Using Literature to Using Literature to Teach Activism for Teach Activism for

Public HealthPublic HealthMartin Donohoe, MD, FACPMartin Donohoe, MD, FACP

Portland State UniversityPortland State University

Oregon PSROregon PSR

Public Health EducationPublic Health Education

Principles of public health rooted in Principles of public health rooted in social justicesocial justice

Importance of social, cultural, and Importance of social, cultural, and economic factors in health and economic factors in health and diseasedisease

Public health issues are storiesPublic health issues are stories Teaching/vicarious experienceTeaching/vicarious experience AnalysisAnalysis

Harvey CushingHarvey Cushing

““A physician is obligated to A physician is obligated to consider more than a consider more than a diseased organ, more even diseased organ, more even than the whole man. He than the whole man. He must view the man in his must view the man in his world.”world.”

Rudolph VirchowRudolph Virchow

““Doctors are natural Doctors are natural attorneys for the poor … attorneys for the poor … If medicine is to really If medicine is to really accomplish its great task, accomplish its great task, it must intervene in it must intervene in political and social life…”political and social life…”

Issues in Teaching Issues in Teaching Humanities/ActivismHumanities/Activism

StudentsStudentsHighly motivatedHighly motivatedNegative attitudinal changes / Negative attitudinal changes /

cynicismcynicism FacultyFaculty Curricular TimeCurricular Time Institutional SupportInstitutional Support

GoalsGoals

Educate students and Educate students and practitioners about social practitioners about social justice issuesjustice issues

Promote activist-oriented Promote activist-oriented research and writingresearch and writing

GoalsGoals

Translate knowledge into practice Translate knowledge into practice through volunteerism and servicethrough volunteerism and service

Encourage lifelong learningEncourage lifelong learning

Heal schism between medicine and Heal schism between medicine and public health; encourage public health; encourage interdisciplinary learning and collegial interdisciplinary learning and collegial practicepractice

IssuesIssues

Access to careAccess to care

Racial, sexual and SES discrepancies Racial, sexual and SES discrepancies in outcomesin outcomes

The effects of poverty on healthThe effects of poverty on health

IssuesIssues

Corporatization of academic and Corporatization of academic and clinical medicineclinical medicine

The role of the pharmaceutical industryThe role of the pharmaceutical industry Drug promotion and advertisingDrug promotion and advertising Drug pricingDrug pricing

Conflicts of interestConflicts of interest Balancing responsibilities to self, patients, Balancing responsibilities to self, patients,

insurers, colleagues, and communityinsurers, colleagues, and community

IssuesIssues

Women’s rights issues:Women’s rights issues: Violence against womenViolence against women Teen pregnancyTeen pregnancy Female genital mutilationFemale genital mutilation Political, legal, and educational Political, legal, and educational

marginalizationmarginalization Sexual harassmentSexual harassment

IssuesIssues

HomelessnessHomelessness Substance abuseSubstance abuse Tobacco industryTobacco industry Privacy:Privacy:

Genetic testingGenetic testing Drug testingDrug testing

IssuesIssues

Physician mistakesPhysician mistakes

Impaired physiciansImpaired physicians

Physician fraudPhysician fraud

IssuesIssues

Human subject experimentationHuman subject experimentation Nazis, Japan’s Unit 731Nazis, Japan’s Unit 731 Tuskegee Syphilis StudyTuskegee Syphilis Study Willowbrook Hepatitis ExperimentsWillowbrook Hepatitis Experiments Henry BeecherHenry Beecher U.S. government-sponsored radiation U.S. government-sponsored radiation

experimentsexperiments Nuremberg Code, Helsinki ConventionsNuremberg Code, Helsinki Conventions

IssuesIssues

Human Subject Experimentation - Human Subject Experimentation - Contemporary Issues:Contemporary Issues: Special populations (e.g., prisoners, Special populations (e.g., prisoners,

cultural minorities, the mentally illcultural minorities, the mentally ill Internationalization of researchInternationalization of research Use of placebo controlsUse of placebo controls The role of for-profit IRBsThe role of for-profit IRBs cloningcloning

IssuesIssues

Environmental degradationEnvironmental degradation OverpopulationOverpopulation Air and water pollutionAir and water pollution DeforestationDeforestation Global warmingGlobal warming Unsustainable agricultural and fishing Unsustainable agricultural and fishing

practicespractices Species lossSpecies loss

IssuesIssues

Environmental degradation – social Environmental degradation – social justice contributors:justice contributors: Overconsumption (“affluenza”)Overconsumption (“affluenza”) Maldistribution of wealthMaldistribution of wealth Rise of the corporationRise of the corporation Third World debt crisisThird World debt crisis Human rights abusesHuman rights abuses

IssuesIssues

War and Militarism:War and Militarism:

Weapons of mass destructionWeapons of mass destruction Diversion of economic resources and Diversion of economic resources and

intellectual capitalintellectual capital Prejudice/hate crimesPrejudice/hate crimes Erosion of civil libertiesErosion of civil liberties

The Role of LiteratureThe Role of Literature

Vicarious experienceVicarious experience Explore diverse philosophiesExplore diverse philosophies Promotes empathy, critical thinking, Promotes empathy, critical thinking,

flexibility, non-dogmatism, self-flexibility, non-dogmatism, self-knowledgeknowledge

Encourages creative thinkingEncourages creative thinking Allows for group discussion/debateAllows for group discussion/debate

Why Use LiteratureWhy Use Literature

Encourage appreciation of non-Encourage appreciation of non-medical literaturemedical literature

Develop reading, analytical, speaking Develop reading, analytical, speaking and writing skillsand writing skills

Promote ethical thinking (narrative Promote ethical thinking (narrative ethics)ethics)

Identification with doctor authors Identification with doctor authors (e.g., Keats, Chekhov, Maugham, (e.g., Keats, Chekhov, Maugham, Williams)Williams)

StigmatizationStigmatization

John UpdikeJohn Updike

““From the Journal of a Leper.”From the Journal of a Leper.”

