I have worked on minority issues, equity, and social justice for as long as I can remember. As a kid, I grew up in Pennsylvania on a small farm, while most of my family lived in the Bronx. From an early age I could see the systemic inequities in education and opportunity, even if I couldn’t describe them as such.
As a junior medical school faculty member, I realized that I wanted to improve minority health by educating the next generation of physicians. My co-course director, Aaron Fox, MD, MS, and I developed a thirteen-session health disparities elective for first-year medical students. The curriculum covers three main content areas: background, provider contributions to health disparities, and systemic contributions to health disparities. We used various teaching methods, including didactic and multimedia presentations, reflective discussions, and active learning skill-building. Using a pre-/posttest assessment, we found that we were able to increase our students’ knowledge, attitudes, and self-reported confidence in addressing provider and systemic contributions to health disparities. Our instructional strategies and the results of our program evaluation can be found in a recent Academic Medicine article. We decided to address both provider and systemic causes of health disparities in our elective course for several reasons.
On the provider level, each medical student will see patients for part or all of his or her career. Evidence shows that an individual physician may achieve varying levels of quality of care with patients of different racial and ethnic backgrounds and other characteristics (e.g., gender, weight, etc.). As future physicians, students can learn to examine their own biases and develop skills to mitigate the impact of such biases on their clinical decision making, thereby providing excellent care to all of their patients.
Regarding the systemic causes of health disparities, the determinants of health and risk of premature death are partially predicted by genetics (~30%), but overwhelming affected by the social determinants of health and behavioral choices (~60%). Health care itself is responsible for the remaining fraction (~10%). By learning about the social determinants of health and how to respectfully uncover factors in a patient’s life that are limiting their behavior choices, physicians may engender more trust with their patients, improve adherence to treatment, and be able to tailor their recommendations to optimize patient outcomes.
Given the importance of the social determinants of health, and the effects of the built environment on behavior choices, in addition to access to health care, physicians are poised to make significant contributions to patient advocacy on an individual, community, and population level. Physicians armed with advocacy skills can effectively utilize social media platforms, lobby legislators, and influence—or even write—policies that enhance health equity and contribute to the ultimate elimination of health disparities.
Not every student will become a physician advocate working at the systemic level, but they all will become physicians who need to advocate for their patients on a one-on-one level. Thus, medical schools must make health disparities and advocacy education part of the longitudinal compulsory curriculum—to enhance the one-on-one advocacy skills of their students, and to show those students who are so inclined how to create a career out of advocacy on all levels. Just as medical education strives to create brilliant clinicians, we also can offer students the opportunity to become brilliant physician advocates.
1. Association of American Medical Colleges. Addressing Racial Disparities in Health Care: A Targeted Action Plan for Academic Medical Centers. Washington, DC: AAMC; 2009.
2. Braunstein S, Lavizzo-Mourey R. How the health and community development sectors are combining forces to improve health and well-being. Health Aff. 2011;30:2042-2051.