Cover Page

Table of Contents

Title Page

Copyright

Introduction

This Book and the Public Health and Social Justice Website

Acknowledgments

The Editor

The Contributors

Part One: Human Rights, Social Justice, Economics, Poverty, and Health Care

Chapter 1: Universal Declaration of Human Rights

Preamble

Chapter 2: Public Health as Social Justice

Market-Justice

Social Justice

Doing Justice: Building a New Public Health

Conclusion

Chapter 3: What We Mean by Social Determinants of Health

Introduction: Welcoming the WHO Commission on Social Determinants of Health

Changes in Political, Economic, and Social Contexts over the Past 30 Years

Look at the Practice, Not the Theory, of Neoliberalism

The Changing Nature of Public Interventions: The Importance of Class

Class Alliances as Determinants of Non-Change

The Situation in Developing Countries

The Failure of Neoliberalism

The Social Situation in Europe

What Explains the Anti-European Mood Among Europe's Working Classes?

Components of a National Health Program: What Should It Contain?

Chapter 4: The Magic Mountain

Chapter 5: Family Medicine Should Encourage the Development of Luxury Practices

Introduction

Luxury Primary Care Clinics

Luxury Primary Care Clinics and Academic Medical Centers

Other Forms of Boutique Medical Care

Barriers to and Legal Risks of Boutique Medicine

Problems Associated with Luxury Medical Care

Do Physicians Receive Luxury Care?

Solutions

Achieving Health Care Equity

Conclusion

Acknowledgment

Part Two: Special Populations

Chapter 6: Homelessness in the United States

Introduction

Health Problems of the Homeless

The Future

Chapter 7: Historical and Contemporary Factors Contributing to the Plight of Migrant Farmworkers in the United States

Introduction

Migrant Agricultural Labor in the United States Today

History of Immigration and Labor Laws

Social and Working Conditions of Migrant Farmworkers

Health Care Issues Related to Undocumented Migrant Farmworkers and Their Children

Conclusions and Call to Action

Chapter 8: The Persistence of American Indian Health Disparities

Encounters and Epidemics

Colonial Precedents

Smallpox and the Moral Life

Tuberculosis, Extinction, and the Civilizing Process

Persistent Disparities

Fighting Poverty with Medical Technology

Conclusions

Acknowledgments

Chapter 9: Prejudice and the Medical Profession

Historical Context

Present-Day Concerns

Impact of the 2007 National Healthcare Disparities Report

Ethical Analysis

Strategies and Reforms

Chapter 10: Sexual and Gender Minority Health

Defining and Measuring Sexual and Gender Minorities

Unique Clinical Concerns of Sexual and Gender Minority Populations

Barriers to Optimal Health Care for Sexual and Gender Minority Patients

Creating a Healthier Environment for Sexual and Gender Minority Patients

The Road Ahead

Acknowledgments

Human Participant Protection

Chapter 11: Mental Disorders, Health Inequalities, and Ethics

Introduction

Inequalities in Mental Health

Unmet Mental Health Needs

Stigma and Discrimination

Mental Disorders and Economic Development

Integrating Mental Health into Primary Health Care Services

Data and the Global Burden of Mental Health Problems

References

Chapter 12: Incarceration Nation

Introduction

Lockdown: Who Are the People Behind Bars in the United States?

Women Behind Bars

Kids on the (Cell) Block

Schools or Prisons: Misplaced Priorities

Race and Detention

“The War on Drugs”

Prison Life

Health Issues of Prisoners

The Death Penalty

Conclusions

Chapter 13: Individual and Societal Forms of Violence Against Women in the United States and the Developing World

Introduction

Individual Violence Against Women

Societal/Structural Violence Against Women

Conclusions

Acknowledgments

Part Three: Women's Health

Chapter 14: Obstacles to Abortion in the United States

Introduction

Epidemiology of Abortion

Barriers to Abortion

Effects of United States' Policy on Access to Abortion Worldwide

Pseudoscience and Ideology Trump Science

Conclusions

Chapter 15: The Way It Was

Part Four: Obesity, Tobacco, and Suicide by Firearms: The Modern Epidemics

Chapter 16: Weighty Matters: Public Health Aspects of the Obesity Epidemic

PART I: Causes and Health and Economic Consequences of Obesity

PART II: Treatments and Approaches to Combating the Problem

PART III: A Look at Food and Beverage Industries

PART IV: Obesity Worldwide, Pathological Underweight, and Gluttony

PART V: Treatments and Public Health Approaches to Combating the Problem

Conclusion

Chapter 17: Cigarettes: The Other Weapons of Mass Destruction

Dirty Bombs

The Framework Convention on Tobacco Control Treaty

Healthcare Organizations and Medical Schools—Whose Side Are They On?

