Activism 101 Public Health and Social Justice Martin Donohoe Perspective The earth spins at 1,038 mph at the equator, between 700 mph and.
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Transcript 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]