using literature to teach activism for public health martin donohoe, md, facp portland state...
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Using Literature to Using Literature to Teach Activism for Teach Activism for
Public HealthPublic HealthMartin Donohoe, MD, FACPMartin Donohoe, MD, FACP
Portland State UniversityPortland State University
Oregon PSROregon PSR
Public Health EducationPublic Health Education
Principles of public health rooted in Principles of public health rooted in social justicesocial justice
Importance of social, cultural, and Importance of social, cultural, and economic factors in health and economic factors in health and diseasedisease
Public health issues are storiesPublic health issues are stories Teaching/vicarious experienceTeaching/vicarious experience AnalysisAnalysis
Harvey CushingHarvey Cushing
““A physician is obligated to A physician is obligated to consider more than a consider more than a diseased organ, more even diseased organ, more even than the whole man. He than the whole man. He must view the man in his must view the man in his world.”world.”
Rudolph VirchowRudolph Virchow
““Doctors are natural Doctors are natural attorneys for the poor … attorneys for the poor … If medicine is to really If medicine is to really accomplish its great task, accomplish its great task, it must intervene in it must intervene in political and social life…”political and social life…”
Issues in Teaching Issues in Teaching Humanities/ActivismHumanities/Activism
StudentsStudentsHighly motivatedHighly motivatedNegative attitudinal changes / Negative attitudinal changes /
cynicismcynicism FacultyFaculty Curricular TimeCurricular Time Institutional SupportInstitutional Support
GoalsGoals
Educate students and Educate students and practitioners about social practitioners about social justice issuesjustice issues
Promote activist-oriented Promote activist-oriented research and writingresearch and writing
GoalsGoals
Translate knowledge into practice Translate knowledge into practice through volunteerism and servicethrough volunteerism and service
Encourage lifelong learningEncourage lifelong learning
Heal schism between medicine and Heal schism between medicine and public health; encourage public health; encourage interdisciplinary learning and collegial interdisciplinary learning and collegial practicepractice
IssuesIssues
Access to careAccess to care
Racial, sexual and SES discrepancies Racial, sexual and SES discrepancies in outcomesin outcomes
The effects of poverty on healthThe effects of poverty on health
IssuesIssues
Corporatization of academic and Corporatization of academic and clinical medicineclinical medicine
The role of the pharmaceutical industryThe role of the pharmaceutical industry Drug promotion and advertisingDrug promotion and advertising Drug pricingDrug pricing
Conflicts of interestConflicts of interest Balancing responsibilities to self, patients, Balancing responsibilities to self, patients,
insurers, colleagues, and communityinsurers, colleagues, and community
IssuesIssues
Women’s rights issues:Women’s rights issues: Violence against womenViolence against women Teen pregnancyTeen pregnancy Female genital mutilationFemale genital mutilation Political, legal, and educational Political, legal, and educational
marginalizationmarginalization Sexual harassmentSexual harassment
IssuesIssues
HomelessnessHomelessness Substance abuseSubstance abuse Tobacco industryTobacco industry Privacy:Privacy:
Genetic testingGenetic testing Drug testingDrug testing
IssuesIssues
Physician mistakesPhysician mistakes
Impaired physiciansImpaired physicians
Physician fraudPhysician fraud
IssuesIssues
Human subject experimentationHuman subject experimentation Nazis, Japan’s Unit 731Nazis, Japan’s Unit 731 Tuskegee Syphilis StudyTuskegee Syphilis Study Willowbrook Hepatitis ExperimentsWillowbrook Hepatitis Experiments Henry BeecherHenry Beecher U.S. government-sponsored radiation U.S. government-sponsored radiation
experimentsexperiments Nuremberg Code, Helsinki ConventionsNuremberg Code, Helsinki Conventions
IssuesIssues
Human Subject Experimentation - Human Subject Experimentation - Contemporary Issues:Contemporary Issues: Special populations (e.g., prisoners, Special populations (e.g., prisoners,
cultural minorities, the mentally illcultural minorities, the mentally ill Internationalization of researchInternationalization of research Use of placebo controlsUse of placebo controls The role of for-profit IRBsThe role of for-profit IRBs cloningcloning
IssuesIssues
Environmental degradationEnvironmental degradation OverpopulationOverpopulation Air and water pollutionAir and water pollution DeforestationDeforestation Global warmingGlobal warming Unsustainable agricultural and fishing Unsustainable agricultural and fishing
practicespractices Species lossSpecies loss
IssuesIssues
Environmental degradation – social Environmental degradation – social justice contributors:justice contributors: Overconsumption (“affluenza”)Overconsumption (“affluenza”) Maldistribution of wealthMaldistribution of wealth Rise of the corporationRise of the corporation Third World debt crisisThird World debt crisis Human rights abusesHuman rights abuses
IssuesIssues
War and Militarism:War and Militarism:
Weapons of mass destructionWeapons of mass destruction Diversion of economic resources and Diversion of economic resources and
intellectual capitalintellectual capital Prejudice/hate crimesPrejudice/hate crimes Erosion of civil libertiesErosion of civil liberties
The Role of LiteratureThe Role of Literature
Vicarious experienceVicarious experience Explore diverse philosophiesExplore diverse philosophies Promotes empathy, critical thinking, Promotes empathy, critical thinking,
flexibility, non-dogmatism, self-flexibility, non-dogmatism, self-knowledgeknowledge
Encourages creative thinkingEncourages creative thinking Allows for group discussion/debateAllows for group discussion/debate
Why Use LiteratureWhy Use Literature
Encourage appreciation of non-Encourage appreciation of non-medical literaturemedical literature
Develop reading, analytical, speaking Develop reading, analytical, speaking and writing skillsand writing skills
Promote ethical thinking (narrative Promote ethical thinking (narrative ethics)ethics)
Identification with doctor authors Identification with doctor authors (e.g., Keats, Chekhov, Maugham, (e.g., Keats, Chekhov, Maugham, Williams)Williams)
StigmatizationStigmatization
John UpdikeJohn Updike
““From the Journal of a Leper.”From the Journal of a Leper.”
