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Teaching the Social Determinants of Health: A Path to Equity or a Road to Nowhere?

Sharma, Malika, MD, MEd; Pinto, Andrew, D., MD, MSc; Kumagai, Arno, K., MD

doi: 10.1097/ACM.0000000000001689
Perspectives

Medical schools are increasingly called to include social responsibility in their mandates. As such, they are focusing their attention on the social determinants of health (SDOH) as key drivers in the health of the patients and communities they serve. However, underlying this emphasis on the SDOH is the assumption that teaching medical students about the SDOH will lead future physicians to take action to help achieve health equity. There is little evidence to support this belief. In many ways, the current approach to the SDOH within medical education positions them as “facts to be known” rather than as “conditions to be challenged and changed.” Educators talk about poverty but not oppression, race but not racism, sex but not sexism, and homosexuality but not homophobia. The current approach to the SDOH may constrain or even incapacitate the ability of medical education to achieve the very goals it lauds, and in fact perpetuate inequity. In this article, the authors explore how “critical consciousness” and a recentering of the SDOH around justice and inequity can be used to deepen collective understanding of power, privilege, and the inequities embedded in social relationships in order to foster an active commitment to social justice among medical trainees. Rather than calling for minor curricular modifications, the authors argue that major structural and cultural transformations within medical education need to occur to make educational institutions truly socially responsible.

M. Sharma is an infectious diseases physician and Canadian Institutes of Health Research (CIHR) Canadian HIV Trials Network (CTN)/Canadian Foundation for AIDS Research (CANFAR) postdoctoral fellow, St. Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada.

A.D. Pinto is a family physician and public health specialist, Department of Family and Community Medicine, St. Michael’s Hospital, assistant professor, Department of Family and Community Medicine, Faculty of Medicine and Dalla Lana School of Public Health, University of Toronto, clinician–scientist, Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, and director, The Upstream Lab, Toronto, Ontario, Canada.

A.K. Kumagai is endocrinologist, professor, and vice chair of education, Department of Medicine, University of Toronto, and F.M. Hill Chair in Humanism Education, Women’s College Hospital, University of Toronto, Toronto, Ontario, Canada.

Funding/Support: M. Sharma’s work was supported by the Clinician Educator Training Program through the Department of Medicine at the University of Toronto. A.D. Pinto is supported by the Department of Family and Community Medicine, St. Michael’s Hospital and Li Ka Shing Knowledge Institute, St. Michael’s Hospital, and the Department of Family and Community Medicine, Faculty of Medicine and Dalla Lana School of Public Health, University of Toronto. A.K. Kumagai is supported by an endowment from the F.M. Hill Foundation of Women’s College Hospital.

Other disclosures: None reported.

Ethical approval: Reported as not applicable.

Correspondence should be addressed to Malika Sharma, Maple Leaf Medical Clinic, 14 College St., Suite 501, Toronto, ON, M5G 1K2; telephone: (416) 465-0756 ext. 3; e-mail: malika.sharma@mail.utoronto.ca.

© 2018 by the Association of American Medical Colleges