Wednesday, June 30, 2010

A New Way of Ranking Medical Schools: Social Mission

"In the June issue of the Annals of Internal Medicine, Fitzhugh Mullan, Candice Chen, Stephen Petterson, Gretchen Kolsky, and Michael Spagnola, mostly from the Department of Health Policy at the George Washington University (and one from the Robert Graham Center) report on “The social mission of medical education: ranking the schools”. This study, sponsored by the Josiah Macy, Jr. Foundation as part of the Medical Education Futures Study (MEFS) is the first report to look at this area, and should be eye-opening to those who assume that “good” medical schools are “good” at everything. Most ranking systems, most notably those of US News and World Report, are based on NIH research funding, grades and test scores of entering students, “competitiveness” (how low a percent of applicants they accept) and reputation. Obviously, the grades and test scores are related to competitiveness and reputation is a tautology, because it reinforces itself. It should depend upon what you are looking at, of course. I addressed this in “Rankings of Medical Schools: Do they tell us anything?” (September 25, 2009), and observed that what they tell us is who does well in what is measured, and that this should only be important to us if those are the outcomes we value.

Mullan and colleagues evaluate different outcomes, the degree to which medical schools meet their “social mission”, or to put it another way, the degree to which they produce the physicians that will take care of the American people. More to the point, since it can be argued that most medical school graduates take care of some American people, physicians who will take care of those people who need it the most because they don’t already have doctors. This means largely those in poor communities, rural communities, and minority communities (and especially those communities that are two or three of these). They look at 3 characteristics of graduates: 1) what percent of their graduates are practicing primary care, 2) what percent of their graduates are practicing in designated Health Professions Shortage Areas (HPSAs), and 3) what percent of their graduates are members of underrepresented minority groups? This is pretty straightforward, and they take two other steps to try and ensure that this is an accurate reflection..."

To read more, visit Dr. Josh Freeman's brilliant site Medicine and Social Justice

Friday, June 25, 2010

Video: What G20 Leaders Will Not See in Toronto

Scott A. Wolfe, Health and Social Policy Advisor with One World Partners
As world media attention turns to Toronto and many important issues of global concern, perhaps what's receiving least attention is Canada's own local and national stories of human crisis. This video from the Toronto Star provides images and stories from the "Toronto" that G20 leaders and international media are unlikely to see. Below the video are some statistics and points of information that might surprise many non-Canadians and Canadians alike.

-As of 2009 Canada ranked 18th out of 30 wealthy (OECD) countries in terms of equitable income distribution

-Canada has the 2nd highest increase in income inequality among OECD countries, from the mid-1990s to mid-2000s

-Canada has the 12th highest overall poverty rate among the world's 30 wealthy (OECD) countries, and 10th highest child poverty rate

-While poverty in Canada actually declined from the mid-1980s to mid-1990s, Canada has the 2nd highest increase in poverty rates among OECD countries from the mid-1990s to mid-2000s

-Canada has the 5th lowest level of public social spending among 30 OECD countries. Only the United States, Turkey, Korea and Mexico spend less, as a percentage of national income

-Despite this very low overall social spending, Canada ranks 8th in terms of health care spending. This means that while Canada provides very low investment on social programs compared to other wealthy countries, it provides an especially low level of investment on social supports outside of health care (ie, housing, child care, employment benefits, other social programs).

-The impact of poverty, and this low social spending has a particularly serious impact on a number of sub-population groups in Canada, including Aboriginal people, other racialized groups and recent immigrants. For instance, while Canada ranks high overall on the United Nations Human Development Index, First Nations people in Canada rank 63rd according to these UN indicators.

Sources: Society at a Glance 2009 - OECD Social Indicators and Assembly of First Nations

Tuesday, June 15, 2010

Who will care for the underserved? The role of off-shore medical schools

Josh Freeman June 2nd, 2010

I have written in several previous posts (most recently Universal Coverage and Primary Care: The US needs both, May 27, 2010) about the challenges facing American medicine, particularly regarding specialty choice (= not primary care, not rural, notunderserved) of US allopathic graduates, and the problems this has already created in providing health care to the American people, which is only likely to worsen as this trend continues. I have noted that, in the production of physicians as in any other process, the outcome results from variables in inputs (who is admitted in this case), the process itself (in education, the curriculum, both formal and informal), and output variables (in the case of physicians, what the practice environment is: reimbursement, work load, quality of life, respect and regard within the profession and community). I have argued that, while output variables may be the most important in terms of specialty choice and practice location, it is the one over which medical educators have the least control. While the curriculum, the process through which we educate medical students, is critical (see Are we training physicians to be empathic? Apparently not., Sept 12, 2009), it is likely that the characteristics of the students selected is most important in determining practice location, particularly for rural areas, but also for urban underserved settings (Medical Student Selection, Dec 14, 2008). Selecting students who grew up in the suburbs of major cities (what Robert Bowman, MD, who has done much research in this area, calls “major medical centers”) in homes with high socioeconomic status and excellent high school and college educations (which is what is mainly done) will result in students with excellent test performance and is likely to produce skilled physicians, but not ones likely to practice in rural or underserved areas.

