A.D.P. Prince is a medical student, University of Michigan Medical School, Ann Arbor, Michigan.
A.R. Green is associate professor of medicine, Massachusetts General Hospital Division of General Internal Medicine, Harvard Medical School, Boston, Massachusetts.
Acad Med. 2021 Nov 1;96(11):1518-1523. doi: 10.1097/ACM.0000000000004139.
Public health crises palpably demonstrate how social determinants of health have led to disparate health outcomes. The staggering mortality rates among African Americans, Native Americans, and Latinx Americans during the COVID-19 pandemic have revealed how recalcitrant structural inequities can exacerbate disparities and render not just individuals but whole communities acutely vulnerable. While medical curricula that educate students about disparities are vital in rousing awareness, it is experience that is most likely to instill passion for change. The authors first consider the roots of health care disparities in relation to the current pandemic. Then, they examine the importance of salient learning experiences that may inspire a commitment to championing social justice. Experiences in diverse communities can imbue medical students with a desire for lifelong learning and advocacy. The authors introduce a 3-pillar framework that consists of trust building, structural competency, and cultural humility. They discuss how these pillars should underpin educational efforts to improve social determinants of health. Effecting systemic change requires passion and resolve; therefore, perseverance in such efforts is predicated on learners caring about the structural inequities in housing, education, economic stability, and neighborhoods-all of which influence the health of individuals and communities.
公共卫生危机明显表明,健康的社会决定因素如何导致了不同的健康结果。在 COVID-19 大流行期间,非裔美国人、美国原住民和拉丁裔美国人的惊人死亡率揭示了顽固的结构性不平等如何加剧差距,使不仅是个人,而且整个社区都变得极其脆弱。虽然教育学生了解差异的医学课程对于提高认识至关重要,但经验最有可能激发对变革的热情。作者首先考虑了与当前大流行有关的医疗保健差异的根源。然后,他们探讨了可能激发支持社会正义承诺的重要学习经验的重要性。在不同社区的经验可以使医学生产生终身学习和倡导的愿望。作者介绍了一个由信任建立、结构能力和文化谦逊三个支柱组成的框架。他们讨论了这些支柱应如何为改善健康的社会决定因素的教育工作提供支持。要实现系统变革,需要热情和决心;因此,坚持不懈地努力需要学习者关心住房、教育、经济稳定和社区中的结构性不平等——所有这些都影响着个人和社区的健康。