Am J Dermatopathol 1982;4(2):137-42Am J Dermatopathol 1982;4(2):137-42
HomelessnessHomelessness
Doris LessingDoris Lessing
““An Old Woman and Her Cat”An Old Woman and Her Cat”
From the Doris Lessing Reader (New York: From the Doris Lessing Reader (New York: Knopf, 1988)Knopf, 1988)
Race and Access to CareRace and Access to Care
Ernest J GainesErnest J Gaines
““The Sky is Gray”The Sky is Gray”
in Gray, Marion Secundy, ed. in Gray, Marion Secundy, ed. Trials,Tribulations, and Celebrations: Trials,Tribulations, and Celebrations: African American Perspectives on Health, African American Perspectives on Health, Illness, Aging and LossIllness, Aging and Loss. Yarmouth, Maine: . Yarmouth, Maine: Intercultural Press, 1992Intercultural Press, 1992
PovertyPoverty Orwell, George. Orwell, George. How the Poor DieHow the Poor Die. . In Sonia In Sonia
Orwell and Ian Angus, eds. Orwell and Ian Angus, eds. The Collected Essays, The Collected Essays, Journalism and Letter of George Orwell, IV; In Journalism and Letter of George Orwell, IV; In Front of Your Nose,Front of Your Nose, 1945-1950. New York: 1945-1950. New York: Harcourt, Brace and World, Inc: pp.223-233.Harcourt, Brace and World, Inc: pp.223-233.
Checkhov, Anton. Checkhov, Anton. Letter to AF KoniLetter to AF Koni, , January 26, 1891,January 26, 1891, Letter to AS Survivor Letter to AS Survivor, , March 9, 1890. March 9, 1890. In Norman Cousins, ed. In Norman Cousins, ed. The The Physician in Literature PhiladelphiaPhysician in Literature Philadelphia: WB Saunders, : WB Saunders, 1982. 1982.
Eighner, Lars. Phlebitis: At the Public Eighner, Lars. Phlebitis: At the Public Hospital. Hospital. In In Travels with LizbethTravels with Lizbeth. New York: St. . New York: St. Martin’s Press, 1993.Martin’s Press, 1993.
Domestic ViolenceDomestic Violence
Michael LaCombeMichael LaCombe
““Playing God”Playing God”
In LaCombe M, ed. On Being a Doctor. In LaCombe M, ed. On Being a Doctor. Philadelphia: American College of Philadelphia: American College of Physicians, 1994Physicians, 1994
Human Subject Human Subject Experimentation / Human Experimentation / Human
Rights AbusesRights AbusesShusaku EndoShusaku Endo
The Sea and PoisonThe Sea and Poison
(New York: Taplinger Publishing Co., 1972)(New York: Taplinger Publishing Co., 1972)
Conflicting Responsibilities Conflicting Responsibilities of Physiciansof Physicians
Pearl S. BuckPearl S. Buck
““The Enemy”The Enemy”
In Far and Near: Stories of Japan, China, In Far and Near: Stories of Japan, China, and America and America (New York: The John Day (New York: The John Day Company, 1934)Company, 1934)
Mental IllnessMental Illness
Anton ChekhovAnton Chekhov
Ward Number SixWard Number Six
in Chekhov A. Seven short novels (New in Chekhov A. Seven short novels (New York: Bantam, 1976)York: Bantam, 1976)
Single Motherhood / The Single Motherhood / The Welfare SystemWelfare System
Grace PaleyGrace Paley
““An Interest in Life”An Interest in Life”
In In We are the Stories We Tell: The Best We are the Stories We Tell: The Best Short Stories by North American Women Short Stories by North American Women since 1945since 1945, Wendy Martin, ed. (New York: , Wendy Martin, ed. (New York: Pantheon Books, 1990)Pantheon Books, 1990)
SuggestionsSuggestions
Use literary selections in Use literary selections in courses and community workcourses and community workInterdisciplinary educationInterdisciplinary education
Share stories with Share stories with colleagues, patients/clientscolleagues, patients/clients
SuggestionsSuggestions
Create dedicated reading and Create dedicated reading and writing groupswriting groups
Encourage conferencesEncourage conferences Read activist journalsRead activist journals
““Activist” JournalsActivist” Journals
American Journal of Public HealthAmerican Journal of Public Health Public Citizen’s Health LetterPublic Citizen’s Health Letter PNHP NewsletterPNHP Newsletter Mother JonesMother Jones HarpersHarpers Z MagazineZ Magazine Hightower LowdownHightower Lowdown
““Activist” JournalsActivist” Journals
Rachel’s Environmental WeeklyRachel’s Environmental Weekly SierraSierra The Amicus JournalThe Amicus Journal Bulletin of Atomic ScientistsBulletin of Atomic Scientists Multinational MonitorMultinational Monitor Some articles in NEJM, JAMA, JGIM, Some articles in NEJM, JAMA, JGIM,
SSM, Policy, Politics, and Nurs Prac, SSM, Policy, Politics, and Nurs Prac, othersothers
Nurse Margaret SangerNurse Margaret Sanger
Books have been to me what gold is Books have been to me what gold is to the miser, what new fields are to to the miser, what new fields are to the explorer. the explorer.
Contact InformationContact Information
Public Health and Social Public Health and Social Justice WebsiteJustice Website
http://www.phsj.orghttp://www.phsj.org
[email protected]@phsj.org