Category Archives: Health Equity

Addressing unequal and unjust health outcomes across different populations.

Intimate Partner Violence

Recognize structural factors that contribute to IPV and IPV disparities, using this example of IPV among Indigenous women.

There will be an in-class discussion of this reading. Amnesty International “Maze of Injustice” Chapters 1, 2 and 8 (pp 1-18, 75-82)

Here is a brief (2min) frame of IPV and the importance to health & healthcare

IPV introductory video:

Optional reference for students to have as they travel throughout WWAMI, to understand their responsibilities/requirements if they encounter a disclosure:

Information on rules/requirements for mandatory reporting by state

Optional reference for students to have as they travel throughout WWAMI, to direct patients to appropriate resources ;

Information on state-specific DV/IPV/assault resources: state by state numbers and resources 2018

Optional printable reference for students who wish to use/give out the cards and/or lose the hard copy they were given:

“Is Your Relationship Affecting Your Health” safety card

Optional reading for students who wish to learn more about dating violence among teens/tweens:

Fact sheet on dating violence among adolescents

Intersectionality and Structural Competency

These three readings explore the complexities of identity and power in the clinical setting from the patient and physician perspectives.

Optional readings for students who want to explore more:

Justice in Healthcare: Difficult Encounters

This lecture discusses an approach called “DEAR” to responding to difficult encounters. This will be used to form responses to cases.

Describe: “I notice…”
Express: “I feel/think…”
Assert: “I want…” or “I plan to…”
Reinforce: (“This will work out well for you because…”)

Optional Resources:

History of Marginalized Groups and Health Impacts

This article discusses the concept of narrative humility in patient interactions.

This model explores how historical trauma impacts community and individual health:

To learn more, read the corresponding article “Historical trauma as public narrative: A conceptual review of how history impacts present-day health“

Introduction to Health Equity

Read the first 3.5 pages of this article “The Many Roads Towards Achieving Health Equity” to build a broad overview of health equity, it’s evolution, and pertinent terms that will be discussed in class. The remainder of the article references areas of further reading for interested students.

Justice in Healthcare: Bedside Rationing

Justice in healthcare is a substantial part of ethics in medicine, here we will cover some of the distinctive aspects of justice-based concerns and some basic ethics language to help wade through these interesting ethical issues.

READ: this short piece by Dr. Jonsen and Dr. Edwards goes into some detail about resource allocation in the medical setting.

Now start to apply what you’ve learned. This reading provides some preliminary perspectives on a case of transplant tourism. This is just one among many forms of distributive justice where we see an inclination to ration at the bedside.

READ: Satel and Aronson. (2008). “Transplant Tourism: Treating Patients when They Return to the U.S.”, Virtual Mentor, American Medical Association Journal of Ethics. Volume 10, Number 5: 271-277.

As you read CONSIDER:

What does bedside rationing mean in this case?
What is the central ethical question the physician faces in this case?
What do you think should be done? Why?
How does this case affect your vision of collective efforts towards social justice?

WATCH: When thinking about justice, it is important to explore the perspectives of all stakeholders and consider the procedures through which they interact. In the case of transplant tourism, this means knowing where organs can come from as well as who seeks them out. See this short video from BBC News that portrays one family’s experience.

For further reading (not required)…

There are several impressive documentaries on transplant tourism, here is one from the UK that is slightly older (2004) but provides extensive insight into the perspectives of various stakeholders including patients, families, and transplant surgeons on multiple sides of the debate: The Transplant Trade. There is another newer documentary that investigates China’s illegal organ trade called Human Harvest, which can be accessed through the library here.

The Medical Safety Net

After Class:

GOAL for this reading: Provide additional data regarding community health centers, populations served, and funding received.

Instructions: Read the “Executive Summary” of “Community Health Centers: Recent Growth and the Role of the ACA” after class in preparation for community experience.