Journal of General Internal Medicine

, Volume 25, Supplement 2, pp 182–185

Teaching About Health Disparities Using a Social Determinants Framework

Perspectives

Abstract

The intersection of two trends in health intervention has the potential to fundamentally change the practice of medicine. First, research into the social determinants of health is revealing the mechanisms by which living conditions cause disease. Second, the restructuring of primary care around preventive interventions represents the convergence point of medicine and public health. These trends have profound implications for medical education. Whereas traditional educational paradigms favor a “bottom-up” approach to disease—focusing on molecular origins or organ systems—new paradigms must emphasize the entire causal chain of ill health to facilitate the understanding of novel interventions available to tomorrow’s clinician.

KEY WORDS

medical education health disparities social determinants of health 

References

  1. 1.
    Satcher D. The Initiative to eliminate racial and ethnic health disparities is moving forward. Public Health Rep. 1999;114:283–7.CrossRefPubMedGoogle Scholar
  2. 2.
    Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. Washington, D.C.: Institute of Medicine; 2002.Google Scholar
  3. 3.
    Functions and Structure of a Medical School: Standards for Accreditation of Medical Education Programs Leading to the M.D. Degree. Washington, D.C.: Liaison Committee on Medical Education; 2008.Google Scholar
  4. 4.
    Smith WR, Betancourt JR, Wynia MK, Bussey-Jones J, Stone VE, Phillips CO, Fernandez A, Jacobs E, Bowles J. Recommendations for teaching about racial and ethnic disparities in health and health care. Ann Intern Med. 2007;147:654–65.PubMedGoogle Scholar
  5. 5.
    Isaacs SL, Schroeder SA. Class - the ignored determinant of the nation's health. N Engl J Med. 2004;351:1137–42.CrossRefPubMedGoogle Scholar
  6. 6.
    Marmot M, Friel S, Bell R, Houweling TA, Taylor S. Closing the gap in a generation: health equity through action on the social determinants of health. Lancet. 2008;372:1661–9.CrossRefPubMedGoogle Scholar
  7. 7.
    Flexner, A. Medical Education in the United States and Canada: A Report to the Carnegie Foundation for the Advancement of Teaching. Merrymount Press, Boston; 1910.Google Scholar
  8. 8.
    McGinnis JM, Williams-Russo P, Knickman JR. The case for more active policy attention to health promotion. Health Aff (Millwood). 2002;21:78–93.CrossRefGoogle Scholar
  9. 9.
    For a Healthy Nation: Returns on Investments in Public Health. (Office USGP ed. Washington, D.C.: Department of Health and Human Services; 1994.Google Scholar
  10. 10.
    McGinnis JM, Foege WH. Actual causes of death in the United States. Jama. 1993;270:2207–12.CrossRefPubMedGoogle Scholar
  11. 11.
    Mokdad AH, Marks JS, Stroup DF, Gerberding JL. Actual causes of death in the United States, 2000. Jama. 2004;291:1238–45.CrossRefPubMedGoogle Scholar
  12. 12.
    Masi CM. When less is more in public health. Perspect Biol Med. 2008;51:479–83.CrossRefPubMedGoogle Scholar
  13. 13.
    Inequalities in health: report of a research working group. London, UK: Department of Health and Social Security; 1980.Google Scholar
  14. 14.
    Mackenbach JP, Stirbu I, Roskam AJ, Schaap MM, Menvielle G, Leinsalu M, Kunst AE. Socioeconomic inequalities in health in 22 European countries. N Engl J Med. 2008;358:2468–81.CrossRefPubMedGoogle Scholar
  15. 15.