Clearing the Air: How to Disarm the Tobacco Industry

Chapter 18: Guns and Suicide in the United States

Part Five: Food: Safety, Security, and Disease

Chapter 19: Factory Farms as Primary Polluter

The Checkered History of Bayer

Suggestions for Citizen Action

Chapter 20: Genetically Modified Foods: Health and Environmental Risks and the Corporate Agribusiness Agenda

Health and Environmental Risks

Biopharming

Vertebrates and Trees

GM Foods and World Hunger

The Future

Chapter 21: Opposition to the Use of Hormone Growth Promoters in Beef and Dairy Cattle Production (American Public Health Association Policy Statement, Adopted 2009)

Synthetic Hormones in Beef Production

rBGH Use in Dairy Production

A Precautionary Approach to Hormone Growth Promoters in Beef and Dairy Cattle Production

Part Six: Environmental Health

Chapter 22: Roles and Responsibilities of Health Care Professionals in Combating Environmental Degradation and Social Injustice: Education and Activism

Introduction

Causes and Health Consequences of Environmental Degradation and Social Injustice

Contributors to Environmental Degradation and Social Injustice

Environmental Sexism and Racism

Confronting Environmental Degradation and Social Injustice

Education in Health Professions and the Medical Humanities

Conclusions

Chapter 23: Global Warming: A Public Health Crisis Demanding Immediate Action

Causes of Global Warming

Consequences of Global Warming

Corporations, the Media and Unsound Science

Confronting Global Warming

Conclusions

Chapter 24: Flowers, Diamonds, and Gold: The Destructive Public Health, Human Rights, and Environmental Consequences of Symbols of Love

Introduction: Cupid's Poisonous and Deadly Arrow

Flowers

Diamonds

Gold

Alternatives and Solutions

Alternative Tokens of Affection

Chapter 25: Is a Modest Health Care System Possible?

Energy in Health Care

Boiling Health Care Down to Its Essentials

The Modest Proposal

Health Care Basics

Some Cautions

Concluding Note: Obesity and Climate Change

Part Seven: War and Violence

Chapter 26: The Health Consequences of the Diversion of Resources to War and Preparation for War

Military Spending in the United States

Developing Countries

What Needs to Be Done

Chapter 27: A Brief Summary of the Medical Impacts of Hiroshima

Chapter 28: Medical Science Under Dictatorship

Preparatory Propaganda

Euthanasia

The Science of Annihilation

Medico-Military Research

Motivation

The Early Change in Medical Attitudes

The Example of Successful Resistance by the Physicians of the Netherlands

The Situation in the United States

Chapter 29: War, Rape, and Genocide: Never Again?

Introduction

History

War and “Masculinity”

Violence and Rape in War

Health Consequences

Refugee Camps

Human Rights Issues

Role of Health Professionals

Conclusions and Recommendations

Part Eight: Corporations and Public Health

Chapter 30: Combating Corporate Control: Protecting Education, Media, Legislation, and Health Care

Corporate Taxes and Crime

Corporate Involvement in Education

Corporate Control of the Media

Corporations' Effects on Democracy and US International Policy

Corporate Influence on Public Health

Chapter 31: The Pharmaceutical Industry: Friend or Foe?

Chapter 32: Unnecessary Testing in Obstetrics, Gynecology, and General Medicine: Causes and Consequences of the Unwarranted Use of Costly and Unscientific (yet Profitable) Screening Modalities

Overview

Evidence-Based Screening

Unnecessary Testing by Clinicians and Independent Companies

Risks of Unnecessary Testing

Unnecessary Testing, Luxury Care, and the Erosion of Science and Medical Ethics

Recognizing Health Scams

Conclusion

Chapter 33: Urine Trouble: Practical, Legal, and Ethical Issues Surrounding Mandated Drug Testing of Physicians

Introduction

Drug Testing: History, Prevalence, Policies, and Recommendations

Substance Use and Abuse by Physicians

The “Science” and Costs Behind Drug Testing

Physicians' Attitudes Toward Drug Testing

The Physicians' Dilemma: To Be or Not to Be Tested

Testing, Treating, and Disciplining Impaired Physicians

The Growth of Drug and Other Pre-Employment Testing

Drug Testing and the Erosion of Privacy

Patients' Privacy

Conclusions

Suggested Alternatives/More Effective Ways to Improve Quality of Care

Acknowledgments

Part Nine: Achieving Social Justice in Health Care Through Education and Activism

