An Historical Perspective of the Social Determinants of Health, Disparities, and Desire for Workforce Diversification in Medicine
Plus ça change, plus c’est la même chose (The more things change, the more they stay the same)
-Jean Baptiste-Alphonse Karr
Although these famous words were not necessarily referring to medicine and healthcare, Karr’s quote is applicable to the theme of this piece and how some things rarely change. In a recent article, Drs. Jesse Goitia and Quinn Capers, IV are interviewed regarding a study that concludes the social determinants of health that increase MI risk are still there when patients return home–unsurprisingly, being Black and in a disadvantaged neighborhood puts one at a higher long-term risk. Interestingly, historical discussions on this topic can be traced back even further in literature. The purpose of this short piece is to provide an example of the importance of studying history to better understand and overcome our current challenges to help us create a better future.
In 1933, American author, journalist, and historian Carter Godwin Woodson penned a book entitled The Miseducation of the Negro. The book was a critique of the educational system and its failure to properly educate Black people in topics such as Black history and their contributions to the greater society. Despite its publication almost 90 years ago, he was also aware of the social determinants of health, health disparities, the need for more Black physicians, and how access to care is a challenge. Many of his thoughts still hold true today. Below is an excerpt from his book:
The Negroes of today are very much in need of physicians who in their professional work will live up to what they are taught in school, and will build upon their foundation by both experience and further training. In his segregated position in the ghetto the Negro health problem presents more difficulties than that of whites who are otherwise circumstanced. The longetivity of the Negro depends in part upon the supply of the Negro physicians and nurses who will address themselves unselfishly to the solution of this particular problem. Since the Negroes are forced into undesirable situations and compelled to inhabit germ-infested districts, they cannot escape ultimate extermination if our physicians do not help them to work out a community health program which will provide for the Negroes some way to survive.
Negro medical schools and their graduates must do more preaching of the necessity for improving conditions which determine health and eradicate disease. A large number of phyiscians and nurses must be trained, and new opportunities for them to practice must be found. This can be done by turning out better products from these schools and the extension of hospitals among Negroes who have been so long neglected in this campaign; however, the Negro physicians must supply the leadership, and the other must join them in these efforts.
From medical schools, too, we must have Negroes with a program of medical research. Today the world is inclined to give attention to the health of the Negro since unsanitary conditions of the race will mean the lose of health among the whites. Philanthropists, however, hardly know how to provide wisely for them; and the Negro physicians themselves have failed to give adequate attention to these conditions. Negro medical students have not directed sufficient attention to the ante-bellum background of the Negro who, still under the influence, indulges in superstitious and religious practices which impede the progress of medicine among them. One would be suprised to know the extent to which primitive medicine is practiced Among American Negroes today. Often in the rural districts they seldom see a physician. The midwife and the herb doctor there control the situation.
Studying the past helps to provide an historical context for today’s challenges. These challenges cannot be examined in isolation. Legendary actor, director, producer, and lay historian Tom Hanks discussed this in a recent essay regarding the 1921 Tulsa Race Massacre:
“America’s history is messy but knowing that makes us a wiser and stronger people.”
Although many scholars have discussed the social determinants of health, diversification of the medical workforce, and healthcare disparities, it was interesting to read this narrative in a section of Woodson’s book published almost a century ago. The question going forward is: what are we going to do as both a society and profession so we aren’t having this conversation in another 90 years? The last 18 months have been complicated by a contentious presidential election, an ongoing pandemic, and a worldwide movement in the wake of the murder of Mr. George Floyd. As a result, these complicated times have brought even more awareness to the fractures in our society and healthcare system. Only after we address these issues will be able to improve our healthcare outcomes in our patients and the overall human condition. The time to act is now.
