Physicians and Social Justice

by D. Frederick Sparks

The classic version of the Hippocratic Oath states that a physician should keep the sick from “harm and injustice”.  A modern version of the oath used in many medical schools declares that physicians should remember that they remain members of society, “with special obligations to all fellow human beings, those sound of mind and body as well as the infirm.”

For some physicians, living out the promises of their oaths manifests itself in using their platform and medical expertise to highlight issues of social justice and social inequality, and in particular, the degree to which social inequities impact health outcomes.

Physicians and Criminal Justice Reform

In 2013, the venerable television show Sesame Street introduced the character Alex, a young boy who reluctantly reveals to his friends that his father is incarcerated.  Alex serves as a voice for the increasing number of children with at least one incarcerated parent.

The introduction of this character served as an unlikely catalyst for a group of physicians to make a call to action for doctors to address the impact of mass incarceration on health outcomes. In an article published in the Annals of Internal Medicine,  the group of doctors noted that incarceration is a Social Determinant of Health (SDOH), and that SDOHs such as incarceration, poverty, and housing and educational disparities shape patients’  health and access to care.  The article also notes that while incarceration is a finite experience, a history of incarceration may lead to lasting negative health outcomes, as the formerly incarcerated experience  higher rates of homelessness, lower rates of employment, and permanent disqualification from many anti-poverty and health assistance programs all of which are factors associated with poorer health.  Importantly, the health consequences affect not only to the incarcerated person, but also the family members including children.

The organization Physicians for Criminal Justice Reform  (PfCJR) was launched in May 11, 2015, co-founded by  Dr. Edjah Nduom, a  neurosurgeon (all similarities to a former presidential candidate end there) currently serving as a Staff Clinician in the Surgical Neurology Branch at the National Institutes of Health, and Dr. Nzinga Harrison, a psychiatrist who is the Chief Medical Officer for Anka Behavioral Health, Inc., a private, non-profit mental health system.   According to Dr. Nduom,  the organization was struck by the myriad of ways in which negative interactions with the criminal justice system lead to detrimental health consequences. They believe that changing the interactions between the criminal justice system and targeted communities will lead to improved health outcomes.  PfCJR has organized its advocacy efforts around three core issues:

  • Decriminalization of mental health and addictive disorders, noting that individuals with severe mental illness are three times more likely to be in a jail or prison than in a mental health facility and 40 percent of individuals with a severe mental illness will have spent some time in their lives in either jail, prison, or community corrections.
  • Reform of the juvenile justice system to identify and divert at risk adolescents, as research suggests that as many as 70 percent of youth in the juvenile justice system have a diagnosable mental health disorder.   And youth housed in adult jails are 36 times more likely to commit suicide than are youth housed in juvenile detention facilities.   Also,  youth under the age of 18 represented 21 percent of all substantiated victims of inmate-on-inmate sexual violence in jails in 2005, and 13 percent in 2006 – despite the fact that only 1 percent of inmates are juveniles, a
  • Provision of adequate access to physical and psychiatric health care for current inmates. Prison inmates have a higher incidence of chronic and infectious diseases, such as AIDS and hepatitis C, and mental illness than that of the general population.

Since its founding, PfCJR has established several partnerships to help physicians use their specific medical expertise to further the cause of one of the most significant civil rights issues of our time. In a new partnership with the Campaign for Youth Justice, they are using their knowledge of the difference between the brain biology of juveniles and adults to support the need to #raisetheage of criminal responsibility in states that treat juvenile offenders as adults. The group has also been traveling the country, presenting for the American Medical Association Young Physicians Section, the Student National Medical Association, the American Psychiatric Association and the National Physicians Alliance. “All physicians naturally want to find ways to improve the health of our communities,” says Dr Nduom. “When we let our colleagues know the many ways that healthcare intersects with the criminal justice system, many physicians find that they are already working on our core issues, but did not realize that their work was actually part of a social justice movement.”

Targeted Services to Underserved Populations

In addition to specific political and civic advocacy, physicians contribute to the push for social justice through targeted services to underserved populations. The French founded group Doctors Without Borders is one of the most well-known groups providing medical services and supplies to disadvantaged populations globally.   More locally, In Los Angeles and other cities, many doctors are practicing ‘street medicine‘ ,  in which healthcare providers go to where homeless patients are, rather than waiting for them to come to offices and emergency rooms.  Other physicians have specifically targeted under-served populations within their research and clinical practice.  Dr. Sande Okelo,  Division Chief of Pediatric Pulmonology at Mattel Children’s Hospital UCLA,  focuses on developing tools and strategies to improve asthma care, particularly for poor, minority and under-served children who are most at risk for poor asthma care and poor outcomes.