Chapter 34: Promoting Public Understanding of Population Health

Introduction

What We Know About Population Health

Paradigm Shifts in Public Health

Public Dissemination of the New Science on Health

Conclusion: A Call to Action for Public Health Professionals

References

Chapter 35: Some Ideas for a Common Agenda

The Golden Rule

From the Golden Rule and the Universal Declaration: Justice

Good Health Is a Fundamental Right

The Basis of Community and the Economy Is Sharing the Commons

Prevention Is Essential

Our Goal Together Can Be to Permanently Alter the Culture

Chapter 36: Taking On Corporate Power—and Winning

India's Generic Gambit

Babyfood Justice

Essential Drugs

Pittston Coal Strike

Banning the Global Waste Trade

Providing Civil Justice

Nutrition Labeling

Antarctica Off-Limits to Mining

Fishing-Free Reserves

Forest Protection up the Supply Chain

Sweating for Sweat-Free Goods

Outlawing Bribery

Full-Time Strike at UPS

M.A.I. Goes M.I.A.

Saving Organic Standards

The Spread of Smokefree Spaces

Cochabamba Claims the Right to Water

Preserving Biodiversity

Solar Wins at the Ballot Box

Science for Women

Arsenic No More

Reaching for Sustainability

Taking on Predatory Lending

Computer TakeBack Campaign

Canceling Third World Debt

Chapter 37: US Health Care: Single-Payer or Market Reform

Failure of Incremental Reforms

Consumer-Directed Health Care, Another Disappointment

Chapter 38: US Health Professionals Oppose War

World War I

The War in Vietnam

The 1991 Gulf War

Lessons Learned

Chapter 39: The Residency Program in Social Medicine of Montefiore Medical Center: 37 Years of Mission-Driven, Interdisciplinary Training in Primary Care, Population Health, and Social Medicine

Historical Background and Context

Hallmarks of Innovation

Outcomes

Leadership and Excellence

RPSM and Its Institutional Relationships

Lessons Learned

Looking Ahead

Summing Up

Acknowledgments

Chapter 40: Stories and Society: Using Literature to Teach Medical Students About Public Health and Social Justice

Introduction

Current Medical School Training in Ethics and Public Health

Social Injustices and Public Health

Literature and Public Health

Photography and Public Health Education

The Call to Service

Doctors as Social Justice Advocates

Conclusions

Acknowledgments

Index

Title Page

Introduction

Many of the rights described in the Universal Declaration of Human Rights, this collection's first and most important reading, were earlier enumerated by President Franklin Delano Roosevelt. In his penultimate State of the Union speech, Roosevelt called on Americans to work toward a new bill of rights, to complement the one laid out by the country's founding fathers. He said,

True individual freedom cannot exist without economic security and independence. Necessitous men are not free men. People who are hungry and out of a job are the stuff of which dictatorships are made. … We have accepted … a second Bill of Rights under which a new basis of security and prosperity can be established for all regardless of station, race, or creed. Among these are: The right to a useful and remunerative job in the industries or shops or farms or mines of the Nation; the right to earn enough to provide adequate food and clothing and recreation; the right of every farmer to raise and sell his products at a return which will give him and his family a decent living; the right of every businessman, large and small, to trade in an atmosphere of freedom from unfair competition and domination by monopolies at home or abroad; the right of every family to a decent home; the right to adequate medical care and the opportunity to achieve and enjoy good health; the right to adequate protection from the economic fears of old age, sickness, accident, and unemployment; [and] the right to a good education. All of these rights spell security.…We must be prepared to move forward, in the implementation of these rights, to new goals of human happiness and well-being.1

In many ways, our government and others around the world have failed, individually and collectively, to guarantee these rights. As such, social injustices abound, many of which have profound implications for public health. These include widespread poverty; social and economic inequalities; homelessness; environmental degradation; racism, classism, and sexism; war and other forms of violence; and increasing corporate control over basic resources.

This reader is designed to present an overview of the links between public health and social justice along with in-depth analyses of certain topic areas. It began as a collection of many of my own writings over the years, originally published in journals whose circulation is dwarfed by most news magazines and medical periodicals. As the project took shape, I decided to add writings (from peer-reviewed articles to newspaper articles to personal essays) that have influenced my personal philosophy and career development, affected me emotionally, and that I have used in my courses in medical humanities, public health, ethics, and women's rights. This reader is not meant to serve only as a comprehensive overview of the very broad area of public health and social justice, but also to provide an analysis of certain important areas and issues, some of which have not been addressed in other relevant, important collections.

From ancient times through the nineteenth century, medical (and nursing) training was carried out via the apprenticeship model, which was then replaced by a patchwork system of educational institutions of variable quality, offering nonstandardized curricula of varying length, which produced practitioners of varying quality. Following educator Abraham Flexner's important report on this uneven and often subpar system of medical education, early twentieth-century schools adopted the European model, and the medical curriculum was transformed into the one that still largely exists today, consisting of two preclinical years, followed by two clinical years, followed by an internship and residency in one's chosen field, with some undertaking further subspecialty fellowship training.

