Category Archives: Populations

Interrupting and Responding to Bias

Goals:

  • Introducing concepts of ingroup, outgroup, and creating opportunities for positive exposure to individuals different from oneself.
  • Introduce (de)individuation and empathy as key factors in quality of care.

(1) WATCH: Verna Myers TEDTalk at “How to overcome our biases?  Walk boldly toward them.”

  • Verna Myers urges viewers to move beyond denying or suppressing bias, to employing strategies to alter perceptions of certain groups over time.

(2) LISTEN to the short podcast and read the accompanying article. “A Patient, Not a Person“: Medicine’s bad habit of dehumanizing patients.

  • Discussion with Adam Waytz about how physicians tend to dehumanize their patients over time and the consequences this can have on the care provided.

(3) READ the op-ed piece by Dr. Okwerekwu. “The patient called me ‘colored girl.’ The senior doctor training me said nothing.”

  • Read this post from STAT Newsthat describes a medical student’s experience with racist comments during her clinical training and how it felt when no one spoke out against it.

(4) READ the JAMA op-ed piece “Speak Up” by Dr. Merrill. 

  • Read this JAMA Piece of My Mind“Speak Up” which describes one physician’s experience with speaking up when witnessing micro-aggressions or biased comments or behavior in the clinical workplace.

(5) REVIEW “Tools for Responding to Bias” on the EHM WordPress site.

  • Read over methods for responding to witnessed bias. Consider how you might respond as a bystander or the person receiving the bias.

Geography and Health

In this session, we will consider how the environment influences the health of individuals and populations, and how the local geography of the place we live and the places we and others travel to can impact our well-being. The relationship between geography and health was recognized as far back as the time of Hippocrates, who stated that “airs, waters, and places” all had a significant impact on human health. In Week 1, we learned about the cholera outbreak in London in 1854, and how John Snow’s study of the homes of people who had died and where they got their water led to a ground-breaking understanding of how public health interventions can interrupt an epidemic.

Environmental health concerns often are areas where public health and policy are important tools, and progress in protecting health requires the concerted efforts of a large number of concerned stakeholders.

To gain an understanding of how the environment impacts health, please complete the following before class:

Activity 1:

As you view the report, CONSIDER…

  • What was the cause of the problem and why did it take so long to acknowledge there was a problem?
  • What role did physicians play in helping to identify and address the problem?
  • Who came together to make sure that the problem was recognized, investigated, and acted upon

Activity 2:

Activity 3:

  • After completing your pre-class assignment and considering the questions above, take our survey to identify the concerns of your class regarding geography and health, at the link below.
  • When you respond, try to use one-word answers if possible, as this will help us identify the concerns that appear most commonly.

Gender and Health

In this session, we will consider how the relationship between gender and health by examining the historical and present-day influences of sexism and cissexism on disparities in health status and care. Gender, like race, is considered a “master status” in US society: one of the first things we notice about someone is their gender and gender is central to our perceptions of self and our attribution of characteristics and qualities to others. Medicine is not immune to these social influences and in many ways, has perpetuated inequities based on gender. To gain an understanding of the relationship between gender and health, please complete the following before class. It is recommended that you read/watch and take notes as you complete the following three activities.

(1) WATCH: Toxic Masculinity In Boys Is Fueling An Epidemic Of Loneliness (6 min 44 sec)

  • Content Warning: homophobic language is used in this video as a descriptive
  • Goal: Introduce students to the concept of “Toxic Masculinity” and how it affects men’s health

As you watch the video, CONSIDER…

  1. How might this impact diagnosis and treatment of depression or other mental illness in adults and older adolescents in the primary care setting?
  2. Think about what you have learned in other EHM talks, and in your physiology courses.  How might this also impact the development of other illnesses such as cardiovascular disease?
  3. Suggested: Consider the research on social isolation among baby boomers. As adolescent and young men age, what might this mean for health status and care throughout the life course?

(2) READ: The XX & XY Lie: Our Social Construction of a Sex and Gender Binary (15 min)

  • Goal: Introduce students to the sex and gender binary, the concept of intersex, and definitions of trans/non-binary identities

As you read the article, CONSIDER…

  1. What is your gender identity? How do you know this about yourself? What does this identity mean to you?
  2. Imagine not being able to see your anatomy or chromosomal makeup. Pause and reflect on how this does and/or does not impact your identity?

(3) READ: I Was Pregnant and in Crisis. All the Doctors and Nurses Saw Was an Incompetent Black Woman (5 minutes)

  • Goal: Introduce students to biases experienced by women in clinical settings and allude to the idea of intersectionality (racism and sexism; “misogynoir”)

As you read the article, CONSIDER…

  1. Intersectionality is defined by sociologist and legal scholar Kimberlé Crenshaw as, “the interconnected nature of social categorizations such as race, class, and gender as they apply to a given individual or group, regarded as creating overlapping and interdependent systems of discrimination or disadvantage.” Recalling your sessions on race, how is intersectionality at play in this essay?

