HSCI 101: Introduction to the Health Science Professions

Health and Social Justice

F.S. Rosenthal, Ph.D.frank@purdue.eduDecember 6, 2011

Purdue University School of Health Sciences

Why this lecture is important…

• Social Justice is essential in caring for the sick and improving health of people.

• Health professionals have opportunities and obligations to consider social justice issues in their work.

• Social Justice should be a concern of all members of society.

What is Social Justice?• Social justice generally refers to the idea of

creating an egalitarian society or institution that is based on the principles of equality and solidarity, that understands and values human rights, and that recognizes the dignity of every human en.wikipedia.org/wiki/Social_justice

• The fair and proper administration of laws conforming to the natural law that all persons, irrespective of ethnic origin, gender, possessions, race, religion, etc., are to be treated equally and without prejudice. http://www.businessdictionary.com/definition/social-justice.html

•

• Social justice means moving towards a society where all hungry are fed, all sick are cared for, the environment is treasured, and we treat each other with love and compassion. Not an easy goal, for sure, but certainly one worth giving our lives for! http://www.reachandteach.com/content/index.php?topic=socialjustice

Social Justice

• Equality and fairness• Human rights and dignity• Fulfillment of human needs

What are the goals of Health Professionals?

• Care for the sick• Reduce illness through prevention, diagnosis

and treatment.• Increase human health, longevity, productivity,

potential and well-being.

How do the goals of health professionals and social justice relate?

Health Professionals •Care for the sick•Reduce illness through prevention, diagnosis and treatment.•Increase human health, longevity, productivity, potential and well-being.

Social Justice•Fairness and equality•Human rights and dignity•Fulfillment of human needs

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Statement by the National Association of County and City Health Officials

“We embrace social justice as the cornerstone of our work…We advocate for comprehensive strategies that attend to the root determinants of health such as standard of living, quality of housing and education…”

Topics

• Social Injustice – Health Indicators– Unequal access to healthcare– Environmental Justice– Effects of war on health

• What Health Professionals (and Students) Can Do

Factors Influencing Infant Mortality

• Poor nutrition• Poor housing• Lack of access to prenatal and infant healthcare

services• Lack of access to preventive health information• Low birthweight and pre-term births• Infant mortality is considered an indicator of the

general health of a population

http://en.wikipedia.org/wiki/Infant_mortality

U. S. rate = 6.8

Infant Mortality Rates in the U.S.

Deaths (< age 1 y) per 1,000 live birthsNon-Hispanic White 5.7Non-Hispanic Black 13.4Hispanic 5.3Total 6.8

http://www.statehealthfacts.org/profileind.jsp?ind=48&rgn=1&cat=2

Unhealthy housing

• Defined by conditions such as rodents recently seen, leaks in preceding 12 months, peeling paint, no working smoke alarm, etc.

• Increase in unhealthy housing compared to white population– Blacks -- 30% … – Hispanics -- 10% …– American Indians/Alaskan natives -- 60% …

Centers for Disease Control, Health Disparities and Inequalities Report, 2011 (data from 2009)

Coronary Heart Disease Deaths for Men per 100,000 population

Age White Black45-54 86.2 130.955-64 221.7 340.165-74 483.8 704.975-84 1456.9 1275.5>85 3396.0 2656.7

Centers for Disease Control, Health Disparities and Inequalities Report, 2011 (data from 2006)

Unhealthy air qualityPercent of Population Living in Areas with Air

Pollution Levels Exceeding EPA standardsFine

Race/Ethnicity Particulate OzoneWhite 9.7 32.0Black 15.2 40.0Asian 26.2 50.2Amer Indian 8.2 18.6Hispanic 26.6 48.4

Centers for Disease Control, Health Disparities and Inequalities Report, 2011 (data from 2006-2009)

Inadequate Health Insurance

White 14.6Black 22.1Hispanic 41.6

Nonpoor1 8.9 Near-poor2 30.5Poor3 37.0

Income Level1 > 3 times Federal Poverty Level (FPL)2 1.0 – 2.9 times FPL3 < FPL

Centers for Disease Control, Health Disparities and Inequalities Report, 2011 (data from 2008

Percent, Aged 18-64 Without Health Insurance

Study by Woolf et al in the American Journal of Public Health (2008)…

• “…For 1991 to 2000, we contrasted the number of lives saved by medical advances with the number of deaths attributable to excess mortality among African Americans. Medical advances

averted 176,633 deaths, but equalizing the mortality rates of Whites and African Americans would have averted 886,202 deaths. Achieving equity may do more for health than perfecting the technology of care.

Woolf, SH, et al. The Health Impact of Resolving Racial Disparities: An Analysis of US Mortality Data Steven H. Woolf, MD, Am. J. Pub. Health, 2008.

Effects of War on Health and the Environment

• Civilian casualties• Environmental destruction and contamination• Huge needs for care of returning veterans. • Effects on families and social health (PTSDs,

divorce, homelessness, drug addiction, suicide).• Carbon “footprint” of military activities• Depletion of funds needed for social progams.

“Every gun that is made, every warship launched, every rocket fired signifies, in the final sense, a theft from those who hunger and are not fed, those who are cold and not clothed. This world in arms is not spending money alone. It is spending the sweat of its laborers, the genius of its scientists, the hopes of its children. “

-- Dwight Eisenhower34th President of the U.S.5-star GeneralSupreme Commander of the Allied Forces in Europe (WW II)

Social Justice – What Health Professionals (and Students) Can Do…

• Work in underserved areas• Work with professional and health advocacy

organizations.• Advocate for government programs that

address health inequities.• Promote social and economic justice in all

areas of society.

http://phsj.org/activism-and-education

Rudolph Virchow 1821 - 1902German Physician, ScientistFounder of Modern PathologyIdentified Role of cells in disease.

Worked to outlaw child labor.Worked for improvements in sewage systems and food inspections. Advocated for free medical care for the poor.

Considered a founder of “Social Medicine” – based on the idea that health and disease largely arise from social conditions.

• “A physician is obligated to consider more than a diseased organ, more even than the whole man - he must view the man in his world.”

• Harvey Cushing, MD (1869-1939), American Neurosurgeon

• “Every article I wrote in those days, every speech I made, is full of pleading for the recognition of lead poisoning as a real and serious medical problem. “– Alice Hamilton, MD (1869- 1970) – Physician– Activist – Social Reformer

Some Organizations…

• Center for prisoner health and human rights• http://www.prisonerhealth.org/• • Grassroots soccer• http://www.grassrootsoccer.org/• • Doctors without borders• http://www.doctorswithoutborders.org/• • Physicians for Social Responsibility• http://www.psr.org/

• IU-Kenya Partnership AMPATH• http://medicine.iupui.edu/kenya/• • Hoosiers for a Commonsense Health Plan• http://www.hchp.info/• • Illinois Physical Therapy Association• http://www.ipta.org/?SocialResponsibility

• Maquiladora Health and Safety Support Network • http://mhssn.igc.org/

• The end• Acknowledgement. Some material was

adapted from a slide show by Martin Donohoe (see: http://phsj.org/biography/)