Prior to the adoption of Flexner's recommended changes, the fields of public health and medicine were intertwined. Regrettably, the new model of medical education had little room for public health and the latter field developed independently. Given the profound advances in basic sciences over the last century and the need for new health care providers to acquire an exponentially increasing knowledge base in physiology, biochemistry, and molecular biology, the social sciences were excluded from most curricula until the 1970s. Since the 1980s, ethics and medical humanities have gained some traction in medical education.

Over the last three to four decades, progressives have developed a strong voice to advocate for the disenfranchised and for inclusion of basic principles of public health and social justice in health professions training and practice. A seminal event was the 1978 conference organized by the World Health Organization (WHO) and the United Nations Children's Emergency Fund (now the United Nations Children's Fund, or UNICEF) at Alma Ata in the Soviet Union. The main product of this meeting was the Alma Ata Declaration, which defines health as a fundamental human right and “a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.”2 The declaration emphasizes primary care and addresses many of the economic and social inequities that prevent the attainment of health for all. The declaration has inspired many movements, notably the People's Health Movement (PHM). The PHM's charter lays out a vision for social justice in public health:

Equity, ecologically sustainable development and peace are at the heart of our vision of a better world—a world in which a healthy life for all is a reality; a world that respects, appreciates and celebrates all life and diversity; a world that enables the flowering of people's talents and abilities to enrich each other; a world in which people's voices guide the decisions that shape our lives …3

Programs to improve public health and social justice are carried out internationally by groups like the United Nations (UN) and WHO, nationally by entities such as the Centers for Disease Control and Prevention (CDC), and at all levels, locally to internationally, through treaties and by nongovernmental organizations, many of which are identified on the Public Health and Social Justice website (http://www.publichealthandsocialjustice.org or http://www.phsj.org).

Today public health is gaining traction in undergraduate,4 medical, and nursing education but many efforts are incipient, underfunded, and subject to battles with basic science and clinical departments for curricular time and funding. Some programs involve only a few faculty members, and if these instructors switch institutions, the programs can dissolve. Even so, today major national and international medical organizations advocate for, and accreditation agencies require, training and evaluation in professionalism, including advocacy for the societal, economic, educational, and political changes that can ameliorate suffering and contribute to human well-being.5

Nevertheless, important topics in public health and social justice remain marginalized in most curricula taught in health professions training schools, including schools of medicine, nursing, and sometimes even public health. Public health students and professionals often work independently from health care providers, confronting the same health problems, each in their own, important ways, yet without the type of coordinated approach that would improve the health status of individuals and of the overall population.

This reader is designed for health professions students, health care providers, and public health professionals. It provides an exposé of injustices present in the United States and worldwide and an entrée into the lives of society's disenfranchised. I hope the readings contained herein will not only educate health care professionals about important social justice topics, but also motivate them to work collaboratively with each other, with their patients, with nongovernmental organizations, and through their elected officials, to achieve social justice and promote the health and welfare of the world's many peoples.

The reader should also be valuable for undergraduate and graduate students from a number of fields, including but not limited to ethics, sociology, anthropology, history, and philosophy, as well as to activists of all ages working to solve society's most pressing, and often most intractable, problems.

The reader is divided into nine sections:

The struggle for social justice is a struggle for democracy and equality, which are critical to the survival of our country and indeed the world. The United States, for all its proclamations of moral leadership and support of just causes, has a disturbing history of domestic and international activities antithetical to freedom, peace, and justice. The increasing disparities between rich and poor in America portend societal dissolution and eventual collapse. Primo Levi has counseled, “A country is considered the more civilized the more the wisdom and efficiency of its laws hinder a weak man from becoming too weak or a powerful one too powerful.”6 Uncivilized countries eventually dissolve from within.

Advocating for the voiceless and promoting social justice can take many forms but all involve a willingness to speak out on behalf of the disenfranchised, in accordance with Nobel Prize–winning writer Günter Grass's admonition, “The first job of a citizen is to keep your mouth open.”7 It is best to start small, think globally and act locally, and join groups committed to solving problems about which you feel particularly passionate. When problems seem overwhelming, remember the African proverb, “If you think you are too small to have an impact, try going to bed with a mosquito in your tent.” Do not grow discouraged at what may seem an endless, uphill battle against powerful forces. No doubt those who fought against slavery and child labor and for women's suffrage faced daunting challenges, yet they ultimately succeeded. Keep in mind anthropologist Margaret Mead's encouraging observation, “Never doubt that a small group of thoughtful, committed people can change the world. Indeed, it is the only thing that ever has.”8

Happily, a life spent in the pursuit of justice and service to others can be most satisfying. As Ralph Waldo Emerson recognized, “To know that even one life has breathed easier because you have lived, that is to have succeeded.”10 It is my hope that those who read this book come away with increased knowledge, inspiration, and a burning desire to achieve justice. Together we can create a better world for ourselves, our children, our children's children, and all the creatures of the world.

