Providers need to address ‘marginalization, exclusion, discrimination’ in the populations served

By Esperanza Cantu

In the TED Talk https://www.ted.com/talks “Why your doctor should care about social justice,” Mary Bassett, MD, MPH, current commissioner of the New York City Department of Health and Mental Hygiene, speaks about her experience understanding the core of health equity and social justice after time she spent serving as medical faculty in Zimbabwe for almost 20 years.

During her time in Zimbabwe, she participated in multiple interventions that spanned the social determinants of health. Now, she recognizes that she was not advocating for the structural change that is necessary to truly impact population health. Specifically, she mentions the AIDS epidemic and how she and others likely regret not having done more earlier to save lives.

Biomedical epidemics reflect not just biology, but especially the impact of “marginalization, exclusion, discrimination related to race, gender, sexuality, class and more.” Bassett mentions the medical anthropologist Paul Farmer who refers to this as ‘structural violence’ because “inequities are embedded in the political and economic organization of our social world, often in ways that are invisible to those with privilege and power; and violence because its impact—premature deaths, suffering, illness—is violent.”

Inherent in her message is the need to sound the alarm to do public health right, and how to create real change together, despite how different stakeholders may feel uncomfortable talking about racism. Her call-to-action includes sounding alarms about “the impact of racism on health in the United States, the ongoing institutional and interpersonal violence that people of color face, compounded by our tragic legacy of 250 years of slavery, 90 years of Jim Crow and 60 years of imperfect equality,” and she considers this central to her current role in New York.

Health professionals are witness to great injustice consistently, and she believes we need to treat patients well and also sound the alarm and advocate for change; she notes that “rightfully or not, our societal position gives our voices great credibility, and we shouldn’t waste that.”

View her TED Talk here:

http://www.ted.com/talks/mary_bassett_why_your_doctor_should_care_about_social_justice

Esperanza Cantu is the 2015-16 W.K. Kellogg Fellow at Authority Health.