Part 2: Introduction to Social Determinants of Health

In this session, we will continue learning about the social determinants of health with a focus on social class and neighborhood effects. Students were introduced to social class/classism as a fundamental cause of health inequity in Week 1. This week, we expand on the SES-health relationship by describing what it is about social class that effects health both in relative and absolute terms. We also cover key aspects of environments and theories of how environmental conditions affect health. We close by offering anecdotes from faculty and community members on risk factors, protective factors, resilience, and prevention.

Optional activity:

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

Population Health Panel

In this session, we will consider how organizations, including healthcare systems and public health institutions, promote the health and well-being of entire patient populations by addressing problems that impact large numbers of people. We will readdress topics that were introduced in week 1, including thinking broadly about what constitutes “health” and how we can address some of the social determinants of health. In order to do this, we need to define “population health” and understand what is meant by this term.

In addition, this session focuses on the “Triple Aim.” The Triple Aim involves three goals that are critical to improving the health of populations, whether here in the United States or elsewhere:

  1. Improving the individual experience of care.
  2. Reducing the per capita costs of care for populations.
  3. Improving the health of populations.

Activity 1:

  • Go to IHI Online Open School Modules – http://app.ihi.org/lms/home.aspx
  • COMPLETE:Module  TA 101 Lessons 1-3 Introduction to the Triple Aim for Populations
    • After you complete the module, CONSIDER…
      • How do we learn about health disparities in a given population? What kinds of data are required? What is needed to address disparities?
      • Why should physicians focus on improving the individual experience of care?
      • Why do costs matter? Is it really necessary for physicians to think about reducing per capita cost of care?
      • How can we improve the health of populations as a whole? What is the role of individual clinicians in improving population health? Why is a clinical approach not enough?

OPTIONAL Activity 2:

  • DISCUSS your thoughts on health disparities and the Triple Aim with your classmates, on your own before class.
  • After completing the IHI Module TA 101, Lessons 1-3 and considering the questions above, write a brief entry (no more than 100 words) into the Population Health Panel discussion board linked on your Canvas page for this session.
  • Before you write, read the Discussion Board entries and try to incorporate or address other students’ thoughts in your posting.

OPTIONAL Activity 3:

Key Take Home Points:

  1. Remember the World Health Organization definition of health we learned in Week 1: Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.
  2. Remember the definition of public health from Week 1: Public health is the science and the art of preventing disease, prolonging life, and organized community efforts to prevent, identify, preempt, and counter threats to the public’s health.
  3. Population health aims to address health disparities and improve health outcomes for the entire population of a specific geographic area.
  4. Population medicine aims to address health disparities and improve health outcomes for the population served by a given care provider (clinic, hospital, etc.).
  5. Both public and population health efforts rely on data that may often be limited; physicians can help improve public health data by reporting patient outcomes as required by law.
  6. All physicians can contribute in some way to health improvements at the population level by supporting public and population health programs

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)

 

Social Determinants of Health in US Populations

Required:

  • Link and Phelan. 1995. “Social Conditions as Fundamental Causes of Disease” Journal of Health and Social Behavior pp.80-94
    • In this foundational article, social epidemiologists Bruce Link and Jo Phelan argue three main points:
      1.  social conditions (e.g., SES, inequality, racism, segregation) have a causal effect on health and well-being,
      2. to understand patterns of disease prevalence and incidence, we need to contextualize risk factors and understand what conditions put people “at risks of risks” (i.e., people in poor neighborhoods have an elevated risk of exposure to crime which increases the risk of stress accumulation), and
      3. researchers need to acknowledge that social conditions are not just distal causes of disease, they are FUNDAMENTAL causes, meaning that the relationship between the social conditions (e.g., SES) and health is robust and will remain present even as the risk factors for disease and the leading causes of disease/death change.
    • This is because high SES individuals are afforded flexible resources that they can use to avoid risks and minimize the consequences of disease.
  • Frieda, Misha. 2016. “For Native Americans, Health Care Is a Long, Hard Road Away”.
    • NPR : https://www.npr.org/2016/04/13/473264076/for-native-americans-health-care-is-a-long-hard-road-away
  • Social Determinants of Health PPT

Race and Racism in Medicine

Watch “The Biology of Race in the absence of Biological Races” by Dr. Rick Kittles

Watch video or read transcript:

Race: The Power of an Illusion – Episode 2

Read:

Goal for these activities:

  1. Recognize why using race in biomedical studies can be problematic.
  2. Recognize how and why race is a social and political construct and its current function in society.
  3. Recognize how race is still used in medicine, and “pros” and “cons” to using race as a social identifier.