On activism
Should Clinicians Be Activists?
Kristen N. Pallok, MD and David A. Ansell, MD, MPH
https://journalofethics.ama-assn.org/article/should-clinicians-be-activists/2022-04
This articles uses a case and commentary based approach to this question. The case illustrated is that of an undocument uninsured child requiring transplantation for end-stage renal failure.
The article makes several interesting suggestions
It describes competencies for 'social medicine'
It suggests that there is a moral obligation for doctors to practice 'social medicine'
These competencies can be developed into a curriculum for medical education, support commissioning and improve healthcare delivery.
The competencies for social medicine
Structural competencies
Structural competency teaches physicians how social, political, and economic determinants of health cause illness
recognizing how structures like forms of marginalization shape clinical encounters
developing a language of these structures (reducing epistemic injustice)
rearticulating ‘cultural’ formulations in structural terms
envisioning structural interventions
developing structural humility (the awareness that professionals must be led by the community to solve problems)
Allyship
Allyship is an intentional practice in which persons in positions of privilege and power build authentic relationships with marginalized groups in order to address unjust power structures.
https://en.wikipedia.org/wiki/Allyship
Accompaniment
'an ethical value expressed in actions of pragmatic solidarity with the community'
It is a deeper form of involvement in which the doctor is present with the individual or community towards health equity.
Activism
'Activism requires health professionals to publicly leverage their privilege for social change. In this case, activism meant showing up at demonstrations at the transplant centers, convening meetings with the demonstrators and transplant leaders, and being vocal supporters for the petitioners in the media and in dialogue with political leaders'
Uses
Health equity
Deep End issues
Climate change & sustainable health
Adverse childhood events & trauma informed care
Suggested steps for social medicine
Practice structural competency by speaking out about health injustice.
Engage with the community: 'nothing about us without us'
Use narrative: Narrative + Data + Action = Change
Leverage public policy to create social change
Related ideas
Social determinants of health
https://www.who.int/health-topics/social-determinants-of-health#tab=tab_1
The social determinants of health (SDH) are the non-medical factors that influence health outcomes. They are the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life. These forces and systems include economic policies and systems, development agendas, social norms, social policies and political systems.
The SDH have an important influence on health inequities - the unfair and avoidable differences in health status seen within and between countries. In countries at all levels of income, health and illness follow a social gradient: the lower the socioeconomic position, the worse the health
Health inequalities
https://www.cdc.gov/chronicdisease/healthequity/index.htm
Health equity is achieved when every person has the opportunity to “attain his or her full health potential” and no one is “disadvantaged from achieving this potential because of social position or other socially determined circumstances.” Health inequities are reflected in differences in length of life; quality of life; rates of disease, disability, and death; severity of disease; and access to treatment.
Commercial Determinants of Health
'Commercial determinants of health (CDoH) are the private sector activities impacting public health, either positively or negatively, and the enabling political economic systems and norms'
https://www.who.int/health-topics/commercial-determinants-of-health#tab=tab_1
Helen Salisbury: The commercial determinants of health
BMJ 2022; 378 doi: https://doi.org/10.1136/bmj.o1704 (Published 12 July 2022)