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Realizing Our Power: Advocating for Social Justice

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Realizing Our Power: Advocating for Social Justice. Summer Institute Sarah-Anne Schumann F. Daniel Duffy August 3, 2012. Social Justice. The new professional contract with society. - PowerPoint PPT Presentation
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Realizing Our Power: Advocating for Social Justice Summer Institute Sarah-Anne Schumann F. Daniel Duffy August 3, 2012
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Page 1: Realizing Our Power: Advocating for Social Justice

Realizing Our Power: Advocating for Social Justice

Summer Institute Sarah-Anne Schumann

F. Daniel Duffy August 3, 2012

Page 2: Realizing Our Power: Advocating for Social Justice

Social Justice

The new professional contract with society

Page 3: Realizing Our Power: Advocating for Social Justice

The practice of medicine and delivery of healthcare are

morally relevant acts aimed at preventing or relieving human suffering in life,

liberty, and the pursuit of happiness

Page 4: Realizing Our Power: Advocating for Social Justice

Moral Act of ProfessionPatient’s Predicament Vulnerable Frightened Unable to help self Dependant on others Low social status

Healthcare Professionals swear a public oath to: Be trustworthy Use specialized knowledge

and training for the good of the sick

Keep patients from harm to the best of their ability

Put aside self-interest for the good of their patients

Sulmasy D. The Rebirth of the Clinic: An Introduction to Spirituality in Health Care. 2006 The Georgetown University Press, Washington, DC.

Page 5: Realizing Our Power: Advocating for Social Justice

Medicine’s Contract

PhysicianPatient

Page 6: Realizing Our Power: Advocating for Social Justice

Community Medicine’s Contract

Professional

Society

Patient

Page 7: Realizing Our Power: Advocating for Social Justice

The ABIM Foundation, The American College of Physicians Foundation, The European Federation of Internal medicine, Ann Intern Med & Lancet, March 2002

We make a personal commitment to improve the health of our patients

Devote our collective

efforts to improve the health care system for the welfare of society

Expanded Contract

Page 8: Realizing Our Power: Advocating for Social Justice

A Just Society Assures equality of opportunity and

fairness Guarantees its members a fair share of

what is required for them to pursue their individual ends

Upholds the principle of “Just Sharing” of the “financial burdens of medical misfortunes equally by the well and ill alike, unless individuals can be reasonably expected to control those misfortunes by their own choices”

Smith, GP. Social Justice and Health Care Management: an Elusive Quest. Houston Journal of Health Law & Policy. 2009

Page 9: Realizing Our Power: Advocating for Social Justice

Social Justice in HealthcareExamines the relationships between groups and individuals that influence the distribution of healthcare across society.

Advocates for the poor on an individual level and for solutions to the structural barriers that deny the poor access to affordable, adequate health care.

Justin M. List, MD, Medicine Resident JAMA 2011

Page 10: Realizing Our Power: Advocating for Social Justice

Community Medicine’s Agenda

Marketplace Commodity

Social Determinants of Health

Physician

SocietyPatient

Page 11: Realizing Our Power: Advocating for Social Justice

Social Injustice is a Cause of Disease

Lack of universal access to healthcare reduces the well-being and economic viability of the entire society.

Health status is tightly tied to education, financial status, healthy environment, and a secure social situation.Treating the disease of addiction mainly as criminal activity prevents effective research and treatment.Childhood poverty, neglect, and abuse threatens adult opportunity for life, liberty, and the pursuit of happiness.

Page 12: Realizing Our Power: Advocating for Social Justice

Healthcare as a Market Commodity US society has come to view healthcare

as a market commodity Subject to supply and demand forces and

rationing decisions imposed by providers Medicine’s contract yields to “social good

and economic need” Individual wealth or privilege of

insurance rather than need of the patient determines the degree of participation in the US healthcare marketplace

Justin M. List, MD, Medicine Resident JAMA 2011

Page 13: Realizing Our Power: Advocating for Social Justice

Charity Health CareIn the United States charity care or uncompensated care is health care provided for free or at reduced prices to the poor or uninsuredFaith Based Hospitals

