Why Social Justice Belongs in Medical Education

Richard Brach '23
Richard Brach ’22

Written by Richard Brach ’22

The well-being of a country’s children is an important measure to track, as poverty in early years can have long-lasting consequences on children’s performance in school and their adult health status (1). The United States is considered one of the wealthiest countries in the world, but we have childhood poverty rates that are some of the worst. When compared to other countries with similar gross domestic products in a recent State of the World’s Children Report, the United States ranked 34/35, only ahead of Romania (2). Things look more grim when you look at childhood poverty by race in the U.S,: one in three Native American, one in four black and Hispanic, and one in nine white children (3) live in poverty. To get a better idea of where we stand today and how best to proceed, we need to come to terms with how we got here.

Our nation has a deep history of racism and inequality. This country was built on the backs of slaves after which decades of lynchings, Jim Crow laws, and legal harassment crushed the possibility of upward mobility for African Americans. One example: 98 percent of the $120 billion in federal home loans distributed between 1933 and 1962 went to white homeowners, excluding African Americans from economic opportunity (4). This kept money and power in the hands of white Americans. Even after legislation banned discrimination in housing loans in 1968, the stage of structural racism was already set, permeating every aspect of our culture. In schools, African American students are suspended and expelled three times more often than white students, which is fueling the school-to-prison pipeline and mass incarceration (5). There are now more African American men in prison than there were enslaved in 1850 (6).

Health care and STEM research are not immune to these challenges. We have a dark history of subjecting marginalized communities to cruel treatment and punishments. Most people are familiar with the Tuskegee Syphilis Experiments between 1932 and 1972 in which the U.S. Public Health Service knowingly withheld treatment from hundreds of African Americans that had contracted syphilis in order to study the progression of the gruesome disease. Even in Vermont, where we’re so proud of being the first state to abolish slavery, we have a racist history of eugenics, in which healthcare professionals forcibly sterilized Abenaki Indians between 1930 and 1957 (7). We need to recognize that we, as current and future health care professionals, are just as fallible as anyone else.

Now, it’s no wonder that there are huge health disparities in these communities that our nation has abused for decades. Native Americans have the highest rates of suicide in the country among ethnic groups.  More than 200 African Americans die prematurely every single day (9, 10). Practicing medicine without recognizing this social context perpetuates the structural violence in our society.  To blame these health disparities on biological differences or personal choices is unacceptable, and completely ignores the oppression and injustice of the past and present.

The “Social Medicine Theme of the Week” – developed through a partnership between the College’s Social Justice Coalition, faculty, and medical education leaders – encourages students to think about these concepts throughout their medical education. Our student-led coalition connected with the College’s Office of Diversity and Inclusion and Office of Medical Student Education on this effort to integrate social justice topics into the curriculum.

During our Attacks and Defenses course, we brainstormed with faculty, including course director Bill Raszka, M.D., ways to weave the theme “Toxicology and Environmental Justice” into our classes. In small groups during the Professionalism, Communication and Reflection course, with leadership from course director Shaden Eldakar-Hein, M.D., we discussed the negligence that lead to the water crisis of Flint, Michigan and Dr. Hanna-Attisha’s advocacy that brought national attention to the fact that she was finding dangerously high levels of lead in child after child at her clinic.

Then, in our toxicology class, we worked through a case where the parents brought in a girl to the emergency department with carbon monoxide poisoning. When we discussed what to tell the child’s parents, our responses were all focused on the girl’s health and her prognosis. While we were pretty satisfied with how well we recalled how carbon monoxide impairs tissue oxygen delivery and needs to be treated with 100 percent oxygen, Dr. Raszka, told us that we had all overlooked the most important issue: Where was the carbon monoxide leak and who is in danger of being exposed to it as we speak? We need to remember to see patients not just as the clinical vignettes on our exams or another case of diabetes in our clinics, but as complex human beings within the context of society. Only then will we be able to help rebuild trust in communities that have been historically harmed and serve as advocates for those that need it the most.

 

Works Cited

  1. Smeeding, Timothy, and Céline Thévenot. “Addressing Child Poverty: How Does the United States Compare With Other Nations?” Academic Pediatrics, vol. 16, no. 3 Suppl, Apr. 2016, pp. S67–75. PubMed Central, doi:10.1016/j.acap.2016.01.011.
  2. Fisher, Max. “Map: How 35 Countries Compare on Child Poverty (the U.S. Is Ranked 34th).” The Washington Post, WP Company, 15 Apr. 2013. Accessed 2 July 2019.
  3. Child Poverty in America 2017 National Fact Sheet.
  4. Adelman, Larry. “Racial Preferences for Whites: The Houses That Racism Built. Race: The Power of an Illusion, 29 June 2003,
  5. School-to-Prison Pipeline [Infographic].” American Civil Liberties Union.
  6. Mulvaney, Katie. “Brown U. Student Leader: More African-American Men in Prison System Now than Were Enslaved in 1850.” Politifact, 7 December 2014.
  7. Vermont.” Vermont Eugenics.
  8. Arias, Elizabeth. United States Life Tables, 2016. p. 66.
  9. Curtin SC, Hedegaard H. Suicide rates for females and males by race and ethnicity: United States, 1999 and 2017. NCHS Health E-Stat. 2019.
  10. Williams, David R. “Why Discrimination Is a Health Issue.” RWJF, 12 June 2019.

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