This Book and the Public Health and Social Justice Website

Physician-editor Gavin Yamey notes that many corporate publishing industry practices make it impossible for most people worldwide, particularly in low- and middle-income countries, to access the biomedical literature. This has important consequences for health care policy makers, practitioners, and ultimately patients. Yamey, acknowledging that knowledge is power, argues that access to scientific and medical knowledge is a human right. He presents an alternative publishing model, open access, a more socially responsive and equitable approach to knowledge dissemination.11

The publisher of this book has graciously allowed this reader to realize this model, and all the chapters in this collection that I wrote are available on the Public Health and Social Justice website at http://www.publichealthandsocialjustice.org (or http://www.phsj.org). Moreover, almost all the other chapters reprinted herein are available elsewhere on the Internet.

In fact, all of my publications, as well as accompanying open-access slide shows (updated every six to twelve months), syllabi, and contributions from others working in related fields, can be found on the Public Health and Social Justice website (see http://www.publichealthandsocialjustice.org or http://www.phsj.org). (Note that the website's link addresses have “2007” in them…. this is because they were originally created then, and it does not designate when the most recent update occurred.) The site, which also contains links to hundreds of academic programs, publications, and progressive and activist groups, is always accepting new material. This book will be of greatest use to the reader who supplements the articles with the material present on the website.

 

 

Notes

1 Roosevelt, F. D. State of the Union address. January 11, 1944. Retrieved from http://www.presidency.ucsb.edu/ws/index.php?pid=16518.

2 Baum, F. Health for all now! Reviving the spirit of Alma Ata in the twenty-first century: An introduction to the Alma Ata Declaration. Social Medicine, 2007, 2(1), 34–41. Retrieved from http://www.medicinasocial.info/index.php/socialmedicine/article/view/76/187.

3 People's health movement: People's charter for health. Retrieved from http://www.phmovement.org/sites/www.phmovement.org/files/phm-pch-english.pdf.

4 Association of Schools of Public Health. Undergraduate public health learning outcomes model. July 2011. Retrieved from http://www.asph.org/document.cfm?page=1085.

5 American Medical Association. Declaration of professional responsibility: Medicine's social contract with humanity. Retrieved from http://www.ama-assn.org/ama/upload/mm/369/decofprofessional.pdf; Earnest, M. A., Shale, L. W., & Federico, S. G. Physician advocacy: What is it and how do we do it? Academic Medicine, 2010, 85(1), 63–67; Royal College of Physicians Policy Statement. How doctors can close the gap: Tackling the social determinants of health through culture change, advocacy, and education. Retrieved from http://www.sdu.nhs.uk/documents/publications/1279291348_jQjW_how_doctors_can_close_the_gap.pdf, and: http://www.rcplondon.ac.uk/professional-Issues/Public-Health/Documents/RCP-report-how-doctors-can-close-the-gap.pdf. Global consensus for social accountability of medical schools. December 2010. Retrieved from http://globalhealtheducation.org/resources/Documents/Both%20Students%20And%20Faculty/Global_Consensus_for_Social_Accountability_of_Med_Schools.pdf.

6 Levi, P. Survival at Auschwitz (New York: Simon and Schuster, 1996; originally published in 1958).

7 Hightower, J. In a time of terror, protest is patriotism. Hightower Lowdown, November 14, 2001. Retrieved from http://www.alternet.org/story/11924/.

8 Mead, M. Retrieved from http://www.quotedb.com/quotes/1821.

9 Emerson, R. W. Success quotes, sayings, and thoughts. Retrieved from http://www.inspirationalspark.com/success-quotes.html.

10 Yamey, G. Excluding the poor from accessing biomedical literature: A rights violation that impedes global health. Health and Human Rights, 2008, 10(1), 21–42. Retrieved from http://hhrjournal.org/index.php/hhr/article/view/20/103.

Acknowledgments

This book owes its inspiration to a number of individuals who have shaped my life, supported my education, and opened my eyes to the many injustices facing our world, without closing them to the goodness within people and the possibilities for a better world. I hope that in my life and work I can live up to their examples.

