The COVID-19 pandemic, if nothing else, has aimed a harsh light at our healthcare systems, illuminating the type of public health system we all need to better prepare for the next pandemic. To a person, it behooves us to work on changing these uncovered and pressing issues that COVID-19 has now exposed, so that we can be stronger as we move forward into a post-pandemic society. But what is in our lane of responsibility and what is not?
The healthcare playing field has never been level — neither in access, opportunity nor equity towards quality. One of the scathing failures of our healthcare systems — known about pre-pandemic — has now been exacerbated by the virus. Black, Indigenous, and People of Color (BIPOC) are becoming infected and dying at disproportionate rates compared to their white neighbors. This is not new. While it may be a novel virus, the underlying instigator for their health issues remains the same — the social determinants of health.
Let me be clear. As physicians, understanding and diagnosing social determinants of health is in our lane. We do have the bandwidth to both care for patients and attend to issues related to social justice. Is there an expectation that we can serve, for example, as a talented social worker in helping our patients with a housing issue? Of course not. This is why, in quality healthcare systems, we work to deploy team-based care. What we, as clinicians, can do is become more aware of how these determinants have immediate care implications on patient outcomes. Our patient, for example, might not be taking her or his medicine because of a problem with housing. Most physicians I know are talented individuals who can comprehensively look at care and connect with other colleagues to achieve sought after outcomes.
But for many decades we have not done this. Perhaps due to the tumultuous issues in our world, many people are uncomfortable with addressing the history of medicine. Medicine has ushered us into a world with longer lifespans and innovation in acute and chronic diseases, so there is much to be proud about. Simultaneously, medicine has a grim history that we need to teach, address and intentionally and actively, disrupt. That reckoning includes acknowledging Henrietta Lacks’ experience, the Tuskegee Study experiment, long-standing health disparities for Indigenous people, Mississippi appendectomies, La Operation and more. Our medical history has hurt BIPOC and it is our collective imperative to be transparent with our history, to atone for our past, and meaningfully pledge to actively change the way we operate.
So, what will it take to make medicine “just”? To move the needle in terms of access to health? To appropriately represent, include and care for our patients and communities? The path is long and challenging, as much as with any novel virus. We need to delve into root-cause analyses to avoid focusing exclusively on simple, superficial issues. By diving deeply into what maintains our status quo, we can transform our siloed environments into productive, matrixed teams. Working to find the best talent, to include all voices, to provide opportunities to overcome barriers to access, are all ways that diversity, equity and inclusion can propel systems to mission excellence. And, all three pieces play a critical role in sustainable, transformational change. If you don’t have inclusion, why should they go to work? If you don’t have equity, how will you retain them? If you don’t have diversity, how will you get those robust ideas your team needs? They are linked concepts. The good news is that the “elephant in the room” is large, so there are many places to touch it, and a lot of ways that you can make progress relevant to your institutional goals.
At an individual level, start with your medical specialty and its affiliated medical organization. Look there for advocacy opportunities to engage in. At home, take an open spot at your local soup kitchen. Immerse yourself in the communities that we have failed to serve equitably to learn more about their lived experiences. Support scholarships and training opportunities. And, keep reading and watching online talks and webinars. Continue to educate yourself about the social determinants of health and finding initiatives you can help collaborate on.
Success looks like all of us having a voice around a common goal that has meaning and purpose. As we co-create impactful solutions, we can dynamically problem-solve, improve our relationships and address the bigger challenges, together. No, it’s not a small lift, but it is totally in line with improving the quality of medicine, safety, and advocacy for our patients. Our oath says, “do no harm.” We need to collaborate to do good. Those are all ingredients to make medicine just, and yes that is in our lane, squarely in our lane.