The Beyond Flexner Alliance was saddened to hear of the recent death of H. Jack Geiger, MD. Dr. Geiger was the inaugural recipient of the Josiah Macy Jr. Foundation award for his lifetime of work in health, poverty and civil rights including marching with Dr. Martin Luther King, Jr. Dr. Geiger was a founding member of Physicians for Human Rights which won a Nobel prize in 1985, and was considered the Father of Community Health Centers in America.
A clinician, an educator, a humanitarian, a change agent, and a human rights advocate, Dr. Geiger was the embodiment of compassion with an unwavering commitment to improve the health outcomes and well-being of underserved populations in the U.S. and worldwide. Through his actions, Dr. Geiger demonstrated why medicine must address the relationship of health, poverty, and human rights.
Dr. Geiger was a dear friend and mentor to our founder, Dr. Fitzhugh Mullan and had an enormous impact on the founding of the Beyond Flexner Alliance. He attended, and spoke at, our first three conferences, and was often found spending time speaking with students one-on-one during any breaks. He was a giant and will be dearly missed by our organization.
Dr. Geiger shared his insights on social mission, BFA, and reflected on some of his life in this video with us in 2015.
The Beyond Flexner Alliance community is deeply heartbroken by the loss of George Floyd, Tony McDade, Ahmaud Arbery, and Breonna Taylor – and so many others in America’s black communities - who have suffered discrimination and inexcusable losses because of racism, violence and injustice. Racism pervades all sectors of society. Healthcare and education is no exception. The Beyond Flexner Alliance is built on the principle of dismantling racism and injustices in health professions education, health systems, and society. We are committed to continuing our work to integrate anti-racist curricula; support and advance health workforce diversity; and provide multidimensional, sustained professional learning experiences for providers, educators, and administrators that advance the health of all racial and ethnic groups. Let us highlight the final words of the Beyond Flexner Alliance’s founder, Dr. Fitzhugh Mullan, as he reflected on his life as a civil rights doctor and the need for medical schools – and all health professions schools – to reform.
"The civil rights doctor and many others have spent careers in pursuit of what we now call health equity, but the world has not moved as far as he would have wanted. Racism is still very much with us, as are massive and growing disparities in health and wealth. These disheartening realities account for tens of thousands of deaths and uncounted days of unnecessary pain and suffering every year. The civil rights doctor’s mission turned out to be changing the culture of medicine, making the idea of health equity central to the character of medicine, and positioning medicine as an agent of social as well as individual healing. Choices physicians make about where and how to practice can bring more compassion to the system but, ultimately, it is the U.S. medical education community that can do the most. Large, resourceful, and distributed, the nation’s medical schools and teaching hospitals have early and strong leverage to change the culture of medicine. The civil rights doctor may have worked hard and with purpose but it is only with a forceful, enduring, and community-wide commitment to social mission that medical education will realize its full 21st century capabilities to build a healing profession."
Fitzhugh Mullan, MD
The Civil Rights Doctor Revisited (Dec. 17, 2019). Academic Medicine
As federal officials determine when and how to reopen the country, numerous public health experts fear that the United States is significantly short of the public health workers needed to mitigate another occurrence and properly perform contract tracing.
On April 8, 2020 JAMA published an editorial co-authored by Dr. Josh Sharfstein and Dr. Howard Bauchner proposing a public health response to the COVID-19 pandemic by electively suspending medical education for the medical students of the class of 2024 and implementing a National Service Program for interdisciplinary graduate students.
Dr. Jamar Slocum, on behalf of the Beyond Flexner Alliance, recently sat down with Dr. Josh Sharfstein, to discuss his recent editorial and its impact on medical education. Dr. Sharfstein is the current Vice Dean for Public Health Practice and Community Engagement for the Bloomberg School of Public Health and Director of the Bloomberg American Health Initiative. He previously served as Principal Deputy Commissioner of the U.S. Food and Drug Administration, Commissioner of Health for Baltimore City, and health policy advisor for Congressman Henry A. Waxman.
This discussion has been edited for length and clarity.
Medical Schools Do Need an Overhaul. Doctors need to be trained in public health, health equity, and social justice.
COVID-19 is laying bare society’s underlying structural inequities that increase the risk of exposure, infection, and death for minority and disadvantaged communities across the US. The pandemic is also disproportionately affecting healthcare workers, who continue to work despite insufficient personal protective equipment and further, face disciplinary actions for speaking out.
Despite these realities, Dr. Stanley Goldfarb in his April 13 commentary suggests “doctors should be trained in pandemics, not injustice,” and that “the medical profession should abandon the fantasy that physicians can be trained to solve the problems of poverty, food insecurity and racism.” Clinical care is estimated to account for only 10-20% of what ultimately impacts health outcomes. Social determinants of health – health behaviors, social and economic factors, and the physical environment – account for the other 80-90% (National Academy of Medicine). The attitude that physicians should focus solely on clinical care aims to disempower the profession and frankly, is dangerous.
