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  • Viewpoints

    Academic Medicine and Social Justice

    Dr. Darrell G. Kirch
    Darrell G. Kirch, MD

    I have been reflecting on the recent events in Ferguson, Mo., and Staten Island, N.Y., and the resulting national conversation about interactions among minority communities and the police. Both deaths were avoidable tragedies that should have sparked serious and productive dialogue to address the underlying social issues. Like many of you, I was disheartened when, instead, strident, competing narratives developed in the wake of these events—with people often talking past one another. I am no better positioned than anybody to adjudicate the facts of what happened in Ferguson or on a street corner in Staten Island—responsible people with good intentions can interpret the same events in very different ways. It should be possible to acknowledge the difficult and dangerous work that police officers do to make our communities safer, while also recognizing that communities with high rates of poverty face barriers to fair outcomes within our justice system. But when our only dialogue is with people who share our own background and outlook, I worry we have lost the ability to put ourselves in one another’s shoes.

    For that reason, in the midst of competing narratives, I was pleased to see so many of our medical students make their voices heard in a peaceful and powerful way, sparking dialogue rather than division. Hundreds of medical students, faculty, and staff from every race, class, and background at more than 80 institutions nationwide participated in the “White Coats for Black Lives” movement, donning their white coats and staging on-campus “die-ins” to express their concern about the deaths of Eric Garner and Michael Brown. They joined a long tradition of social activism in academic medicine, from the medical students who participated in the Civil Rights movement, to the medical schools and teaching hospitals that have opened their doors to DREAMers with Deferred Action for Childhood Arrival status. Our institutions and learners have been on the front lines not only in times of natural disaster or sudden crisis but also in periods of social upheaval.

    “As doctors, our ethics are tested every day of our careers—not only in the care decisions we make but also in how we speak to and about our patients, in how we interact with our colleagues and learners, and in the steps we take to help those in our communities live healthier, longer lives.”

    With the White Coats for Black Lives movement, medical students again have underscored the link between health care and social justice. When the Centers for Disease Control and Prevention reports 56,000 violent deaths each year in the United States, we face a serious public health crisis. The problem of violence, as with other health disparities, disproportionately impacts communities with high poverty rates. As community healers and leaders, we must do our part to address the systemic issues relating to inequality, social exclusion, racism, and bias that all too often are linked to the problem of violence in our society.

    The AAMC has developed a robust research initiative in health equity to support our medical schools and teaching hospitals in identifying practical solutions to improve the health of their communities. We recently launched a series of Health Equity Research Virtual Site Visits, which highlight the research, innovative care solutions, and best practices that medical schools and teaching hospitals are implementing to address health inequity in their communities. The AAMC health equity research team also undertook a recent study into the Affordable Care Act’s Community Health Needs Assessment (CHNA) requirement for nonprofit hospitals, which illuminates the ways in which the CHNA can be a useful tool for improving community health and engaging our learners in efforts to ameliorate negative social determinants of health. We also offer workshops for our constituents to help them understand how unconscious biases develop and how they can influence perceptions, decision making, education, and patient care.

    But there is still more to do. As the training ground for our nation’s doctors, we have a unique opportunity and a critical responsibility to produce a health care workforce that both understands the social determinants of health and will meet the needs of our increasingly diverse population. When our physician workforce reflects the diversity of our communities, we will be better prepared to meet the needs of all patients in their most vulnerable moments. Initiatives like the Summer Medical and Dental Education Program, sponsored by the Robert Wood Johnson Foundation, increase the pool of students from diverse or disadvantaged backgrounds pursuing careers in health care. In admissions, we must prioritize holistic review and approach the process with the understanding that effective physicians require a broad sociological knowledge base, not just strong test scores in biology and chemistry. Changes in the new Medical College Admission Test® (MCAT®), introduced in April 2015, were made in recognition that effective physicians need to understand the critical roles that behavioral and sociocultural factors play in health and illness. And in the classroom, we need to develop strong social medicine curricula that avoid reinforcing stereotypes and teach our students the true issues underlying poverty, education, unemployment, and access.

    Social justice is a core tenant of medical ethics. By donning their white coats and declaring that black lives matter, medical students embodied the principles of trust and humanistic care that the white coat represents. As doctors, our ethics are tested every day of our careers—not only in the care decisions we make but also in how we speak to and about our patients, in how we interact with our colleagues and learners, and in the steps we take to help those in our communities live healthier, longer lives. Our medical students have shown themselves to be empathic, engaged, and resilient in the face of deep-rooted social problems. They give me hope that we can find our way back to dialogue and to working toward solutions to our most entrenched social problems.

    This commentary originally appeared in print in the February 2015 issue of the AAMC Reporter.