Public Health and Social Justice: Linking Sciences and Humanities

1. Public Health and Social Justice:Linking the Sciences and Humanities Martin Donohoe, MD, FACP

2. Overview • Issues • Literature and Public Health • Quotes • Photos • Education, the media, and democracy • Time Permitting • Case Study in Institutional Ethics: • GE – NY Presbyterian Hospital agreement

3. Portland, OregonMount Hood

4. Multnomah Falls, Oregon

5. 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”

6. Martin Luther King “Injustice anywhere is a threat to justice everywhere”

7. 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.”

8. Medicine and Public Health • Schism between the fields • Witnessed victims vs. “statistical” victims • Medical ethics / public health ethics • Activism

9. Important Historical Figures in Medicine/Public Health and Social Justice • Florence Nightingale • Clara Barton • Margaret Sanger • Thomas Hodgkin • Albert Schweitzer

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

11. 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

12. 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

13. 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

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

15. 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…”

16. Issues • Access to care • Racial, sexual and SES discrepancies in outcomes • The effects of poverty on health

17. Issues • Corporatization of academic and clinical medicine • Boutique Medicine • Outsourcing of medical care • Developing world brain drain

18. Issues • The role of the pharmaceutical industry • Drug promotion and advertising • Drug pricing • Conflicts of interest • Balancing responsibilities to self, patients, insurers, colleagues, and community

19. Issues • Women’s rights issues: • Violence against women • Teen pregnancy • Female genital mutilation • Political, legal, and educational marginalization • Sexual harassment

21. Issues • Homelessness • Substance abuse • Tobacco industry • Privacy: • Genetic testing • Drug testing

22. Issues • Medical mistakes • Impaired providers • Health care fraud

23. Issues • Human subject experimentation • Nazis, Japan’s Unit 731 • Tuskegee Syphilis Study • Willowbrook Hepatitis Experiments • Henry Beecher • U.S. government-sponsored radiation experiments • Nuremberg Code, Helsinki Conventions

24. Issues • Human Subject Experimentation - Contemporary Issues: • Special populations (e.g., prisoners, cultural minorities, the mentally ill) • Internationalization of research • Use of placebo controls • The role of for-profit IRBs • cloning

25. Issues • Environmental degradation • Overpopulation • Air and water pollution • Toxins • Deforestation • Global warming • Unsustainable agricultural and fishing practices • Famine • GMOs, biopharming, and rBGH

26. Air Pollution

27. Air Pollution

28. Air Pollution

29. Water Pollution:Bathtub=Toilet=Source of Drinking Water

30. Deforestation:Clear Cutting with Corridors

31. Minimata DiseaseW Eugene Smith

32. Greenland’s Ice Cap Melting: 1992

33. Greenland’s Ice Cap Melting: 2002

34. Greenland’s Ice Cap Melting: 2005

35. Glaciers Calving

36. Drought

37. Factory Farming

38. Factory Farming

39. Overfishing:Factory Trawlers

40. Dynamite Reef Fishing

41. Issues • Environmental degradation – social justice contributors: • Species loss • Third World debt crisis • Human rights abuses

42. Polar Bears Stranded / Dying Off

43. A Cure for Cancer?

45. Wallace Stegner “We simply need … wild country available to us, even if we never do more than drive to its edge and look in. For it can be a means of reassuring ourselves of our sanity as creatures, a part of the geography of hope”

47. Issues • Social justice: • Overconsumption (“affluenza”) • Maldistribution of wealth • Rise of the corporation

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

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