Teaching Hospitals

Physician Generosity

Community Health CentrPublic Hospitals

Free (Mission) Clinics

Hospital Emergency Rooms

Page 14: Realizing Our Power: Advocating for Social Justice

Charity Care in the US In 2004, 68% of physicians provided

charity care, down from 76% in 1996 In 2006, Senate investigators found

Many hospitals did not inform patients that charity care was available

Some for-profit hospitals provided as much charity care as some non-profit hospitals

Some non-profit hospitals charge poor, uninsured patients more than they did insured patients

Page 15: Realizing Our Power: Advocating for Social Justice

Is Charity Care Social Justice?“Though it is sorely needed, charity care may in some ways perpetuate the unjust system that makes it necessary in the first place.

True social justice in medicine demands that physicians take the lead in advocating for systemic change.”

Justin M. List, MD, Medicine Resident JAMA 2011

Page 16: Realizing Our Power: Advocating for Social Justice

Rudolph Virchow

“Doctors are natural attorneys for the poor … If medicine is to really accomplish its great task, it must intervene in political and social life…”

Page 17: Realizing Our Power: Advocating for Social Justice

Community Health Centers

Access to Healthcare for the poor

Page 18: Realizing Our Power: Advocating for Social Justice

Federally Qualified Health Centers: Part of the Solution Located in or serve a high need community (OK has 40 sites

currently, +6 fall 2012) Governed by a community board composed of a majority (51% or

more) of health center patients who represent the population served. Provide comprehensive primary health care services as well as

supportive services (education, translation and transportation, etc.) that promote access to health care.

Provide services available to all with fees adjusted based on ability to pay (OK 40% uninsured, 30% Medicaid)

Grant-Supported Federally Qualified Health Centers are non-profit health care organizations that meet certain criteria under the Medicare and Medicaid Programs and receive funds under the Health Center Program (Section 330 of the Public Health Service Act).

Page 19: Realizing Our Power: Advocating for Social Justice

Boston: Codman Square Health Center Medical services

Include dental and behavioral health, residency programs

Open until 9 weekdays for primary care

Urgent care 7 days a week Community Services

Fitness center Teen center Job/computer training Food Pantry Farmers Market Charter School

Page 20: Realizing Our Power: Advocating for Social Justice

Chicago’s Urban Health Initiative“DELIVERING THE RIGHT CARE IN THE RIGHT PLACE AT THE RIGHT TIME”

Page 21: Realizing Our Power: Advocating for Social Justice

Wuhan, China

Page 22: Realizing Our Power: Advocating for Social Justice

Tulsa:Morton Comprehensive Health Services Program highlights

Transportation PAL clinic Multiple options for

specialty care referrals Example of limitations

of safety net

Page 23: Realizing Our Power: Advocating for Social Justice

Now that the Summer Institute is ending, what do I do next?

Page 24: Realizing Our Power: Advocating for Social Justice

Power, Privilege, Advocacy

The non-self serving influence of healthcare professionals to foster social justice in health care

Page 25: Realizing Our Power: Advocating for Social Justice

Power without Love……is reckless and abusive; love without power is sentimental and anemic. It is precisely this collision of immoral power with powerless morality which constitutes the major crisis of our time”

Martin Luther King, Jr.

Page 26: Realizing Our Power: Advocating for Social Justice

Love and Social Justice Justice validates the dignity of the

human person Love is the “driving force” behind

justice A spirit of love, humaneness, and

compassion in medicine and healthcare will minimize human suffering and maximize social good

The social good allows attainment of the “good life.”

Page 27: Realizing Our Power: Advocating for Social Justice

Power and Social-Justice Power can correct the inequities

Without power there can be no justice, Without justice inequities between the haves

and the have-nots can not be fairly resolved Power must often be exercised coercively

through appropriate laws and policy Laws must rest on moral reasons that the

public in whose name they are enacted could be expected reasonably to accept

Page 28: Realizing Our Power: Advocating for Social Justice

The Cost of Healthcare Privilege Professional education Self-justification of inequity – “I rose above

it” Rationalization - specialty procedures

“deserve” a higher price than primary care or cognitive specialty services

Status quo – our practice overhead is not under our control

Widening wealth-poverty gap in the U.S. leading to more working poor and uninsured individuals and demand for more charity care

