Why your doctor should care about social justice | Mary Bassett

TL;DR

This content highlights the author's realization that as a health professional, speaking out against social injustices such as racism is central to doing their job right.

Transcript

When I moved to Harare in 1985, social justice was at the core of Zimbabwe's national health policy. The new government emerged from a long war of independence and immediately proclaimed a socialist agenda: health care services, primary education became essentially free. A massive expansion of rural health centers placed roughly 80 percent of the p... Read More

Key Insights

• 🌍 Social justice was at the core of Zimbabwe's national health policy after gaining independence in 1980, resulting in significant improvements in healthcare access and immunization rates.
• 💉 The AIDS epidemic in Zimbabwe presented a major challenge, with infection rates soaring and limited access to treatment, highlighting the need for structural change and addressing social inequalities.
• 🔔 Sounding the alarm about public health issues, including racism and institutionalized violence, is essential for creating real change and reducing health disparities.
• ⚕️ Medical professionals have a responsibility to address social injustices and advocate for change, going beyond treating individual patients to addressing systemic issues.
• 🔎 Patterns of marginalization and exclusion contribute to health disparities, such as racial disparities in premature mortality and childbirth outcomes in New York City.
• 👥 The ongoing impact of racism on health, including higher rates of disease and premature death for people of color, needs to be acknowledged and addressed by the medical community.
• 🌍 Biological and genetic targets should not overshadow the importance of considering social determinants of health, recognizing that where a person lives and their daily context greatly influences their health.
• 📣 Health professionals should use their societal position and credibility to speak out against inequality and advocate for health equity, even if they don't have all the answers. It requires courage and collective action.

Questions & Answers

Q: What were some of the accomplishments in Zimbabwe's national health policy in the 1980s?

Zimbabwe's national health policy in the 1980s included a socialist agenda that made health care services and primary education essentially free. There was also a massive expansion of rural health centers, which resulted in placing approximately 80 percent of the population within a two-hour walk from these facilities. The proportion of fully immunized Zimbabwean children increased from 25 percent in 1980 to 80 percent in 1990.

Q: How did the AIDS epidemic impact Zimbabwe during the speaker's time there?

The speaker arrived in Zimbabwe in 1985 and witnessed the country's first reported AIDS case that same year. In the early days, the infection rate was only about two percent, but it would later soar to one out of every four adults by the time the speaker left Harare 17 years later. The epidemic led to the setup of a clinic, condom demonstrations, school education, and workplace interventions.

Q: What did the speaker initially focus on during their time in Zimbabwe regarding HIV/AIDS?

Initially, the speaker's focus in Zimbabwe was on their technical skills in clinical care and research epidemiology. They aimed to take care of patients and improve understanding of the population patterns of transmission. However, the speaker acknowledges that they did not address structural change or speak out about the unequal access to life-saving drugs and underlying economic and political systems driving infection rates.

Q: How does the speaker connect the concept of structural violence to epidemics like AIDS?

The speaker, inspired by medical anthropologists such as Paul Farmer, describes structural violence as the presence of inequities embedded in the political and economic organization of society. These inequities, which are often invisible to those with privilege and power, contribute to the disproportionate impact of epidemics on socially marginalized populations. This was evident in the case of AIDS, as infection rates were higher in socially marginalized groups.

Q: What does the speaker emphasize in their current role as New York City's Health Commissioner?

As New York City's Health Commissioner, the speaker emphasizes the importance of recognizing and addressing racial disparities and institutionalized racism in the field of medicine and public health. They highlight statistics showing higher mortality rates for black individuals and the ongoing impact of discrimination on disease profiles and mortality. The speaker advocates for speaking out against racism and working towards health equity.

Summary & Key Takeaways

• Zimbabwe's national health policy in the 1980s focused on social justice, with free healthcare services and education.

• The AIDS epidemic in Zimbabwe presented challenges, with infection rates rising to 25% by the time the author left Harare after 17 years.

• The author reflects on their role as a health professional, acknowledging their silence in addressing structural inequalities and advocating for change.