Social Justice in Medicine:Perspectives from History, Literature, and Photography

Martin Donohoe

PerspectiveThe earth spins at 1,038 mph at the

equator, between 700 mph and 900 mph at mid-latitudes

The earth rotates around sun at 18.5 miles/sec

The solar system orbits the center of the Milky Way Galaxy at 137 miles/secOne rotation per 225 million years

PerspectiveThe sun is one of hundreds of billions of stars in the Milky Way Galaxy

The Milky Way is one of over one hundred billion galaxies in the known universe

The universe may be one of an infinite number of universes

The Planets

Our Solar System

Jupiter = one pixel, Earth = invisible

Sun = one pixel, Jupiter = invisible

Our Home

Earth/Moon Seen by Voyager Spacecraft through Saturn’s Rings

Am I Stoned?A 1999 Utah anti-drug pamphlet warns:“Danger signs that your child may be smoking marijuana include excessive preoccupation with social causes, race relations, and environmental issues”

Harvey Cushing“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.”

Martin Luther King, Jr.

“Injustice anywhere is a threat to justice everywhere”

Important Historical Figures in Medicine/Public Health and Social JusticeFlorence NightingaleClara BartonMargaret SangerThomas HodgkinAlbert SchweitzerRachel CarsonLois Gibbs

Important Historical Figures in Medicine/Public Health and Social JusticeCharles DickensAnton ChekhovUpton SinclairGeorge OrwellWilliam Carlos Williams

Important Historical Figures in Public Health and Social JusticeDr. Thomas Hodgkin (abolitionist and

opponent of British oppression of native populations in South Africa and New Zealand)

Nurse Margaret Sanger (founder of the family planning movement in the US)

Dr. Albert Schweitzer (won Nobel Peace Prize in part for developing a missionary hospital for the poor in Gabon, Africa)

Important Historical Figures in Public Health and Social JusticeFlorence Nightingale (feminist, founder of

the modern nursing profession, and advocate for hygienic hospitals)

Dr. Salvador Allende (assassinated president of Chile and promoter of better living conditions for the poor and working classes).

*The quiet and unknown*

Rudolph VirchowFounder of modern pathology

Thrombosis, pulmonary embolism, leukocytosis, leukemia

Member of state and local government for over 30 years

Founded journal Medical Reform

Rudolph VirchowArgued that many diseases result from “the unequal distribution of civilization’s advantages”

Advocated public provision of medical care for the indigent

Promoted universal education

Rudolph VirchowWorked to outlaw child laborImproved water distribution and sewage system

Enhanced food inspection processPublished study of skull volumes to dispute myth of larger Aryan brains

Rudolph VirchowPassed hygiene standards for public schools

Set new standards of training for nurses

Improved local hospital system

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…”

The Role of LiteratureVicarious experienceExplore diverse philosophiesPromotes empathy, critical thinking, flexibility, non-dogmatism, self-knowledge

Encourages creative thinkingAllows for group discussion/debate

Why Study Literature?“Why live? Life without literature is reduced to penury. It expands you in every way. It illuminates what you’re doing. It shows you possibilities you haven’t thought of. It enables you to live the lives of other people…It broadens you, it makes you more human. It makes life more enjoyable.”

M.H. Abrams

Race and Access to CareErnest J Gaines

“The Sky is Gray”

in Gray, Marion Secundy, ed. Trials,Tribulations, and Celebrations: African American Perspectives on Health, Illness, Aging and Loss. Yarmouth, Maine: Intercultural Press, 1992

U.S. Health CarePer capita expenditure on health

care = $8,160Typical poor African/Asian country = $5-50

49 million uninsured48,000 deaths/yr

Health outcomes poor

Headline from The Onion

Uninsured Man Hopes His Symptoms Diagnosed This

Week On House

Racial Disparities in Health Care:African-AmericansHigher maternal and infant mortality

Higher death rates for most diseases

Shorter life expectanciesLess health insuranceUndergo fewer diagnostic tests / therapeutic procedures

Racial Disparities in Health Care:African-AmericansEqualizing the mortality rates of whites and African-Americans would have averted 686,202 deaths between 1991 and 2000Whereas medical advances averted 176,633 deathsAJPH 2004;94:2078-2081

PovertyOrwell, George. How the Poor Die. In Sonia Orwell and Ian Angus, eds. The Collected Essays, Journalism and Letter of George Orwell, IV; In Front of Your Nose, 1945-1950. New York: Harcourt, Brace and World, Inc: pp.223-233.

