Act justly, love mercy
Most readers of this newsletter will probably be familiar with the famous words of the Old Testament Biblical prophet Micah, ‘He has shown you, O mortal, what is good. And what does the LORD require of you? To act justly and to love mercy and to walk humbly with your God.’1 I have an illustrated batik with this verse printed on it in the hallway of my house, as an ever present reminder of my calling and privilege as a Christian.
It is encouraging then to read a recent paper in Academic Medicine entitled, ‘Teaching the Social Determinants of Health: A Path to Equity or a Road to Nowhere?’2 In it the authors argue that medical schools are increasingly called to include social responsibility in their mandates and are focusing their attention on the social determinants of health (SDOH) as key drivers in the health of the patients and communities they serve. However, they say, underlying this emphasis on SDOH is the assumption that teaching medical students about SDOH will lead future physicians to take action to help achieve health equity. There is little evidence to support this belief. In many ways, the current approach to SDOH within medical education positions the SDOH as "facts to be known" rather than as "conditions to be challenged and changed”. Educators talk about poverty but not oppression, race but not racism, sex but not sexism, and homosexuality but not homophobia. The authors say the current approach to SDOH may constrain or even incapacitate the ability of medical education to achieve the very goals it lauds, and in fact perpetuate inequity.
They go on to explore how "critical consciousness" and a re-centring of the SDOH around justice and inequity can be used to deepen our collective understanding of power, privilege, and the inequities embedded in social relationships in order to foster an active commitment to social justice among medical trainees. Rather than calling for minor curricular modifications, the authors argue that major structural and cultural transformations within medical education need to occur to make educational institutions truly socially responsible. (So for example, teaching about the influence of poverty on health might change so that the questions students have to answer change from, ‘can you describe the influence of poverty on health?’, to, ‘how will you as a socially responsible physician-citizen address the issues of poverty causing ill health in your practice?’) PRIME has always sought to ensure that our teaching goes beyond knowledge acquisition to attitudinal and behavioural change. Our focus has primarily been on encouraging individual healthcare professionals to practice in a compassionate, holistic, person-centred way. However, addressing the SDOH very quickly becomes necessary for this to happen, and so is something that is increasingly on our agenda.
How is it where you work? Does the teaching of SDOH focus only on knowledge (‘facts to be known’), or does it go beyond this to help prepare young professionals to invest themselves in working to redress the gross inequities in our broken healthcare systems, so that the poor and marginalised are served with the justice and mercy that all human beings deserve?
Huw Morgan
References:
1. Micah 6 v 8 New International Version, Bible
2. http://journals.lww.com/academicmedicine/Abstract/publishahead/Teaching_the_Social_Determinants_of_Health___A.98221.aspx
