Fighting for social and health justice is not what I went to medical school for, but it has now become the driving force behind my work. As the nation's health needs once again take center stage in the new political narrative of 2017, we physicians and other health professionals must not shy away from acknowledging and calling out the elephant, donkey, kangaroo or zebra in the room. To truly protect our patient's health, we must be on the frontlines of advocacy.
Most of us are aware that health is determined by factors--called the social determinants of health--that are beyond the doctor's office and hospital walls. Those factors vary by zip code.
Access to safe neighborhoods, clean parks, quality homes, great schools and well-paying jobs is rooted in and influenced by politics, economics and histories of oppression shaped by the "-isms." This is not to be denied.
Knowing we still have a ways to go, our country has successfully battled some of those "-isms" to advance health. In part, because of pressure from physicians and health leaders who raised their voices to demand not only increased health care access, but also improved public health and human rights.
In the 1800s, for example, it was the persistent advocacy of a New York City physician, named John Griscom, avowing the horrid impact of the city's squalid living conditions and trash-ridden streets on health that spurred one of the most powerful public health movements--sanitation reform. It continues to save lives to this day.
Now, it is crucial for physicians and other health professionals to broaden their advocacy efforts to include public health through the lens of social justice. Without this added perspective, we run the risk of losing hard earned gains in public health as we did last month, when new surveillance data showed that life expectancy dropped for the first time in the U.S. since 1993.
How do we move forward? I suggest four strategies to consider that further our work to advance health and equity:
• Push the public health agenda. Promote and safeguard the public health infrastructure that protects people before they get sick (prevention!) and before they touch the health care system.
Vast and unnoticed, the public health infrastructure is the source of so much that we take for granted--clean drinking water, a safe food supply, daycare centers that are up to code, campaigns for immunizations and against tobacco use, home visiting programs for mothers and their families, interventions to curb the opioid epidemic, gun violence prevention and quick responses to threats such as Zika and Ebola.
Yet, right now, there is an urgent need to replenish the empty Public Health Emergency Response Fund--our defense against the impact of disasters and epidemics. And we must not forget mental health--a core tenet of health. We need increased investments in services as we are doing in New York City with ThriveNYC.
• Expand our physician role to include social change work. Jack Geiger, M.D., a pioneer in the community health center movement in the 1960s in the South said it best:
"As our national health care system continues to evolve, I believe it is time for community health centers to return to those early initial models [of the 1960s] that saw health care as an instrument of social change--partnering with communities to confront the social, economic, environmental, and political circumstances that so powerfully shape the population health status of the disadvantaged and marginalized. Access to good clinical primary care should remain their central contribution, but their task is incomplete without this broader social effort."
• Align with other movements fighting for social and health justice. As physicians, we need to expand our boundaries and become allies with those that are not in our usual spheres of influence and comfort.
Other activists have already recognized the need to fight for better health care. The Movement for Black Lives is calling for equitable health care for all, mental health benefits, paid parental leave and care for children and elders--policies that most health professionals support. Towards the end of 2016, we all witnessed the collective power of stakeholders from different constituencies--students, health professionals, parishioners, veterans, politicians, unions and institutions--who stood together when the health of a community was threatened. They successfully prevented the completion of the Dakota Access Pipeline, a danger to their water supply and health.
• Learn the language of power and privilege, unconscious bias, and the history of structural oppression. Many Americans struggle to engage in conversations about racism and bias related to gender, sexual orientation and religion, often expressing anxiety described well by the Perception Institute. This is a barrier to advancing justice in all corners of our country and at all levels of government. No matter where you are in your career as a health professional, here are several resources to help you get you started: Race-The Power of Illusion, Harvard's Implicit Association Test, Cracking the Code, 13TH, Requiem for the American Dream, and America Divided.
In 2017 and beyond, we must embody the idealism of envisioning the world as it ought to be, instead of what is. We must deploy the pragmatism to seek out justice step-by-step. We must embrace the collectivism to recruit and welcome others to our cause. And lastly, we must display the courage to confront and call out policies, systems and practices that exacerbate the deadly inequities in health.
James Baldwin once said, "Since we live in an age in which silence is not only criminal but suicidal, I have been making as much noise as I can." Let's make as much noise as we can to further the most integral of justices--equity in health.
This was originally posted January 2017 on New York Academy of Medicine's blog.