Jacob Riis

Dorothea Lange

Poverty and Inequality in the U.S.22% of children live in poverty

Food insecurity common

Gap between rich and poor widening, largest of any industrialized nation

Poverty Worldwide1.1 billion people lack access to

safe, clean drinking water2.6 billion do not have adequate

sanitation servicesHunger kills 18,000 people per day,

most under age 5

James Nachtwey

Maldistribution of WealthRichest 1% own 46% of the world’s wealth

Top 85 billionaires worldwide worth $1.7 trillion, the combined income of bottom 3.5 billion people (1/2 of world’s population)

Maldistribution of WealthU.S: Richest 1% of the population owns 40% of the country’s wealth -poorest 90% own 30%-widest gap of any industrialized nation

Overconsumption (“Affluenza”)U.S. = 6.3% of world’s population

Owns 50% of the world’s wealth

U.S. responsible for:25% of world’s energy consumption33% of paper use72% of hazardous waste production

Income InequalityLower life expectancyHigher rates of infant and child mortality

Short heightPoor self-reported healthAIDS

Income InequalityDepressionMental IllnessObesityCrimeDiminished trust in people and institutions (↓ social cohesion/happiness)

Maldistribution of Wealth is Deadly880,000 deaths/yr in U.S. would be averted if the country had an income gap like many Western European nations, with their stronger social safety nets

BMJ 2009;339:b4471

U.S. Constitution/Thomas Jefferson

“All men are created equal”

George Orwell

“Some people are more equal than others”

Voltaire

“The comfort of the rich rests upon an abundance of the poor”

Hudson River, 2009

Primo Levi“A country is considered the more civilized the more the wisdom and efficiency of its laws hinder a weak man from becoming too weak or a powerful one too powerful.”

Homelessness

Doris Lessing. “An Old Woman and Her Cat”

From the Doris Lessing Reader (New York: Knopf, 1988)

Rachel Adams

Homeless3 million homeless (13-17% of homeless adults work)7% lifetime prevalence

Combined income of 10 richest American’s could pay one year’s rent for every homeless person

Women’s RightsViolence against womenAccess to reproductive health careFemale genital cuttingPolitical, legal, and educational marginalizationWomen do 67% of the world’s workReceive 10% of global incomeOwn 1% of all property

IssuesEnvironmental degradation

OverpopulationAir and water pollutionToxinsDeforestationGlobal warming

IssuesEnvironmental degradation

Unsustainable agricultural and fishing practices

FamineCommodification of world’s food and water supply by corporations

Species loss

Toxins:Minimata Disease - W Eugene Smith

Wars and Human Rights Abuses250 wars in 20th CenturyWorld military budget = $1.8 trillion

in 2012US - largest military budget, largest

arms supplierGreatest debtor to UN peacekeeping fund

Non-cooperation viz a viz international agreements

Colonial ExploitationChristopher Columbus’ log entry upon

meeting the Arawaks of the Bahamas:“They…brought us…many…things…They willingly traded everything they owned…They do not bear arms…They would make fine servants…With fifty men we could subjugate them all and make them do whatever we want.”

Colonial ExploitationCecil Rhodes (Rhodesia, Rhodes Scholarship,

DeBeers Mining Company):“We must find new lands from which we can easily obtain raw materials and at the same time exploit the cheap slave labour that is available from the natives of the colonies. The colonies would also provide a dumping ground for the surplus goods produced in our factories.”

WarWars often fueled by battles over natural resources:LandWaterGold, diamonds, rare earth metals

Sebastiao Salgado

Sebastiao Salgado

Sebastiao Salgado

Sebastiao Salgado

Sebastiao Salgado

The Military: Diversion of Resources Away from Health Care3 hours world arms spending = annual

WHO budget1/2 day of world arms spending = full

childhood immunizations for all world’s children

3 weeks of world arms spending/yr. = primary health care for all in poor countries, incl. safe water and full immunizations

“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.”

~ Dwight D. Eisenhower

Impediments to Public Health and Social JusticeScientific IgnorancePseudoscienceDamaged educational systemThe corporate media/media

consolidation

All lead to the decline of democracy“Information is the currency of

democracy” (Thomas Jefferson)

What you can doExplore the history of medicineRead great literature

Patients illnesses are storiesDevelop a public health-oriented perspective in care of patients

Find your passion

Work Together“Never doubt that a small group of thoughtful, committed people can change the world. Indeed, it is the only thing that ever has.“

- Margaret Mead

Speak Up for the Disenfranchised

“The first job of a citizen is to keep your mouth open.”

- Günter Grass

“First they came for the Jews”by Pastor Niemoller“First they came for the Jews, and I did not

speak up, for I was not a Jew.Then they came for the communists, and I

did not speak up for I was not a communist.Then they came for the trade unionists, and I

did not speak up, for I was not a trade unionist.

Then they came for me, and there was no one left to speak up for me.”

African ProverbIf you think you are too small to have an impact, try going to bed with a mosquito in your tent

Contact InformationPublic Health and Social

Justice Website

http://www.phsj.orgmartindonohoe@phsj.org