Students from rural areas, from underserved communities, from low socioeconomic status backgrounds, and from underrepresented minority groups are much more likely to serve these populations, as are students who are older at the time of matriculation. But their lower grades and MCATs, may make them less likely to be accepted, and to have difficulty with the pre-clinical medical curriculum. Students, even from privileged backgrounds, whose prior life history includes significant service are also more likely to work in urban underserved settings; less so (although more than their colleagues without these characteristics) in rural areas. But what about schools of other types or medical schools not in the US?

Click here to read more

Health-related events at the 2010 Peoples Summit in Toronto, Canada

1. Creating Health for All - From the Ground Up
June 20th, 10-noon
Ryerson University, Student Campus Centre - Room G. 55 Gould St.

Despite Canada's perceived 'universal' health care system, thousands of people residing in Canada are actively excluded from health care access on the basis of 'immigration status'. This interactive participatory workshop facilitated by the local migrant justice group Health For All explores the causes of forced migration and discusses the systemic denial of healthcare access to migrants in Canada. The workshop will highlight how local community based campaigns, such as Access Without Fear, are fighting back to create health for all from the ground up.

2. Emancipatory Healthcare: Local Resistance to Global Neoliberalism
June 20th, 1-2:50pm
Ryerson University, VIC 209- Victoria Building, 285 Victoria St.

This panel explores the ground level impact of neoliberal economics on the health of communities within this country. From moves to privatization of medicare, to cuts in the Special Diet Allowance in Ontario, to the systemic denial of healthcare access to migrants- the deep and broad undermining of public services to further profit motives is being met by significant resistance from an emerging radical left health sector within Canada. Join local organizations- Health Providers Against Poverty, Justicia For Migrant Workers, Health For All and Students For Medicare in a discussion on local community resistance against neoliberal attacks on health.

3. Globalization, the G20, and the Attack on Healthcare as a Human Right
June 19th, 10 am - 12 pm
Ryerson University, VIC 204- Victoria Building, 285 Victoria St.

This panel focuses on the impact of globalization and the policies of the G20 as they link to forces supporting privatization. We will further discuss why privatization can lead to negative consequences in our health system,
and what better solutions we can find within the public system, as well as how best to organize around these issues.
with Gareth Blair, Ontario Health Coalition Research Director, Pam Beck, activist, Ritika Goel, Students for Medicare

Monday, June 14, 2010

Red Cross declares opposition to Israeli blockade of Gaza

On Monday, June 14th, 2010, the International Committee of the Red Cross (ICRC) declared their opposition to the Israeli blockade of the Gaza Strip. Noting the blockade's devastating effects on the social determinants of health, the prevalence of disease, and the availability of health care, the ICRC recognized the blockade as a form of collective punishment and a violation of the Geneva Conventions.

The ICRC statement, entitled "Gaza Closure: not another year!" reads: "Humanitarian aid cannot address the hardship faced by Gaza's 1.5 million people. The only sustainable solution is to lift the closure. The blockade imposed on Gaza is about to enter its fourth year, thwarting any real chance of economic development. As Gazans endure unemployment, poverty and warfare, the quality of their health care has reached an all-time low."

To read the ICRC's full statement on their website, click here.

Friday, June 4, 2010

Social Medicine as Human Rights Praxis

As HR activists working in health, we face a double challenge. We must work for fundamental economic, social and political changes underlying what we know as the social determinant of health and, at the same time, we must work on changes in the specific field of health where additional localized resistance (often by doctors) is to be reckoned with. We thus need to set-up networks –not forgetting the health workers, organized or not– to integrate our health and our human rights (HR) aims in what will inevitably become a political challenge.

Actually, it is the HR-based framework that contains the powerful ideas; ideas that are at odds and counter neoliberal ideology, ideas that are a counter-power to the prevailing market forces –and, let’s face it, that is why the spreading of the HR idea is opposed. The powers-that-be fear HR as they entail an emancipatory praxis, a praxis that eventually is a counter-hegemonic force against globalization. The HR-based framework legitimizes power in the hands of claim holders, away from male, adult, middle and upper-class property owners. In so doing, the HR framework confers on rights holders a legitimate claim on the resources necessary to fulfill specific HR –and that is feared. HR are ultimately the legal expression of a collective will –and that is feared. Moreover, the HR-based framework prioritizes dignity and solidarity over accumulation, over competition, and over the market, as well as the inclusion of environmental rights –and that is feared. (I think I am not being harsh in my analysis here; I am just calling a spade, a spade)

To read the rest of the article, click here to visit the Social Medicine Portal

Ideas and Action for Global Maternal Health

The Lancet: Special-themed issue on Maternal-Child Health
"Large numbers of the public remain unaware of the health issues facing women and children. Women and girls make up 60% of the world’s poorest and two-thirds of the world’s illiterate. Yet with education and empowerment, they can lead healthy lives and lift themselves and their families out of poverty. This week a themed issue of The Lancet covers a range of global issues on maternal, child, and newborn health."

Women Deliver: brining together voices for global maternal health
"Launched at a groundbreaking conference in 2007, Women Deliver works globally to generate political commitment and financial investment for fulfilling Millennium Development Goal #5 — to reduce maternal mortality and achieve universal access to reproductive health. The initiative builds on commitments, partnerships, and networks mobilized at the conference, fighting to end the deluge of preventable deaths that kill between 350,000 - 500,000 girls and women from pregnancy-related causes every year. Women Deliver’s message is that maternal health is both a human right and a practical necessity for sustainable development."