Health Disparities and a Call for Health Justice: Cause and Effects…

The growing #BlackLivesMatter movement has focused long overdue national attention to issues arising out encounters between Black citizens, especially youth,  and law enforcement authorities that range from warrantless stop and search, to the uncalled for use of violent and deadly force.  In reflecting on the ongoing protests and unrest over these issues, Brian Smedley, Executive Director of the National Collaborative for Health Equity, makes an important point when he explains that the root causes that drive the unrest and resultant protest are the same causes that lead to health inequities.

It is these underlying social conditions that Link and Phelan point to in their groundbreaking article Social Conditions as a Fundamental Cause of Disease.  They make the central argument that underlies serious study in Health Disparities and society when they argue that social conditions such as class and race are not just contributing factors to some more ‘fundamental’ cause of illness, but rather the cause itself.  They write:

 “In sum, a fundamental social cause of disease involves resources that determine the extent to which people are able to avoid risk for morbidity and mortality.   Because resources are important determinants of risk factors, fundamental causes are linked to multiple disease outcomes thought multiple risk-factor mechanisms.  Moreover because social and economic resources can be used in different ways in different situations, fundamental social causes have effects on disease even when the profile of risk factors changes radically.  It follows that the effect of a fundamental cause cannot be explained by the risk factors that happen to link it to disease at any given time.”

This argument challenges us to move beyond questions of risk factors for any given disease at any given time, and address the underlying historical and social relations that sentence whole generations of people of color and other communities to health and healthcare inequality.

When we talk of treating the whole patient, we know that what happens to our patients before they are in front of us and after they leave is critically important.  If we want to improve the care of our patients and improve population health, can we as doctors be doing more to make improvements in health justice?