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

1. Social Justice in Medicine: Perspectives from History, Literature, and Photography Martin Donohoe

2. Perspective • The 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/sec • One rotation per 225 million years

3. Perspective • The 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

4. The Planets

5. Our Solar System

6. Jupiter = one pixel, Earth = invisible

7. Sun = one pixel, Jupiter = invisible

8. Our Home

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

10. 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”

11. 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.”

12. Martin Luther King, Jr. “Injustice anywhere is a threat to justice everywhere”

13. Important Historical Figures in Medicine/Public Health and Social Justice • Florence Nightingale • Clara Barton • Margaret Sanger • Thomas Hodgkin • Albert Schweitzer • Rachel Carson • Lois Gibbs

14. Important Historical Figures in Medicine/Public Health and Social Justice • Charles Dickens • Anton Chekhov • Upton Sinclair • George Orwell • William Carlos Williams

15. Important Historical Figures in Public Health and Social Justice Dr. 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)

16. Important Historical Figures in Public Health and Social Justice Florence 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*

17. Rudolph Virchow • Founder of modern pathology • Thrombosis, pulmonary embolism, leukocytosis, leukemia • Member of state and local government for over 30 years • Founded journal Medical Reform

18. Rudolph Virchow • Argued that many diseases result from “the unequal distribution of civilization’s advantages” • Advocated public provision of medical care for the indigent • Promoted universal education

19. Rudolph Virchow • Worked to outlaw child labor • Improved water distribution and sewage system • Enhanced food inspection process • Published study of skull volumes to dispute myth of larger Aryan brains

20. Rudolph Virchow • Passed hygiene standards for public schools • Set new standards of training for nurses • Improved local hospital system

21. 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…”

22. The Role of Literature • Vicarious experience • Explore diverse philosophies • Promotes empathy, critical thinking, flexibility, non-dogmatism, self-knowledge • Encourages creative thinking • Allows for group discussion/debate

23. 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

24. Race and Access to Care Ernest 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

25. U.S. Health Care • Per capita expenditure on health care = $8,160 • Typical poor African/Asian country = $5-50 • 49 million uninsured • 48,000 deaths/yr • Health outcomes poor

26. Headline from The Onion Uninsured Man Hopes His Symptoms Diagnosed This Week On House

27. Racial Disparities in Health Care:African-Americans • Higher maternal and infant mortality • Higher death rates for most diseases • Shorter life expectancies • Less health insurance • Undergo fewer diagnostic tests / therapeutic procedures

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

29. Poverty • Orwell, 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.

30. Jacob Riis

31. Dorothea Lange

32. 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

33. Poverty Worldwide • 1.1 billion people lack access to safe, clean drinking water • 2.6 billion do not have adequate sanitation services • Hunger kills 18,000 people per day, most under age 5

34. James Nachtwey

36. Maldistribution of Wealth • Richest 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)

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

38. 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 consumption • 33% of paper use • 72% of hazardous waste production

39. Income Inequality Lower life expectancy Higher rates of infant and child mortality Short height Poor self-reported health AIDS

40. Income Inequality Depression Mental Illness Obesity Crime Diminished trust in people and institutions (↓ social cohesion/happiness)

41. Maldistribution of Wealth is Deadly • 880,000 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

42. U.S. Constitution/Thomas Jefferson “All men are created equal”

43. George Orwell “Some people are more equal than others”

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

45. Hudson River, 2009

46. 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.”

47. Homelessness Doris Lessing. “An Old Woman and Her Cat” From the Doris Lessing Reader (New York: Knopf, 1988)

49. Rachel Adams

50. Homeless • 3 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