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 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.
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.
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.
Goal: Apply the concepts of toxic stress and adverse childhood events to the cycle of interpersonal violence, and identify opportunities for clinician intervention.
Context and Instructions: In this JAMA article, Sumner et al explore the epidemiology of interpersonal violence, the effect of childhood exposure to violence on lifetime risk of violence and adverse health, and opportunities for community and clinician intervention.
Goal: Describe the proposed pathophysiologic mechanisms of toxic stress’ effect on health across the lifespan and the mediating effect of known resilience factors.
Context and Instructions: In this Pediatrics article, Shonkoff et al, delve into the science of toxic stress on the developing brain and the moderating effect of resilience factors. Based on this science, they propose an “ecobiodevelopmental framework” from which the clinicians of the future should approach primary care.
Goal: For students who want to read the Kaiser study that introduced the idea of ACES and the impact on health. A caveat that some language in this original paper (“family dysfunction”) would not be used in the trauma informed care environment that this work ultimately produced.
Discussions about race and racism can be inherently uncomfortable. Acts of racism can take all forms and it is important to consider intent versus impact when racist behavior is exhibited. Much of this is driven by societal norms and socialization.
This video in an excerpt from the 1994 film The Color of Fear. Eight men of different backgrounds, races and ethnicities were gathered by director Lee Mun Wah, for a dialog about the state of race relations in America as seen through their eyes. This is a response by David C. after hearing about experienced racism from other members of the group.
Your goal for each activity
Create a personal definition of white fragility.
Understand how societal norms can lead to power differentials that exist between racial groups.
Create a framework for discussions that may be difficult or challenging.
Create a framework for understanding why talking about racism may be more difficult for some than others.