Champion Spotlight | Scholarly Research | News | Announcement & Events
Between #MeToo & #TimesUp, the last year has been a high water mark for the awareness of the challenges faced by women in our society. In honor of Women’s Heritage month, the Beyond Flexner Alliance brings you a newsletter this month highlighting the amazing and diverse work being done on gender inequities across health professions; work often being done by women in academia to highlight the trials they face in their training and the tribulations their patients face in achieving health equity. We encourage you to explore the full breadth of leading content we are highlighting this month from an academic study of bias faced by female dental students to a new WHO strategy to address gender inequity and even a media plea for more women to participate in clinical trials. There is a lot of ground to cover, but we hope to have a curated a few highlights for members of the Beyond Flexner Alliance to stay on the leading edge of work in gender health equity.
Social Mission Champion Spotlight
Dana D. Hines, PhD, RN
Dana D. Hines, PhD, RN is known as an emerging nursing leader in transgender health and for her work on issues related to access to HIV care, affirming environments of care, and cultural competency training and education for clinicians. Prior to entering academia, Dr. Hines worked for the Marion County Public Health Department in Indiana as an HIV surveillance coordinator and clinical quality program manager. During this time she led several health disparities projects aimed at improving engagement in HIV care. Since joining the faculty at GW School of Nursing, Dr. Hines has continued to focus her research on health disparities impacting transgender women, a population rarely offered research opportunities and who have historically been exploited or subsumed under the category of men who have sex with men. Health inequities persist in this population because of stigma, discrimination, and because healthcare providers are inadequately prepared to manage the complex health and social needs of transgender individuals. Dr. Hines’ approach to research targets disparities related to HIV, lack of healthcare provider knowledge, and treats participants as equal partners in the research process.
Sonal Batra MD, MST, is an Assistant Professor of Emergency Medicine and an Assistant Professor of Health Policy and Management at the George Washington University.
Social mission is a potent idea that has been present in health professions education under various labels for many years. Humanitarianism, community-oriented primary care, social responsibility, social justice, diversity, and inclusion are some of the ideas that have generated transformative movements in health care delivery and health professions education. Today the term social mission is increasingly used to embody them all. The Beyond Flexner Alliance has defined the social mission of a health professions school as the contribution of a school in its mission, programs, and the performance of its graduates, faculty, and leadership in advancing health equity and addressing the health disparities of the society in which it exists. A new Initiative from the GW Health Workforce Institute strives to deepen the conversation around social mission by providing a means to measure this important concept within health professions schools.
Faculty are too often the major barrier to change in health education institutions and health systems. Faculty tend to view themselves as teachers, who teach, and the students as learners, who learn. However, this view is fundamentally oppressive. We can improve our ability to instill social medicine in health professions education if, instead of learning coming from a teacher bestowing knowledge on a student, learning comes through experiencing the reality of health inequity together, as students AND teachers, and working together to create new knowledge for all parties and the radical change that must follow it.
This may seem theoretical, but when protests erupted across Haiti on July 6 after the government’s announcement of significant increases in fuel prices, we knew that the content of our sixth annual social medicine course, “Beyond the biomedical basis of disease,” would ensure that students recognized the structural drivers of the unrest rather than accept the superficial news headlines, and that we needed more than ever to move forward with holding the course in Mirebalais, Haiti as planned (1). We began on July 9, despite the unrest, via a webinar by human rights lawyer Brian Concannon (2). We sought to come together as students and teachers (virtually for the first week and then in person for weeks two and three), sharing our experiences through discourse, to generate an understanding of the unrest in Haiti as being driven by structural injustice, rather than an oversimplified and racist narrative insistent on labeling Haitians as vicious plunderers (as a black American, this trick is all too familiar) (3). One of the foundational sessions in our three-week long social medicine immersion course is “Neoliberalism and Health Care,” which explores the complex web of international aid, from the International Monetary Fund’s structural readjustment programs to the real-life impact of tied aid. With this course under their belts, students would not fall into the trap of blaming Haitian leaders alone for the recent unrest, but would recognize the behind the scenes hand of global development paradigms.
Racial and ethnic minorities continue to be subjected to a sustained pattern of disparate treatment in health care with no panacea for the confluence of contributing factors. In the 2003 provocative landmark report, Unequal Treatment; Confronting Racial and Ethnic Disparities in Health Care, the Institute of Medicine (IOM) exposed a painful truth about the health care system. When racial and ethnic minorities enter the clinical arena, they are less likely to receive routine medical procedures, appropriate cardiac medications, or essential clinical services. The differences in how minorities are treated in health care contribute to their higher rate of disability and mortality.
Since the 2003 IOM report, the tendency for racial and ethnic minorities to receive an inferior level of care has not abated. A 2007 systematic review conducted by the Department of Veterans Affairs (VA) found that African American male veterans received less aggressive pain management for osteoarthritis, providers gave them less information about cancer, and clinical decision making varied based on the veteran’s race. More recently, the Agency for Healthcare Research and Quality revealed in the 2016 National Healthcare Quality and Disparities Report that “most disparities have not changed significantly for any racial and ethnic groups…especially among people in poor and low-income households, uninsured people, Hispanics, and Blacks.” Although the gap in health insurance coverage between minorities and whites has narrowed, differences have actually widened for quality indicators such as annual foot exams and prevention of lower extremity amputations among diabetics. Indeed, the persistence of health care disparities, which the Institute of Medicine defined as “differences in the quality of healthcare that are not due to access-related factors or clinical needs, preferences, and appropriateness or intervention,” is alarming and depicts a dismal reality for ethnic and racial groups.