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A New Series on the Social Determinants of Health

 , August 29, 2014

These are tumultuous times as we watch the Ebola outbreak unfold in a distant land, seeking reassurances that it will not reach our shores; hear grave concerns being expressed when some individuals, who cared enough and were brave enough to go there to help, were flown back when they contracted the disease themselves.  At the same time many other local health providers have succumbed without getting this same level of care.  Lack of facilities and supplies, absence of organized health care systems, local customs, beliefs and traditions all are contributing to this immense crisis.  We are reassured that Ebola even if it hits the USA it will be contained unlike in West Africa.


Copy of Carriage Accident 
[Depiction of the carriage accident from the Tale of Two Cities.  Scanned by Phillip V. Allingham. available at Victorian Web]

But even in the USA all is not right.  We recently saw an unarmed teenager shot multiple times by a police officer.  This story has been repeated too many times; all of these cannot be just isolated incidents or random mistakes.  

Clearly where you are born, where you live, your socioeconomic and ethnic backgrounds can affect your health and your life.  As physicians we see this all the time.  We recognize the various factors contributing to our patients’ ill health.  But we often have very little training and knowledge on how to impact some of these.  Even if we do, we may resist diving into some of these issues as we fear the time and effort it will take.  It is often a lot easier to stick to “medicine” and practice what we are trained in, what we feel comfortable with and what is easy to do.

In this “issue” of JGIM Web we have a forthright account from a medical student working in a free clinic.  The essay beautifully captures the transition of the student’s mindset from “How does this experience relate to my getting an MD degree?” to an awareness of the role of the profession in helping others.  Edmund Pellegrino, former director of the Kennedy Institute of Ethics, stated that a fundamental difference between a business and a profession is that, “at some point in the professional relationship, when a difficult decision is to be made, you can depend on the one who is in a true profession to efface his own self-interest.”*  

Hopefully we all have felt that way when faced with difficult situations where socioeconomic and cultural backgrounds impact our patients’ health.  We may have struggled to find solutions.  Today we launch a new series on Social Determinants of Health highlighting some common problems and potential solutions.  A new case will be released each month.  I would like to thank Thui D. Bui and colleagues for this terrific contribution to JGIM Web.  

Please feel free to share, download and use when working with and teaching students and residents.  


Neil Mehta, MD
Web Editor, JGIM Web

*George D. Lundberg, MD; Laurence Bodine, Esq, “Fifty hours for the poor” JAMA. 1987;258(21):3157. doi:10.1001/jama.1987.03400210099034