Page 29: Realizing Our Power: Advocating for Social Justice

Financial Self-InterestA social-justice framework requires that physicians speak out against the forces that continue to make meaningful, truly universal health care unattainable, even when to do so temporarily contradicts their own financial interests.Do the Right Thing

Page 30: Realizing Our Power: Advocating for Social Justice

Don’t obtain screening exercise electrocardiogram testing in asymptomatic individuals and at low risk for coronary heart disease. (ACP)

Don’t perform stress cardiac imaging or advanced non-invasive imaging in the initial evaluation of patients without cardiac symptoms unless high-risk markers are present. (ACP)

Don’t do imaging for low back pain within the first six weeks, unless red flags are present. (AAFP)

Don’t do imaging for uncomplicated headache. (ACR)

Don’t obtain preoperative chest radiography in the absence of a clinical suspicion for intrathoracic pathology. (ACP)

Five Things Physicians and Patients Should

QuestionAAAI, AAFP, ACC, ACP, ACR, AGA, ASCO, ASN,

ASNC

Page 31: Realizing Our Power: Advocating for Social Justice

Support the Affordable Care Act“The Affordable Care Act seeks to increase access to high-quality, affordable healthcare for all Americans.

Three aims: better care for individuals, the community, and making it all more affordable. “Michael Maxwell, MD, OU-Tulsa Alumnus

Page 32: Realizing Our Power: Advocating for Social Justice

Advocate by Speaking Up“What we do know is that those of us with insurance pay for those without, access to care in many areas of our country, even some areas of the Tulsa region, is no better than that in third world countries, the quality of care is widely variable throughout the country. We know we can do better. This [ACA] law is a good start. Now if we can get out of our own way by fostering a spirit of cooperation, collaboration and innovation, we canpull off something great.”

Michael Maxwell, MD, OU-Tulsa Alumnus

Page 33: Realizing Our Power: Advocating for Social Justice

Exercise Political WillPassing the ACA, enduring the misrepresentation of its purpose and content as “Obamacare,” and the Supreme Court’s upholding its legality demonstrate the enormous political will necessary to bring the United States into the company of every other high-income country to assure that every citizen has adequate access to affordable healthcare.

Page 34: Realizing Our Power: Advocating for Social Justice

Free Our Society from Charity Care Demonstrates a fundamental respect

for human dignity Frees healthcare professionals to

spend more energy on patient care, instead of balancing charity care with making ends meet in practice

Bedlam can focus on excellent care for vulnerable patients and education of the next generation of professionalsJustin M. List, MD, Medicine Resident JAMA 2011

Page 35: Realizing Our Power: Advocating for Social Justice

Next steps: ACHIEVING HEALTH EQUITY IN THE MOST CHALLENGING ENVIRONMENTS

1. Critical thinking

2. Critical communication

3. Critical emotions

4. Critical actions

Page 36: Realizing Our Power: Advocating for Social Justice

Critical Thinking: Stay Informed! Medical Education Futures Study: social mission of medical

education Bi-weekly newsletter: www.medicaleducationfutures.org/newsletter

Oklahoma Policy Institute: issue briefs, email alerts www.okpolicy.org/

Health Affairs: eTOCs www.healthaffairs.org/

Health Begins (clinicians addressing social determinants of health) healthbegins.ning.com/ [email protected]

Page 37: Realizing Our Power: Advocating for Social Justice

Critical Communications Generous Listening Shared Decision

Making Learn Spanish!!! Speak up!

Op eds Opportunities to speak

Schools Churches Community centers

Page 38: Realizing Our Power: Advocating for Social Justice

Critical Emotions Keep a journal Record patient stories Talk to colleagues Self-care: “This is

your life” Exercise Relaxation/vacation Friends, family Healthy eating

Page 39: Realizing Our Power: Advocating for Social Justice

Critical Actions: Advocacy Individual: patients Groups:

Specialty choice Practice location

Systems: speak up when you see flaws in the system, innovate! Primarycareprogress.org Narrative Matters

www.healthaffairs.org/NM.php

Page 40: Realizing Our Power: Advocating for Social Justice

OU-Tulsa Center of Excellence

for Bioethics and Social Justice in

Healthcare


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