The lead contamination crisis in Flint, Michigan, garnered national attention and is a stark reminder that populations and communities in our own country suffer from environmental and occupational health issues--often coupled with environmental racism.
It’s a statistical fact: people who live, work, and play in Americas' most polluted and threatening environments are commonly people of color and the poor. Our environments—both natural and built—are significant determinants of health. Yet, the AAMC’s 2013 survey of medical school graduates found that more than one-third of respondents said they received “inadequate” instruction in environmental health.
The academic medicine community can take great pride in the role that Dr. Mona Hanna-Attisha, director of the pediatric residency program at Michigan State University College of Human Medicine’s Hurley Medical Center in Flint, has played in exposing the lead poisoning in Flint's water. But what about our own communities and populations?
Whether poor air quality, exposure to dangerous chemicals, climate abnormalities, workplace risks, substandard food-safety practices, or other environmental factors, all our service areas are susceptible to forms of environmental threats. Is there an elevated role for academic medicine in challenging and reducing environmental injustice?
A panel will detail their own experiences and suggest ways medical schools and teaching hospitals can ensure that current and future health care professionals recognize and work to eliminate these risks.
Dr. Paul Kalanithi was a successful neurosurgery resident at Stanford and a loving husband when he was suddenly diagnosed with advanced lung cancer. He died two years later at the age of 37, soon after his infant daughter was born. His critically-acclaimed memoir, When Breath Becomes Air, debuted at #1 on the New York Times best-seller list in 2016 and has moved both the medical and literary worlds with its honest and heart wrenching exploration of mortality and how, in Paul’s words, coming face to face with your own death changes both nothing and everything.
Paul’s widow, Dr. Lucy Kalanithi—an internist at Stanford who wrote the book’s stunning epilogue—speaks with eloquence and compassion about the writing of When Breath Becomes Air, the power of literature to illuminate the human condition, and the book’s compelling message about living a meaningful life. She reflects, too, on her own experience: standing alongside her husband, shepherding his book to publication after his death, and now—as a physician and widowed mother—carrying the book forward as it finds its place in the canon of books on mortality.
Initiatives to increase minority representation in medical schools, including affirmative action and pipeline programs, were originally implemented to counterbalance the systematic disadvantage faced by minority students, due to the legacy of exclusion, discrimination, and segregation that tilted the playing field in favor of whites. Beginning in the 1970s, court rulings forced a shift in the goal of these initiatives from leveling the playing field to promoting the benefits of diversity. This shift in focus from equity to diversity detached affirmative action policies from their original intent and weakened their foundation. It diluted the focus on race as but one of myriad characteristics contributing to diversity and caused confusion and doubt about the role of affirmative action even among its proponents. This presentation will argue for reviving the equity rationale for increasing minority representation in medical schools, based on:
In his landmark treatise, The Structure of Scientific Revolutions, Thomas Kuhn asserted that scientific progress is not gradually cumulative but occurs in revolutionary fits and starts that punctuate longer steady-state phases of "normal science." These paradigm shifts follow periods of turmoil, uncertainty and angst.
Sixteen years into the 21st century, we keep trying to solve healthcare's present puzzles using the twentieth century's normal science. As a result, low value care, discontent, inequities, and burnout are rampant. We pay more for worse outcomes. Health systems ignore programs proven to help patients and save money. Student debt drives specialty choice. Doctors forced to tend screens, not patients, are quitting medicine in unprecedented numbers. Yet we all continue to believe in our mission.
This is what a crisis looks like.
Using stories, case studies, and data, Dr. Aronson will instruct attendees to reexamine their underlying assumptions and explore alternative frameworks and strategies.
According to Kuhn, progress is achieved when we accept that the current paradigm is inadequate and reject it. Revolution occurs when enough people reject the prevailing heterodoxy and embrace a new one.
It's time for a revolution.
This session is presented by The Arnold P. Gold Foundation and the AAMC.
Author of three best-selling novels (Oxygen, Healer, and Gemini), Carol Cassella, MD, believes that being a doctor is a huge privilege. “By getting insights into people’s lives that are very different from their own, physicians work across many tiers of society on a very profound, personal level. But those insights also come with a price—it's easy to take the inevitable stresses from treating patients home with you.”
A number of physicians have turned to the humanities as a way to balance the everyday pressures. For Dr. Cassella, weaving stories of patients, science, health care, and caregivers has given her a voice and an outlet for her exceptional storytelling abilities. In this session, Dr. Cassella will discuss how she came to her dual role of fiction author and practicing anesthesiologist, what writing has meant to her, and how she encourages all doctors to find their own voice and avocation.
It has become increasingly clear that health is the product of a person’s underlying biology and his or her environment, as shaped by family, community and social, cultural, economic, physical, and policy factors. Precision medicine- though not yet fully specified, is the rapidly emerging practice of delivering healthcare tailored to patient-specific factors that contribute to disease risk, prognosis, and treatment response. Research that integrates determinants of health at multiple levels and across the life span holds promise for improving our ability to predict the occurrence of disease and to devise better interventions. This vision underlies the Initiative in Precision Medicine (PMI) launched by President Obama in his January 20, 2015 State-of-the-Union address.
To maximize the benefits and applicability of precision medicine–driven interventions to all communities, NIH has called for the accrual of a diverse sample of 1 million Americans to contribute genetic, clinical, behavioral and social data. However, the PMI, as well as genetic research and biobanking in general, poses several potential risks, as well as benefits, for American Indian and Alaska Native communities.
Well-publicized conflicts between tribes and researchers such as the Arizona Board of Regents v. Havasupai Tribe lawsuit, have raised tribal governments’ awareness of the need to regulate research and related activities, such as biobanking. The National Congress of American Indians urges tribal governments to consider questions of data sharing, control, and access. Questions such as, Who owns the specimens and data?, Who should be able to access the data? Will the results stigmatize my community? and What strategies can Native communities use to restrict access to sensitive biospecimens and personal data? These concerns, while universal, may be especially important for Native people, because addressing their health disparities relies, in part, on identifying biological risk factors and their interaction with environmental risks.
This session will present an overview of PMI and the varied perspectives of Native researchers and their community partners about precision medicine, biobanking, and contributing data to the 1 million American cohort.
Dr. Jones presents a Cliff Analogy for understanding three dimensions of health intervention: providing health services, addressing the social determinants of health (including poverty and neighborhood conditions), and addressing the social determinants of equity (including racism and other systems of structured inequity). She then turns her focus to a discussion of racism as a social determinant of equity and a root cause of "racial"/ethnic differences in health outcomes.
Dr. Jones defines racism as "a system of structuring opportunity and assigning value based on the social interpretation of how one looks (which is what we call 'race'), that unfairly disadvantages some individuals and communities, unfairly advantages other individuals and communities, and saps the strength of the whole society through the waste of human resources." She identifies three levels of racism (institutionalized, personally-mediated, and internalized) and illustrates these three levels with her Gardener's Tale allegory. She then generalizes her discussion of racism to encompass other systems of structured inequity.
Dr. Jones describes the International Convention on the Elimination of all forms of Racial Discrimination as an organizing tool for addressing the impacts of racism on the health and well-being of our nation. She closes with three additional allegories on "race" and racism to equip attendees to name racism, ask "How is racism operating here?", and organize and strategize to act.
• Illustrate the relationship between health services, addressing the social determinants of health, and addressing the social determinants of equity using a Cliff Analogy.
• Define racism as a system and identify three impacts of that system.
• Describe three levels of racism and illustrate those levels using the Gardener’s Tale allegory.
• Describe the relationship of the United States to the international anti-racism treaty.