    Marmot, M., Wilkinson, R.G. eds. Social determinants of health, 2nd edition. Oxford: Oxford University Press; 2005.Google Scholar
  16. 16.
    Marmot MG, Smith GD, Stansfeld S, Patel C, North F, Head J, White I, Brunner E, Feeney A. Health inequalities among British civil servants: the Whitehall II study. Lancet. 1991;337:1387–93.CrossRefPubMedGoogle Scholar
  17. 17.
    Diez Roux AV, Merkin SS, Arnett D, Chambless L, Massing M, Nieto FJ, Sorlie P, Szklo M, Tyroler HA, Watson RL. Neighborhood of residence and incidence of coronary heart disease. N Engl J Med. 2001;2001(345):99–106.CrossRefGoogle Scholar
  18. 18.
    Marmot, M. Health in an unequal world. Lancet. 2006;368:2081–94.CrossRefGoogle Scholar
  19. 19.
    Wilensky GR, Satcher D. Don't forget about the social determinants of health. Health Aff (Millwood); 2009.Google Scholar
  20. 20.
    Schoeni RF, House JS, Kaplan GA, Pollack H eds. Making americans healthier: social and economic policy as health policy. New York: Russell Sage Foundation; 2008.Google Scholar
  21. 21.
    Shonkoff JP, Boyce WT, McEwen BS. Neuroscience, molecular biology, and the childhood roots of health disparities. Jama. 2009;301:2252–9.CrossRefPubMedGoogle Scholar
  22. 22.
    Anderson GF, Frogner BK. Health spending in OECD countries: obtaining value per dollar. Health Aff (Millwood). 2008;27:1718–27.CrossRefGoogle Scholar
  23. 23.
    Lurie N. What the federal government can do about the nonmedical determinants of health. Health Aff (Millwood). 2002;21:94–106.CrossRefGoogle Scholar
  24. 24.
    Blouin C, Chopra M, van der Hoeven R. Trade and social determinants of health. Lancet. 2009;373:502–7.CrossRefPubMedGoogle Scholar
  25. 25.
    Satterfield JM, Mitteness LS, Tervalon M, Adler N. Integrating the social and behavioral sciences in an undergraduate medical curriculum: the UCSF essential core. Acad Med. 2004;79:6–15.CrossRefPubMedGoogle Scholar
  26. 26.
    Warnecke RB, Oh A, Breen N, Gehlert S, Paskett E, Tucker KL, Lurie N, Rebbeck T, Goodwin J, Flack J, et al. Approaching health disparities from a population perspective: the National Institutes of Health Centers for Population Health and Health Disparities. Am J Public Health. 2008;98:1608–15.CrossRefPubMedGoogle Scholar
  27. 27.
    Cohen S, Janicki-Deverts D, Miller GE. Psychological stress and disease. Jama. 2007;298:1685–7.CrossRefPubMedGoogle Scholar
  28. 28.
    Gehlert S, Sohmer D, Sacks T, Mininger C, McClintock M, Olopade O. Targeting health disparities: a model linking upstream determinants to downstream interventions. Health Aff (Millwood). 2008;27:339–49.CrossRefGoogle Scholar
  29. 29.
    Westerhaus M, Panjabi R, Mukherjee J. Violence and the role of illness narratives. Lancet. 2008;372:699–701.CrossRefPubMedGoogle Scholar
  30. 30.
    Cells to Society. Overcoming health disparities. Chicago: Centers for Population Health and Health Disparities; 2007.Google Scholar
  31. 31.
    Beddington J, Cooper CL, Field J, Goswami U, Huppert FA, Jenkins R, Jones HS, Kirkwood TB, Sahakian BJ, Thomas SM. The mental wealth of nations. Nature. 2008;455:1057–60.CrossRefPubMedGoogle Scholar
  32. 32.
    Fiscella K, Tancredi D. Socioeconomic status and coronary heart disease risk prediction. Jama. 2008;300:2666–8.CrossRefPubMedGoogle Scholar

Copyright information

© Society of General Internal Medicine 2010

Authors and Affiliations

  1. 1.Department of MedicineBrigham & Women’s Hospital and Harvard Medical SchoolBostonUSA
  2. 2.BostonUSA

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