My most significant influences have been my family. My father, Martin, and mother, Annette, provided unconditional love and tirelessly sacrificed to offer my brothers and me educational and cultural opportunities that allowed us to reach our full potential. Their parents in turn sacrificed to give them opportunities, such that within just two generations, a wood, coal, and ice salesman and a bookie, housewife, paper mill worker, and cook raised a mathematician and coloratura soprano, who then raised a physician, a CEO, and a teacher and screenwriter. My brothers, Pat and Paul, have always been my best friends, whose loyalty has been constant and whose own passion for education and justice have pushed me to try harder in my endeavors. My sisters-in-law, Michele and Holly, have also been influential and supportive, as has my extended family (Marie, Bob, Katherine, Nell, Tom, Kathleen, Mary, Nance, Peter, Walt, Sue, Kim, Kelly, Tina, Wayne, Trevor, Kirk, Dana, Brett, Justin, Josh, Melanie, Bonnie, George, Brett, Dana, Justin, Josh, and Melanie).

Edith (White) Achterman, Deborah Meyers, Hermione Loofs, Joan Lebow, Tracey Hyams, Karen Adams, and my daughter, Rachel, brought me much happiness, helped me to grow emotionally, and taught me compassion and myriad new ways of thinking about the world. This book is written with hope for the next generation, especially Rachel; my nephews, Ben, Aidan, and Emerson; and my niece, Paris.

Thanks also to Mario Pariante, the Willigs, the Wadmans, Heidi and Steve Bush, the Mularskis, Mohammad Ismail, D'Anne Rygg, Rob and Jutta Rygg, Linda and Betty Ward, John and Chenit Flaherty, Naseem Rakha, Chuck Sheketoff, Robin Larson, Mariano Torres (and all the staff in Waimea, Kauai), Don Baham, Safina Koreishi, Kari Skedsvold, Judy Rubino, and Patty Marshall.

Certain professors and colleagues have encouraged my development, from basic scientist to clinical researcher to clinician to teacher and public health advocate. Sherman Melinkoff, dean emeritus at UCLA, encouraged my love of literature and appreciation for the rich history of medicine. Drs. Harrison Frank and Andrew Ippoliti, my undergraduate and medical school research mentors, inspired a love of scientific inquiry and developed my ability to question the workings of the human body. Dr. Lee Miller, Dr. Marshall Wolf and many other physicians from the UCLA School of Medicine and the Department of Medicine at Brigham and Women's Hospital helped me to develop as a clinician. Dr. Richard Kravitz taught me about health policy and health services research. Dr. Michael Lacombe (with his wife, Maggie) has been particularly generous, influential, and supportive as a mentor and a dear friend. Dr. Hal Holman at Stanford gave the single most important piece of advice any educator has given me in that it led to a dramatic shift in my career plans. On beginning my fellowship training (generously funded by the Robert Wood Johnson Foundation), filled with uncertainty about what to do with my years of education and clinical training (health services research? medical humanities? public health? teaching? clinical medicine?), he told me to “go sit under a tree and read and think for a month.” This led to a career in which I have aimed to reverse the early twentieth century schism between medicine and public health, introduce students to literature and history relevant to health care, and help to create practitioners not only skilled at treating individuals but also armed with the knowledge and passion to advocate for social, environmental, and economic justice and for the health of their communities and of the world.

In my professional career, major influences have been physician-activists and ethicist-educators including Matt Anderson, Andy Jameton, Peter Whitehouse, Lanny Smith, Vic Sidel, Barry Levy, Bob Gould, Patrice Sutton, Catherine Thomasson, Martha Livingston, Josh Freeman, Bill Wiist, Nick Freudenberg, Rick North, Patch Adams, Oli Fein, Howard Waitzkin, Neil Arya, Shafik Dharamsi, Shelley White, Jonathan White, Sid Wolfe, Peter Lurie, Sue Danielson, Peter Sainsbury, Lynne Madden, Claire Robinson, Albert Hutter, John Pearson, Maye Thompson, Barbara Gottlieb, Fran Storrs, Charles Grossman, Rudi Nussbaum, Andy Harris, Kelly Campbell, Angela Crowley-Koch, Emma Sirois (and all my colleagues at Physicians for Social Responsibility—national and Oregon), Amy Hagopian, Claire Hooker, Federico Hewson, Paul Farmer, Jim Kim, Jared Diamond, Howard Frumkin, Vicente Navarro, Jim Dwyer, David Himmelstein, Steffie Woolhandler, Stephen Bezruchka, David Wallinga, and Lauri Andress. Other major influences on my thinking, without their knowing it, are Charles Dickens, Wendell Berry, Noam Chomsky, Howard Zinn, Carl Sagan, Ralph Nader, Barbara Ehrenreich, Michael Moore, Gret Palast, Eric Schlosser, Jon Stewart, Stephen Colbert, and other members of the progressive media. Thanks also to my clinical colleagues at Kaiser.

