Activism 101 Public Health and Social Justice Martin Donohoe Perspective The earth spins at 1,038 mph at the equator, between 700 mph and.
Download ReportTranscript Activism 101 Public Health and Social Justice Martin Donohoe Perspective The earth spins at 1,038 mph at the equator, between 700 mph and.
Activism 101 Public Health and Social Justice Martin Donohoe Perspective The earth spins at 1,038 mph at the equator, between 700 mph and 900 mph at midlatitudes 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 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 The Planets Our Solar System Stars in the Milky Way Galaxy Stars in the Milky Way Galaxy 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 Justice Florence Nightingale Clara Barton Margaret Sanger Thomas Hodgkin Albert Schweitzer Rachel Carson Lois Gibbs Important Historical Figures in Medicine/Public Health and Social Justice Charles Dickens Anton Chekhov Upton Sinclair George Orwell William Carlos Williams 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) 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* 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 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 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 Rudolph Virchow Passed 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…” Premature Deaths in the U.S. 10% due to inadequate medical care 60% due to behaviors, social circumstances, and environmental exposures Social Factors Responsible for Illness and Death Deaths in 2000 attributable to: Low education: 245,000 Racial segregation: 176,000 Low social support: 162,000 Individual-level poverty: 133,000 AJPH 2011;101:1456-1465 Social Factors Responsible for Illness and Death Deaths in 2000 attributable to: Income inequality: 119,000 (population-attributable mortality – 5.1%) Area-level poverty: 39,000 (population-attributable mortality – 1.7%) AJPH 2011;101:1456-1465 Social Factors Responsible for Illness and Death Deaths in 2000 attributable to: AMI – 193,000 CVD – 168,000 Lung CA – 156,000 AJPH 2011;101:1456-1465 The Role of Literature Vicarious experience Explore diverse philosophies Promotes empathy, critical thinking, flexibility, non-dogmatism, selfknowledge Encourages creative thinking Allows 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 U.S. Health Care Per capita expenditure on health care = $9,255 Typical poor African/Asian country = $550 41 million uninsured 48,000 deaths/yr Health outcomes poor Headline from The Onion Uninsured Man Hopes His Symptoms Diagnosed This Week On House 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 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 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 Poverty George Orwell “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, 19451950. 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 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 James Nachtwey Maldistribution of Wealth Richest 1% (net worth of $800,000+) owns 48% of the world’s wealth Over 500 billionaires worldwide Top 85 billionaires worth $1.7 trillion, the combined income of bottom 3.5 billion people (1/2 of world’s population) 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 Overconsumption (“Affluenza”) U.S. = 4.5% 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 Income Inequality Lower life expectancy Higher rates of infant and child mortality Short height Poor self-reported health AIDS Income Inequality Depression Mental Illness Obesity Crime Diminished trust in people and institutions (↓ social cohesion/happiness) 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 Education Medical advances averted a maximum of 178,000 deaths between 1996 and 2002 Correcting disparities in educationassociated mortality would have save 1.3 million lives during the same period AJPH 2007;97:679-83 Benefits of Education For every $1 spent on early childhood education, up to $17 are saved from increased school achievement, improved health, reduced crime, and reduced reliance on public assistance Income increases 11% for every year of education Benefits of Education College graduates live 5 years longer than high school dropouts Eliminating educational inequities would have saved 8X as many lives as medical advances from 1996-2002 Declaration of Independence Thomas Jefferson “All men are created equal” Care for All Equally “A society should be judged not by how it treats its outstanding citizens, but by how it treats its criminals” -Fyodor Dostoyevsky 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 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 Women’s Rights Violence against women Access to reproductive health care Female genital cutting Political, legal, and educational marginalization Economic Gender Disparities Worldwide, women do 2/3 of the world’s paid and unpaid work (1/3 paid, 2/3 unpaid) Hold 20% of legislative seats Receive 10% of global income Own 1% of global property Women make up 45% of the employed global workforce, yet account for 70% of the world’s poor Environmental Degradation Overpopulation Air and water pollution Toxins Deforestation Global warming Environmental Degradation Unsustainable agricultural and fishing practices Famine Commodification of world’s food and water supply by corporations Species loss Toxins: Minimata Disease - W Eugene Smith Wars and Human Rights Abuses 250 wars in 20th Century World military budget = $1.8 trillion in 2012 US - largest military budget, largest arms supplier Greatest debtor to UN peacekeeping fund Non-cooperation viz a viz international agreements Colonial Exploitation Christopher 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 Exploitation Cecil 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.” War Wars often fueled by battles over natural resources: Land Water Gold, diamonds, rare earth metals Sebastiao Salgado Sebastiao Salgado Sebastiao Salgado Sebastiao Salgado Sebastiao Salgado Robert Capa Nick Ut James Nachtwey The Military: Diversion of Resources Away from Health Care 3 hours world arms spending = annual WHO budget 1/2 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 Justice Scientific Ignorance Pseudoscience Damaged educational system The corporate media/media consolidation All lead to the decline of democracy “Information is the currency of democracy” (Thomas Jefferson) What you can do Explore the history of medicine Read great literature Patients illnesses are stories Develop a public health-oriented perspective in care of patients Find your passion Political Solutions Vote (physician voter turnout low) Run for office (physician-legislators rare) Lobby legislators (visits > calls > letters > emails) Shift focus from reimbursement rates to social justice issues Advocacy Environmental preservation Women’s rights Marginalized populations Tax and election reform Combat corporate malfeasance Halt militarism and promote peace Encourage U.S. international cooperation Follow precautionary principle Get Politically Active Physicians have an obligation, borne of their privileged status, the public’s investment in their training, and their roles as stewards of the public’s health, to be politically active and ensure that our leaders provide for the sickest among us. 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 Proverb If you think you are too small to have an impact, try going to bed with a mosquito in your tent Contact Information Public Health and Social Justice Website http://www.publichealthandsocialjustice.org http://www.phsj.org [email protected]