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.

  1. Manning, Kimberly D. “The nod.” JAMA 312.2 (2014): 133-134.
  2. Gridley, Samantha. “The Gold–Hope Tang, MD 2015 Humanism in Medicine Essay Contest: Third Place Gauze and Guns.” Academic Medicine 90.10 (2015): 1356-1357.
  3. Lynch, Katrina. “The Gold–Hope Tang, MD 2015 Humanism in Medicine Essay Contest: Second Place The Doctor Will See You Now.” Academic Medicine 90.11 (2015): 1530-1531.

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:

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:

  1. What does bedside rationing mean in this case?
  2. What is the central ethical question the physician faces in this case?
  3. What do you think should be done? Why?
  4. 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 with Health Policy

1. READ: The “Executive Summary” for Community Health Centers: Recent Growth and the Role of the ACA

  • NOTE: the longer “Issue Brief” contains additional details but is NOT required reading
  • GOAL: Provide additional data regarding community health centers, populations served, and funding received.
  • INSTRUCTIONS: Read the following summary for basic introductory information regarding community health centers. Pay particular attention to the mechanisms for funding and access.

 

Optional Video

 

Optional additional references

Adverse childhood experiences and trauma informed care

Activities:

  1. Watch Nadine Burke Harris’s TED talk that introduces key concepts about Adverse Childhood Experiences and how they impact health.
    • Goal: Define the scope and frequency of adverse childhood experiences (ACE) and toxic stress, the connection to illness across the lifespan, and opportunities for clinician intervention
    • Context and Instructions: Dr. Nadine Burke Harris explains how incorporating an understanding of the frequency and effects of adverse childhood experiences (ACES) can impact medical practice.

2. Then READ EITHER:

OR

Optional readings:

  1. NYT article on WA state resilient community success story
    • Goal: compare and contrast effective community interventions to promote resilience in our region
  1. Original ACEs study: Felitti VJ, Anda RF, Nordenberg D, et al. Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. American Journal of Preventive Medicine. 1998;14(4):245–258. doi:10.1016/s0749-3797(98)00017-8. 
    • 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.

Additional Resources:

Confronting institutionalized inequity in medicine

Activities

  1. Read: Taylor, A. (2004). Combination of Isosorbide Dinitrate and Hydralazine in Blacks with Heart Failure. NEJM, 351(20), 2049-2057.
    • Do not worry about details of biological mechanism, focus on big picture: what was studied, in whom, what were results and what’s the clinical application?
  2. Read: “The art of medicine. The short life of a race drug” by Sheldon Krimsky
    • Understand how and why BIDIL was able to be marketed as a race-specific treatment.
  3. Optional – Watch: Dorothy Roberts, The problem with race-based medicine (TEDMED 2015)

 

White Fragility

Activities 1-3

  1. Read pages 54-58 (stop before the section Factors that Inculcate White Fragility) in the article White Fragility, by Robin DiAngelo
    • 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.
  2. Review In-class handout: The Art of Mindful Inquiry and Health Ways to Communicate
    • In order to have a deeper discussion please review recommendations for inquiring about difficult topics and look over the discussion points that will be discussed.
  3. Watch the video clip Just Be American from the film Color of Fear.
    • 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

  1. Create a personal definition of white fragility.
  2. Understand how societal norms can lead to power differentials that exist between racial groups.
  3. Create a framework for discussions that may be difficult or challenging.
  4. Create a framework for understanding why talking about racism may be more difficult for some than others.