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.
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.
Innovating to Improve Care Now and In the Future: Screening for and Addressing Social Determinant of Health Needs
Bonnie Ewald, MA, is a Program Coordinator at the Center for Health and Social Care Integration at the Rush University Medical Center.
Physicians and other health care providers can learn a lot from the world of social work. Social work, as a discipline, has long been engaged in addressing social factors that influence health. Through interprofessional collaboration with social workers as part of the team, we can both address social determinant needs today and improve the capacity of healthcare providers less seasoned in doing so. Many interprofessional education initiatives, such as the Camden Coalition’s student hotspotting program, aim to have student groups work with individuals and community resources, which will enhance those students’ care in the future. But we must also focus on how to adapt health care now to better identify and address social determinant of health needs.
Rush University Medical Center developed an interprofessional leadership group and partnered with other hospitals and agencies on the West Side of Chicago including Catholic Charities, Patient Innovation Center, UI Health, Presence Health, and Sinai Health System to form what is now known as West Side ConnectED. In this effort, the institutions are working to identify and mitigate the health and social needs of those living on the West Side of Chicago and being served by the hospitals respective emergency departments: including areas such as food insecurity, housing instability, utility needs, transportation, and access to care (including having a primary care provider and insurance). This screener was designed at Rush for discrete data collection and integration into the Epic electronic health record system, allowing for better reporting and care management. (Similar initiatives are underway across the country; if interested, we recommend reading about efforts by Health Leads, Oregon Community Health Information Network, and the Centers for Medicare and Medicaid Services.)