I would like to thank Matthew Anderson, Erica Frank, Martha Livingston, and Randall White, who provided thoughtful and constructive comments on the draft manuscript. Thanks also to Vicki Anderson, Ursula Snyder, and Peggy Kean of Medscape, and Cameron Madill and Hannah Ferber from Synotac.

Finally, I am grateful to my editors, Andy Pasternack, Seth Schwartz, and Kelsey McGee, who have been very supportive and generous with their time and expertise.

Most of my essays are a consequence of having my own eyes, brain, and spirit opened by these individuals to the issues I cover. Whatever is good and worthwhile is a product of their influence. Any errors, though unintentional, are entirely my own.

Martin Donohoe

The Editor

Martin Donohoe, MD, FACP, is adjunct associate professor in community health at Portland State University and senior physician in internal medicine at Kaiser Permanente. He serves on the social justice committee of Physicians for Social Responsibility and the board of advisors of Oregon Physicians for Social Responsibility (PSR), and was chief scientific advisor to Oregon PSR's Campaign for Safe Food.

He received his BS and MD from UCLA, completed his internship and residency at Brigham and Women's Hospital/Harvard Medical School, and was a Robert Wood Johnson Clinical Scholar at Stanford University.

Donohoe has taught courses in medical humanities, public health, social justice ethics, women's studies, and the history of medicine at UCLA, UCSF, Stanford, OHSU, Clark College, and Portland State. He writes and frequently lectures on literature and medicine and social justice in public health.

His slide shows, articles, and syllabi can be found at http://www.phsj.org or at http://www.publichealthandsocialjustice.org.

