For Academic Medical Centers, There’s More To Healthcare Than Medicine, Experts Say

Aspiring doctors and healthcare leaders must have a keen understanding of how racism, poverty and environmental factors can affect health. A panel at Association of American Medical Colleges' conference examined the role of social justice and advocacy in improving public health.

As more attention is focused on the social factors challenging public health, doctors and healthcare leaders are being urged to take a more active role in addressing those issues.

A seminar at the Association of American Medical Colleges annual conference Tuesday examined the intersection of academic medicine and health equity. The panelists discussed the role of doctors and healthcare leaders as advocates in law and public policy.

The panelists talked about the importance of medical colleges in training doctors to see that healthcare can be greatly affected by poverty, geography and a host of other challenges.

Yael Cannon, associate professor of law at Georgetown University Law Center, talked about how medical students need to understand the concept of health justice. She said health justice - and she stressed the word “justice” - involves racial justice, economic justice and gender justice, among others.

“Our learners who learn through this model are going to go out and practice differently,” Cannon said.

In highly impoverished neighborhoods in southeastern Washington, D.C., just a few miles from the Georgetown campus, life expectancy is typically 15 years shorter, she noted. After seeing families dealing with high levels of lead poisoning, Georgetown law students pushed Washington city officials on lead remediation efforts.

Academic medicine can offer an understanding of how the law affects public health, Cannon said. She argued it’s critical for doctors and aspiring doctors to understand how structural racism, economic inequality and education can adversely affect an individual’s health.

In September, the AAMC established its new Center for Health Justice to address inequities in healthcare. The center aims to work with healthcare centers, community groups and government officials to tackle the health impact of racism, income inequality and gender bias.

“Solutions to health injustice don’t lie solely within the health sector,” said Olufunmilayo Makinde, a health equity research analyst at AAMC.

The AAMC Center for Health Justice is working to collect data to offer a clearer picture of healthcare inequity. Medical experts have pointed to the COVID-19 pandemic as evidence of an incomplete system in collecting healthcare data. In too many instances, healthcare officials said information on new infections lacked race and ethnicity data.

Makinde also talked about the importance of engaging with community groups with a sense of humility to improve healthcare.

Doctors need to understand that environmental hazards pose disproportionate harm to vulnerable communities, said Tracey Woodruff, a professor of obstetrics and gynecology and director of the Program on Reproductive Health and the Environment at the University of California, San Francisco.

While many are exposed to harmful chemicals, neighborhoods with higher populations of minority groups often suffer more serious exposures and health complications.

“Communities of color have higher exposure to many different types of pollutants,” Woodruff said.

“All exposures aren’t equal.”

Scientists and healthcare professionals changed the law in California, Woodruff explained. She pointed to California’s ban of certain flame retardant chemicals widely used in foam, furniture and other products. After the ban, pregnant women showed reduced levels of those chemicals.

But she noted there are countless other ways chemicals can harm people.

“Environmental exposures are ubiquitous,” she said.

Cannon said it’s important for medical centers to think about ways they can break down their silos and build partnerships within their communities to improve health. She also said healthcare professionals need to embrace the role of being advocates, including working with lawmakers to enact changes in public policy.

Academic medical centers must train doctors to be open-minded when it comes to dealing with patients who may have health conditions, Woodruff said. It involves being willing to listen to patients.

But Woodruff also acknowledged the difficulty in getting doctors and healthcare leaders to embrace advocacy and take on a larger role. Healthcare professionals who are busy with a large number of patients may wonder about the value of doing something differently.

“People get embedded in the ways they’re used to working,” Woodruff said. “We need to upgrade the way we’re working together and thinking about the influences of health.”