Public Trust and the Medical Profession

A study completed in 2014 found that, in the United States, the level of public trust in physicians as a group ranked near the bottom of trust levels in 29 industrialized countries (though, paradoxically, Americans reported higher satisfaction with their individual health care provider than with providers as a group).  The level of mistrust, particularly when it comes to participating in medical research studies, is more pronounced among African-Americans.   The author of the 2014 report stated that a key to improving this perception may be physicians and professional societies like the AMA taking “more visible stands on issues broadly affecting people’s health.”  The work that some physicians are doing around criminal justice reform, access for underserved populations, and other social justice issues may help not only in providing a more comprehensive level of care that considers various societal inputs to health outcomes, but may also serve to enhance public trust in the profession.

Physicians and Social Justice
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2015 First in the Family Humanist Scholarship Winners

Flyer 2015

This year, Black Skeptics Los Angeles is proud to award eight youth First in the Family Humanist scholarships. In August, four students from L.A. high schools will receive $1000 apiece through our original fund for homeless, undocumented, foster care, LGBTQ and system-involved youth.  These students are going to some of the most competitive colleges in the country in a prison pipelining climate that has become increasingly difficult for low-income youth of color.

Earlier this year, through the advocacy of secular activist and Freedom From Religion Foundation president Annie Laurie Gaylor, we also received a generous award from the FFRF to fund four more students of color–this award was designated the Catherine Fahringer Memorial scholarship–who identify as secular, atheist, agnostic or humanist, at $2500 apiece.  In addition to these other criteria, students were chosen for their leadership, involvement in their school-communities and insights into the relationship between humanism and social justice.

Congratulations scholars!

Mariana Cervantes, King Drew Medical Magnet
Mariana Cervantes, King Drew Medical Magnet

Mariana Cervantes, Cal State University Northridge (FIF LAUSD): “As an individual, I will break the barriers against Latinas in the science field but will also give back to my community by teaching children the art of foklorico with a focus on education and humanistic qualities of equality for all.”

 

Mercedes Hawkins
Mercedes Hawkins

Mercedes Hawkins, UC Merced (CF): “Too many religious people insist upon waiting for ‘God’ to make a change. They fail to realize that the change is in them and it is their duty to cultivate it outwardly.  Once more people embrace humanism, we will freely celebrate our differences in beliefs and promote acceptance.”

 

Victor Marroquin, Fairfax HS
Victor Marroquin, Fairfax HS

Victor Marroquin, UC Riverside (FIF LAUSD): “I am a Mexican-Guatemalan American, the first in my mixed status family to be born in the U.S. and a bisexual immigrant rights activist.  I have been a victim of hatred for my identity.  I live in between Koreatown and East Hollywood, communities of Los Angeles that face the most immigrant status challenges as a result of the current broken immigration system.  The LGBTQ representation is very weak in both communities. It seems so odd that these communities fall behind in embracing the LGBTQ movement because undocumented immigrants and LGBTQ people share the same obstacles.  These social movements should be more strongly intertwined.”

Zera Montemayor
Zera Montemayor

Zera Montemayor, University of North Texas (CF): “Religion is not the source for social change in the world. It is time the human race understood that words like atheist, agnostic, and humanist are not truly as negative as the connotation they carry. We are not hateful, sinners, harlots, or devil worshipers. We simply believe that each and every human is equal. Not one person deserves to be oppressed simply because they are from different walks of life.  There are so many things I would love to see before my life is over. I would love to see to gay people get married and the public not make a big commotion about it. I would love to see transgender people not be harassed or called “she-man”. I would love to see women wear whatever they please and not be marked by words like “slut” or “whore”. I would love seeing men taking ballet or a cooking class and not be marked with the misnomer “gay”. Finally, I want to be able to tell people I am an atheist without it ruining friendships. I believe humanism is the answer.”

Ramon Cortines, HS
Nyallah Noah, Ramon Cortines, HS

Nyallah Noah, University of Southern California (LAUSD FIF): It wasn’t until this past year that I realized how important feminism, civil rights and LGBT rights were to me.  Born and raised in Los Angeles, being a seventeen year-old African American lesbian has been tough to be quite honest…I do not understand why in 2015 we are still fighting for civil rights for different minority groups, I do not understand why it has taken years for same sex marriage to be a legal act; nor do I understand why every day there are black men, women and children who are being killed because apparently the color of their skin is just as deadly as a weapon.”