The Contributors

Leo Alexander, MD, was a psychiatrist, neurologist, educator, and author. He helped write the Nuremberg Code after World War II.
Dan E. Beauchamp was a professor of health policy at the School of Public Health at the University of North Carolina at Chapel Hill from 1972 to 1990 and also at the State University of New York at Albany from 1988 to 1998.
Stephen Bezruchka, MPH, is senior lecturer at the Department of Health Services, University of Washington School of Public Health.
Judith B. Bradford, PhD, is director of the Center for Population Research in LGBT health, cochair of The Fenway Institute in Boston.
Eleanor Cooney has published four novels. She lives in Mendocino, California.
Peter A. Clark, SJ, PhD, is the director of the Institute of Catholic Bioethics and a professor of medical ethics at Saint Joseph's University in Philadelphia, Pennsylvania.
Alice Fornari, EdD, is assistant professor, Department of Family and Social Medicine, Albert Einstein College of Medicine, Bronx, New York.
Hilary Goldhammer is with the Fenway Institute in Boston.
Victoria Gorski, MD, is assistant professor, Department of Family and Social Medicine, Albert Einstein College of Medicine, Bronx, New York.
David Hemenway, PhD, is an economist and director of the Harvard Injury Control Research Center and the Harvard Youth Violence Prevention Center in Cambridge, Massachusetts.
David U. Himmelstein, MD, FACP, is professor in the CUNY School of Public Health at Hunter College and visiting professor of medicine at Harvard Medical School. He is also a cofounder of Physicians for a National Health Program.
Andrew Jameton, PhD, is professor in the Department of Health Promotion, Behavioral, & Social Health Sciences, College of Public Health at the University of Nebraska Medical Center.
David S. Jones, MD, PhD, is the A. Bernard Ackerman Professor of the Culture of Medicine at Harvard University.
Lincoln Khasakhala, MBChB, is on staff at Department of Psychiatry, Nairobi University and Africa Mental Health Foundation, Nairobi, Kenya.
Safina Koreishi, MD, is a family physician at the Rosewood Family Health Center Yakima Valley Farmworkers Clinic.
Eliana Korin is senior associate, Department of Family and Social Medicine, Albert Einstein College of Medicine, Bronx, New York.
Stewart Landers is with John Snow, Inc., Boston, and the Massachusetts Department of Public Health, Boston.
Walter J. Lear was a prominent medical and public health administrator, political organizer and activist, and medical archivist and historian.
Barry S. Levy, MD, is a physician and a former president of the American Public Health Association.
Harvey J. Makadon, MD, is director of professional education and development at Fenway Institute in Boston, and with the Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston.
Kenneth H. Mayer, MD, is medical research director and cochair of The Fenway Institute, Boston, and Miriam Hospital, Providence, Rhode Island.
Matthew Miller, MD, MPH, ScD, a general internist and medical oncologist, is currently the associate director of the Harvard Injury Control Research Center and an associate professor of health policy and injury prevention at the Harvard School of Public Health.
Peter Montague, PhD, is a historian and journalist and is currently executive director of Environmental Research Foundation, and serves on the board of the Science and Environmental Health Network.
Vicente Navarro, MD, DrPH, is a professor of health and social policy at the Johns Hopkins University. In Spain, he has been an extraordinary professor of economics in the Compentense University in Madrid, a professor of economics at the Barcelona University, and a professor of political and social sciences at the Pompeu Fabra University, where he directs the Public Policy Program jointly sponsored by the Pompeu Fabra University and the Johns Hopkins University.
Emmanuel M. Ngui, DrPH, is assistant professor of health disparities, The UW-Milwaukee Joseph J. Zilber School of Public Health.
Jennifer R. Niebyl, MD, is the head of the department of obstetrics and gynecology, University of Iowa Hospitals and Clinics, Iowa City.
David Nndetei, MD, PhD, is on staff at the Department of Psychiatry, Nairobi University and Africa Mental Health Foundation, Nairobi, Kenya.
Rick North is former project director of the Campaign for Safe Food, Oregon Physicians for Social Responsibility.
Philip Ozuah, MD, PhD, is professor and chair, Department of Pediatrics, Albert Einstein College of Medicine, Bronx, New York.
Matthew Power is a freelance print and radio journalist and a contributing editor at Harper's Magazine.
Carolyn Raffensperger, MA, JD, is executive director of the Science and Environmental Health Network.
Laura Weiss Roberts, MD, MA, serves as chairman and Katharine Dexter McCormick and Stanley McCormick Memorial Professor in the Department of Psychiatry and Behavioral Sciences at the Stanford University School of Medicine. She previously was the chairman and Charles E. Kubly Professor of Psychiatry and Behavioral Medicine at the Medical College of Wisconsin and professor and vice chair for administration in the Department of Psychiatry, the Jack and Donna Rust Professor of Biomedical Ethics, and the founder and director of the Institute of Ethics at the University of New Mexico.
Peter A. Selwyn, MD, MPH, is professor and chair, Department of Family and Social Medicine, Albert Einstein College of Medicine, Bronx, New York.
Victor W. Sidel, MD, is adjunct professor of public health at Weill Medical College of Cornell University. He was also chair of the Department of Social Medicine at Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, New York, and was appointed Distinguished University Professor of Social Medicine in 1984.
Ron Stall, PhD, MPH, is with the Graduate School of Public Health, University of Pittsburgh, as professor and chair, Department of Behavioral and Community Health Sciences and Department of Infectious Diseases and Microbiology.
Elanor Starmer is a special assistant at the US Department of Agriculture. She previously served as western region director at Food & Water Watch and a contributing writer at ethicurean.com.
A. H. Strelnick, MD, is professor, Department of Family and Social Medicine, Albert Einstein College of Medicine, Bronx, New York.
Debbie Swiderski, MD, is assistant professor, Department of Medicine, Albert Einstein College of Medicine, Bronx, New York.
Catherine Thomasson, MD, is executive director of the national organization Physicians for Social Responsibility (PSR), Washington, DC.
Janet M. Townsend, MD, is associate professor, Department of Family and Social Medicine, Albert Einstein College of Medicine, Bronx, New York.
Pamela Bea Wilson Vergun, PhD, was the translator and editor of A Dimly Burning Wick and is a sociologist and policy analyst.
Robert Vergun, PhD, provides education research and economic analysis for Portland Community College in Oregon.
David Wallinga, MD, MPA, is a senior advisor in science, food, and health at the Institute for Agriculture and Trade Policy, Minneapolis.
Robert Weissman, JD, is the president of Public Citizen.
Steffie Woolhandler, MD, MPH, FACP, is professor in the CUNY School of Public Health at Hunter College and visiting professor of medicine at Harvard Medical School. She is also a cofounder of Physicians for a National Health Program.

Part One

Human Rights, Social Justice, Economics, Poverty, and Health Care

In the wake of the Nazi atrocities of World War II, the newborn United Nations (UN) established a commission on human rights to enumerate the fundamental rights of mankind. This group completed the Universal Declaration on Human Rights, which was adopted by the UN in 1948. The thirty rights laid out in this seminal document form the basis for many subsequent national laws as well as international treaties and agreements. These rights grew out of numerous religious and political traditions, historical documents, and social movements. The declaration is the first chapter in this collection because the rights elaborated therein provide the foundation for all the social justice issues discussed in this reader.1

Chapter Two (by Dan E. Beauchamp) was originally presented at the American Public Health Association's annual meeting in 1975, yet it remains relevant today because it provides an ethical framework for the relationship between public health and social justice. The author defines justice as the fair and equitable distribution of society's benefits and burdens. He contrasts the dominant model of American justice, market justice,with its opposite, social justice. In the spirit of Rudolph Virchow (the father of social medicine, discussed in the reader's final chapter) and others, he emphasizes the right to health, prevention, collective action, and the importance of political struggle in achieving justice.