Monday, May 2, 2016

When learners become leaders for health equity

“The physician’s function is fast becoming social and preventive, rather than individual and curative…Directly or indirectly, disease has been found to depend largely on unpropitious environments…(which) are matters for ‘social regulation,’ and doctors have the duty to promote social conditions that conduce to physical well-being.” Abraham Flexner, 1910

While working at the Minneapolis Health Department in the 1980s and early 1990s, I staffed an evening pediatric clinic for Southeast Asian refugees at the Hennepin County Medical Center (HCMC) with Sherry Muret-Wagstaff, a wonderful nurse practitioner. In addition to caring for multiple medical issues, our interdisciplinary team addressed the myriad economic, social, and cultural issues confronting our patients and impacting their health. Occasionally, our clinic team would be augmented by a medical student interested in refugee or global health.

In 1989, in the midst of a major measles outbreak, medical student Joia Mukherjee joined our team. Even though she was in the early stages of her medical education, she had a remarkably clear understanding that health was much broader than just clinical care and she helped us identify and address the barriers to measles immunizations for our patients. It was obvious that she had a social justice perspective and a passion for addressing the conditions that impact health. At that time, I wondered how she would use her talents but was confident they would be used well.

I hadn’t seen Joia since our work on the measles outbreak until this weekend when she was a featured speaker at the “Reimagining Social Medicine” conference at the University of Minnesota. She is now the Medical Director of Partners in Health, a multi-faceted international medical non-profit found by Dr. Paul Farmer. The title of her presentation was “Disrupting the Status Quo: Moving Towards Health Equity and the Role of Social Medicine.” Watching Joia at Northrop Auditorium, it was evident that her understanding about what creates health has become even clearer and that her passion for social justice has grown.

She underscored the fact that “We cannot educate the victims of social inequality out of their problems. We need collective action on many levels.” Using the story of “Stone Soup” as the vehicle, she helped the audience understand that “medical care is just the carrots.” Much more is needed to make a rich and healthy soup; including (among many other ingredients) the potatoes of economic development, the meat of peace and safety, the celery of an equitable justice system, the beans of good sanitation, the salt of education, and the water of social cohesion. All in the pot of community. Her story was a vivid illumination of the Triple Aim of Health Equity and a reminder that it took an entire community to make the Stone Soup.

Even though Joia dislikes the term “social determinants of health” because that “sounds so fixed and unchangeable,” she did acknowledge that these conditions are impacted by the distribution of money, power, social policies, and politics and that they can be changed, though not easily. She underscored for the audience “that people with privilege and power have the obligation to speak the truth because the poor and dispossessed have a difficult time being heard when they speak the truth.”

Dr Mukherjee graciously acknowledged that her time with us at HCMC was an “important cornerstone in her formation” in Social Medicine. However, as one of her teachers, it was evident that she had progressed far beyond whatever we provided for her.

Joia ended her talk with an acapella version of “Give Light and People Will Find a Way.” As she led the audience in singing “Listen deeply, Walk together, Seek justice, Be brave, and People Will Find a Way,” I had tears in my eyes. The learner had become a powerful and inspirational leader. That gives me hope that there are more leaders in our midst learning from us every day and we will find a way to achieve health equity.

Ed