 

Adrienne Parkes
Adrienne Parkes

Adrienne Parkes, University of Pittsburgh (CF): “One of the things that caused me to shy away from religion was the lack of acceptance of those who are different.  Growing up, I felt like an oddball, one of the few biracial kids in a very white neighborhood. I had dabbled in church as a child…but I kept waiting to hear God answer me and it never happened.  This made no sense to me, so I left and never looked back.  In the years following I would learn that most churches weren’t accepting of gays and lesbians, which only affirmed my decision.  Many people are using their religion to hurt the LGBTQ community.  We see it in people like the Duggars, who are campaigning to stop trans individuals from using gender appropriate bathrooms. Or in the recent cases of businesses using “religious freedom” to justify not serving gay patrons. I believe that being a humanist, and being passionate about equal rights and fostering a positive community will create a much needed social change.”

Bryan Sierra, Carson HS
Bryan Sierra, Carson HS

Bryan Sierra, UCLA (LAUSD FIF): “During my Sophomore year of high school, I found out that I was undocumented, but didn’t know what that meant. I wanted to enroll in college classes offered at my school for free, but I needed a social security number.  I confronted my parents several times about the situation; however, I was unsuccessful in getting the nine-digit number. I continued nagging, until one day my parents sat me down and explained to me that I was not from America and that this country is not a part of who I am.  I was confused because the United States is all I had known since I was six.”  

Therrin Wilson
Therrin Wilson

Therrin Wilson, University of Tennessee (CF): “I will be the first male in my entire family to receive a college education and I am also the first to disclaim Christianity. I do not condemn religion because it has influenced people to attribute a positive impact on society hence the Salvation Army, Goodwill, etc. On the other hand, I admire humanism more because humanist act upon a worthy heart when doing positive things for the community.”

2015 First in the Family Humanist Scholarship Winners

Environmental racial disparity and Keystone

by Frederick Sparks

My hometown of Port Arthur, Texas may be considered “famous” for a few things: natives Janis Joplin and former NFL coach Jimmy Johnson, rappers Pimp C and UGK, who collaborated with Jay Z (“big pimpin down in P-A-T”), and for its past as a central point of vice and corruption in Texas; in the late 1950s a special state legislative committee convened to investigate the complicity of law enforcement with open and notorious illegal gambling and prostitution (the actor Steve McQueen once worked as a bouncer at one of Port Arthur’s bawdy houses).

But Port Arthur’s most notorious legacy may be related to its status as home to one of the largest oil refining capacities in the world, and the disproportionate rate of cancer and other diseases and ailments experienced by Port Arthur’s poorest black residents, who live in close proximity to Port Arthur’s refineries.  Now, Port Arthur is the terminus for the Keystone pipeline.

In a 2013 article awarded a prize for social justice journalism, writer Ted Genoways highlighted the health challenges of residents of a housing complex built in close proximity to the refineries:

“Cancer rates among African Americans in Jefferson County are roughly 15 percent higher than they are for the average Texan. Shockingly, the mortality rate from cancer is more than 40 percent higher. And cancer is only part of the story. A study by the University of Texas Medical Branch at Galveston found that residents of Port Arthur were four times more likely than people just 100 miles upwind to report suffering from heart and respiratory conditions; nervous system and skin disorders; headaches and muscle aches; and ear, nose, and throat ailments.”

The article also notes that while African Americans make up only 12 percent of the Texas population, people of color make up more than 66 percent of residents near the state’s most hazardous waste sites.All of this is of course made easier by state and local officials who receive financial incentives from energy companies in exchange for lax or nonexistent enforcement of environmental regulations.  It took years for the Texas legislature to close the loophole exempting refineries and power plants built before 1971 from regulation.  And in 2001 when the EPA was poised to impose ozone limiting restrictions affecting the Beaumont/Port Arthur area, the Texas Natural Resource Conservation Commission (TNRCC) carried the water of the energy industry and convinced the EPA that the levels that were being measure represented pollution drift from Houston, not local refining.  Thus additional regulations were delayed until 2007.

The addition of the pipeline only adds to the risk of environmental degradation and related health consequences.  And Port Arthur is not unique in that there is nationwide pattern of the poor and people of color being far more likely to live close to environmental hazards and to bear negative consequences from that exposure.

So it is particularly disheartening to see Congressional Black Caucus members Sheila Jackson Lee (Texas) and James Clyburn (Florida) cross party lines to vote in favor of the pipeline.  I suspect their votes were influenced by big money energy constituents (particularly in the case of Lee) and by the promise of “job creation”… though as it has been noted, the State Department review shows that only 35 permanent jobs would be created by the pipeline.  Thirty five.  How many cancer deaths are those jobs worth?

 

Environmental racial disparity and Keystone