Why your doctor should care about social justice | Mary Bassett

Summary

The speaker reflects on their experience in Zimbabwe from 1985, witnessing the country's impressive health system transformation and the rise of the AIDS epidemic. Despite offering medical care and research, they acknowledge their failure to advocate for broader structural change in the fight against AIDS. The speaker highlights the importance of addressing social injustices, including racism, which continue to affect health outcomes, particularly for marginalized communities. Now as New York City's Health Commissioner, they vow to speak out against systemic inequality and call for health equity, urging others to join in the fight for justice.

Takeaways

• 😀 The Zimbabwean government's post-independence focus on social justice led to free healthcare and education, drastically improving public health in the 1980s.
• 😀 By 1990, Zimbabwe's childhood immunization rate increased from 25% to 80%, a remarkable achievement in a short time.
• 😀 The AIDS epidemic hit Zimbabwe in the mid-1980s, and infection rates rose dramatically, leading to widespread illness and death.
• 😀 While working in Zimbabwe, the speaker prioritized clinical care and research but later recognized the importance of addressing the broader structural issues affecting public health.
• 😀 The speaker reflects on their regret for not advocating more actively for structural changes to address the HIV/AIDS crisis earlier.
• 😀 Structural violence, as coined by medical anthropologist Paul Farmer, refers to inequities embedded in political and economic systems that negatively impact public health.
• 😀 The speaker emphasizes that public health workers must acknowledge and speak out against systemic inequalities, such as those based on race, gender, and class, that exacerbate health disparities.
• 😀 In the U.S., racial disparities in health outcomes are stark, with black Americans facing disproportionately high risks of premature death, especially among black men.
• 😀 The #BlackLivesMatter movement highlighted ongoing racial violence, and the speaker calls for the medical community to actively address racism and its impact on health.
• 😀 The speaker expresses concern that a focus on personalized medicine may divert attention from the broader social factors that shape health outcomes, such as the environment and systemic inequalities.
• 😀 The speaker encourages health professionals to use their position of influence to advocate for change and not remain silent on issues of inequality and injustice, both in healthcare and society at large.

Q & A

What was the core focus of Zimbabwe's national health policy when the speaker arrived in 1985?

The core focus of Zimbabwe's national health policy was social justice, with an emphasis on providing free health care services and primary education, especially in rural areas. This was part of the government's socialist agenda following the country's independence.

How did the speaker describe the expansion of health services in Zimbabwe in the 1980s?

The speaker described the expansion of health services as a remarkable accomplishment, particularly the massive increase in rural health centers, which made healthcare accessible to about 80% of the population within a two-hour walk.

What was the vaccination rate for children in Zimbabwe in 1980 and how did it change by 1990?

In 1980, only 25% of Zimbabwean children were fully immunized. By 1990, this number had risen to 80%, demonstrating a significant improvement in the country's vaccination coverage.

How did the speaker feel about being part of Zimbabwe's transformation in health care?

The speaker felt privileged to be part of the transformation, describing it as a revolution. They were excited and connected to both the African independence movement and the global progressive public health movement.

What was the state of the HIV/AIDS epidemic in Zimbabwe when the speaker arrived in 1985?

The first case of AIDS in Zimbabwe was reported in 1985, the same year the speaker arrived. At the time, the infection rate was about 2%, but it eventually soared to 25% by the time the speaker left the country in 2002.

What strategies did the speaker and their colleagues employ to combat the AIDS epidemic in Zimbabwe?

The speaker and their colleagues set up a clinic, conducted condom demonstrations, launched school education programs, and worked on workplace interventions. They also did research and provided counseling for partners of infected individuals.

Why did the speaker not advocate for structural changes during their time in Zimbabwe?

The speaker did not advocate for structural changes because they saw their role as focusing on clinical care and research. They believed that speaking out could jeopardize their ability to work in the country, where they were a guest, and might hinder their effectiveness in providing patient care.

What does the speaker mean by 'structural violence'?

Structural violence refers to the inequities embedded in the political and economic systems of society, which result in suffering, illness, and premature death. The speaker highlights that this violence is often invisible to those with privilege and power.

How does the speaker relate the concept of structural violence to public health?

The speaker explains that structural violence manifests in the disproportionate health outcomes experienced by marginalized groups, such as the higher rates of HIV infection among certain populations in Zimbabwe. They argue that public health professionals must acknowledge these inequities to effectively address health disparities.

What is the speaker's stance on racial disparities in health in the United States?

The speaker emphasizes that racial disparities in health, particularly in New York City, are a serious issue, with black men experiencing significantly higher premature mortality rates than white men. They argue that these disparities are rooted in systemic racism and must be addressed by the medical community.

What does the speaker believe the medical community should do in response to issues of racism and health inequity?

The speaker believes that the medical community should stop avoiding discussions of racism and take an active role in advocating for health equity. This includes speaking out against systemic racism and working to address the social determinants of health that contribute to health disparities.

What does the speaker mean by 'sounding the alarm' in the context of public health?

To 'sound the alarm' means to raise awareness and call for action regarding issues of health inequity, racism, and other forms of structural violence. The speaker urges health professionals to use their platform to advocate for change and to not remain silent in the face of injustice.