tag:blogger.com,1999:blog-1509187841033628660.post1922639514858793021..comments2024-03-05T00:29:07.493-07:00Comments on Medicine and Social Justice: Social Determinants, Personal Responsibility, and Health System OutcomesJosh Freemanhttp://www.blogger.com/profile/10248920527894775520noreply@blogger.comBlogger3125tag:blogger.com,1999:blog-1509187841033628660.post-32079216055399995532010-09-14T06:24:31.488-07:002010-09-14T06:24:31.488-07:00What a great post! I wanted to add that Michael Po...What a great post! I wanted to add that Michael Pollan points out in his book, Omnivore's Dilemma, that right now our system encourages unhealthy food choices. Our government subsidizes corn which results in Twinkies that cost a lot less than buying a bag of apples. So I agree with you that it's not enough to say that people need to be more accountable for their health.<br /><br />I also agree that it's easy to be lulled into this discussion of personal accountability as a way to assuage guilt over not providing more health services to those in need. It's as if we're saying, "We don't need to provide you with more health services, you just need to take better care of yourself. Now, go have a Twinkie."<br /><br />Yes, I know, oversimplified. I guess that's the point. <br /><br />However, as someone who is for reform in healthcare, I oftentimes find myself frustrated. What can I do? I've done the typical writing to my congressional representative, phone calls. I even started a blog focused on this topic. Short of resigning my life and setting up camp in DC, I find the topic of personal accountability tempting because it is something I can do right here and now. <br /><br />This is a great discussion and I appreciate the opportunity to contribute to it! MarlyMarlyhttps://www.blogger.com/profile/10786708999592989786noreply@blogger.comtag:blogger.com,1999:blog-1509187841033628660.post-8756145162808673242010-09-12T22:10:53.357-07:002010-09-12T22:10:53.357-07:00From 1997 t0 2005 the US MD medical students from ...From 1997 t0 2005 the US MD medical students from parents making over $100,000 increased by 70% while students from parents making less than $40,000 decreased by 30 - 40% and middle income admissions decreased by 20%. The changes spanned race, ethnicity, and gender. <br /><br />AAMC studies note that those most likely to gain admission are least likely to have awareness of lower income people. Changes in the past decade make this even more likely. <br /><br />Changes also have included Asian and foreign born populations and physicians. This is a group of about 12% of the US population but this group claims about 40% of the physicians entering the US workforce. <br /><br />White populations are now underrepresented with regard to new physicians entering the workforce, joining Hispanic, African American, lower income, middle income, and rural populations. Rural origin white males have declined the most from 25% entering the workforce to 2% over the past 50 years. Rural origin admissions have declined the most in counties dependent upon manufacturing and farming and counties left behind in social organization, income, population density, education, and physicians. <br /><br />Rural origin admissions have declined most rapidly in states with 40 - 50% rural population - those most recently declining below a majority rural population - an indicator of political changes with an urban majority gaining control.<br /><br />Those gaining admission in highest probability and increasing in admission are children of combinations of concentration: most urban, highest income, children of professionals and physicians. Those losing out are those least associated with concentrations. <br /><br />Those gaining in entry to the US workforce from US or non-citizen origins are least likely to be found in family medicine, primary care, rural, and underserved careers - least basic health access contributions. Those being replaced in entry are those most likely to be found in basic health access careers. <br /><br />Changes resulting in more narrow origin physicians least like normal Americans include substantial declines in income, education, and opportunity for lower and middle income Americans, testing to the test, narrow science focus, and legal actions.<br /><br />Bob Bowman www.basichealthaccess.orgBob Bowmanhttps://www.blogger.com/profile/12345017195665837451noreply@blogger.comtag:blogger.com,1999:blog-1509187841033628660.post-1506228500781303932010-09-12T08:01:38.498-07:002010-09-12T08:01:38.498-07:00I was drawn to your blog by the EQUAL e-list. I th...I was drawn to your blog by the EQUAL e-list. I think this post and the slide show is smart and well intentioned but significantly out of date. Consider the following:<br /><br />1. Since 2008 the USA has undergone a major economic meltdown.The public health community is largely unaware of the future impact of this on the fabric of life for all residents of the USA.<br />2.Not only has the (a) poverty level massively increased, but (b)large sectors of the safety net are being atrophied and (c)the security, services, and dreams of the middle class are being destroyed.Thus<br />(3)Social Justice is no longer an issue just for the poor and minorities.Since<br />(4) The distribution of family income (GINI Index)is more distorted in the USA than any time since 1929. At 42 this level is on par with Mexico, Jamaica and other third world countries.As a matter of fact, the CIA lists USA as about the 40th worst country in the world in this regard - and at a level of inequality which promotes social unrest!<br />(5) If you study the data in THE SPIRIT LEVEL by Wilkerson and Picket, you learn that levels of illness and most other parameters of social morbidity in developed countries and USA states are strongly related to income distribution INEQUALITY and not average income.<br /><br />Thus my inference is that the analysis and data presented in this blog are constrained by past conventional policy and academic wisdom and not insightful of our contemporary unfolding catastrophy. Addressing health care and social justice now more than ever requires a paradigm that looks at politics at the broadest level.If you understand the implications of this analysis I invite readers of this blog to join in a discussion of how we can face this challenge and change the course of events.<br />(I have extensive PPT slides on domestic economic and health parameters I can share if I am contacted at paradocs2@hotmail.com)Jeoffry B.https://www.blogger.com/profile/13729308876028989074noreply@blogger.com