plans stemmed from the fact that physicians can no longer simply treat the symptoms in front of them, but must treat the whole patient. A key model that addresses this whole-patient concept, in the field of public health and healthcare, is the socio-ecological model.

The socio-ecological model of health addresses the determinants of someone’s state of health, and the potential causes of a disease. Its foundation is the individual — the patient sitting in front of the doctor — but the model expands to take into account interpersonal, community, and policy aspects. In healthcare today, the individual and these greater dimensions of their life are oftentimes accounted for. The healthcare worker will ask about the patient, but also about their family, friends, partners, etc. Too often, however, this is where the conversation ends, although there are three more components to the model. This article is going to address the next step: community. An individual’s community is a key determinant of health and understanding the community, and aspects of that community, are vital to helping the individual. Indicators can range from access to healthcare, healthy food, safe spaces to exercise, and more. By treating the symptoms without taking into account these other components of health is in a sense only providing a temporary fix for a problem that is likely to reemerge.

So what needs to be done to better equip healthcare workers to treat the person, and not just the symptoms?

In my opinion I believe that frameworks such as the socio-ecological model of health should be integrated as a key educational component for healthcare workers at all levels. An anecdote I have come to use is that healthcare workers can give someone the medication they need and instruct them to take it three times a day with food and water, but will rarely ask if that individual has access to three meals a day and clean, safe, drinking water. The socio-ecological model of health better trains healthcare workers to understand that there are key components to health that are outside of the control of the patient, but that play a major role in their life.

Healthcare workers are individuals who spend their entire lives having tough and sensitive conversations with people, and trying to do so in a respectful and understanding manner. Unfortunately, these conversations tend to focus more on the disease symptoms rather than on the challenges the person may face to reach a better state of health.

A positive sign of change is that the Accreditation Council for Graduate Medical Education is now requiring that all medical residency programs address health disparities, which is a very strong step in the right direction.

I believe that by expanding health workers’ education, training, and scope of work to place a strong emphasis on the community, we will not only see an improvement in individuals’ health outcomes, but we will also start to see an increase in health equity. By addressing this social justice issue, I believe we, as a society, will be one-step further in tackling the huge disparities that exist in our communities. Disparities healthcare workers can, and should be, at the forefront of.