Am J Dermatopathol 1982;4(2):137-42Am J Dermatopathol 1982;4(2):137-42

HomelessnessHomelessness

Doris LessingDoris Lessing

““An Old Woman and Her Cat”An Old Woman and Her Cat”

From the Doris Lessing Reader (New York: From the Doris Lessing Reader (New York: Knopf, 1988)Knopf, 1988)

Race and Access to CareRace and Access to Care

Ernest J GainesErnest J Gaines

““The Sky is Gray”The Sky is Gray”

in Gray, Marion Secundy, ed. in Gray, Marion Secundy, ed. Trials,Tribulations, and Celebrations: Trials,Tribulations, and Celebrations: African American Perspectives on Health, African American Perspectives on Health, Illness, Aging and LossIllness, Aging and Loss. Yarmouth, Maine: . Yarmouth, Maine: Intercultural Press, 1992Intercultural Press, 1992

PovertyPoverty Orwell, George. Orwell, George. How the Poor DieHow the Poor Die. . In Sonia In Sonia

Orwell and Ian Angus, eds. Orwell and Ian Angus, eds. The Collected Essays, The Collected Essays, Journalism and Letter of George Orwell, IV; In Journalism and Letter of George Orwell, IV; In Front of Your Nose,Front of Your Nose, 1945-1950. New York: 1945-1950. New York: Harcourt, Brace and World, Inc: pp.223-233.Harcourt, Brace and World, Inc: pp.223-233.

Checkhov, Anton. Checkhov, Anton. Letter to AF KoniLetter to AF Koni, , January 26, 1891,January 26, 1891, Letter to AS Survivor Letter to AS Survivor, , March 9, 1890. March 9, 1890. In Norman Cousins, ed. In Norman Cousins, ed. The The Physician in Literature PhiladelphiaPhysician in Literature Philadelphia: WB Saunders, : WB Saunders, 1982. 1982.

Eighner, Lars. Phlebitis: At the Public Eighner, Lars. Phlebitis: At the Public Hospital. Hospital. In In Travels with LizbethTravels with Lizbeth. New York: St. . New York: St. Martin’s Press, 1993.Martin’s Press, 1993.

Domestic ViolenceDomestic Violence

Michael LaCombeMichael LaCombe

““Playing God”Playing God”

In LaCombe M, ed. On Being a Doctor. In LaCombe M, ed. On Being a Doctor. Philadelphia: American College of Philadelphia: American College of Physicians, 1994Physicians, 1994

Human Subject Human Subject Experimentation / Human Experimentation / Human

Rights AbusesRights AbusesShusaku EndoShusaku Endo

The Sea and PoisonThe Sea and Poison

(New York: Taplinger Publishing Co., 1972)(New York: Taplinger Publishing Co., 1972)

Conflicting Responsibilities Conflicting Responsibilities of Physiciansof Physicians

Pearl S. BuckPearl S. Buck

““The Enemy”The Enemy”

In Far and Near: Stories of Japan, China, In Far and Near: Stories of Japan, China, and America and America (New York: The John Day (New York: The John Day Company, 1934)Company, 1934)

Mental IllnessMental Illness

Anton ChekhovAnton Chekhov

Ward Number SixWard Number Six

in Chekhov A. Seven short novels (New in Chekhov A. Seven short novels (New York: Bantam, 1976)York: Bantam, 1976)

Single Motherhood / The Single Motherhood / The Welfare SystemWelfare System

Grace PaleyGrace Paley

““An Interest in Life”An Interest in Life”

In In We are the Stories We Tell: The Best We are the Stories We Tell: The Best Short Stories by North American Women Short Stories by North American Women since 1945since 1945, Wendy Martin, ed. (New York: , Wendy Martin, ed. (New York: Pantheon Books, 1990)Pantheon Books, 1990)

SuggestionsSuggestions

Use literary selections in Use literary selections in courses and community workcourses and community workInterdisciplinary educationInterdisciplinary education

Share stories with Share stories with colleagues, patients/clientscolleagues, patients/clients

SuggestionsSuggestions

Create dedicated reading and Create dedicated reading and writing groupswriting groups

Encourage conferencesEncourage conferences Read activist journalsRead activist journals

““Activist” JournalsActivist” Journals

American Journal of Public HealthAmerican Journal of Public Health Public Citizen’s Health LetterPublic Citizen’s Health Letter PNHP NewsletterPNHP Newsletter Mother JonesMother Jones HarpersHarpers Z MagazineZ Magazine Hightower LowdownHightower Lowdown

““Activist” JournalsActivist” Journals

Rachel’s Environmental WeeklyRachel’s Environmental Weekly SierraSierra The Amicus JournalThe Amicus Journal Bulletin of Atomic ScientistsBulletin of Atomic Scientists Multinational MonitorMultinational Monitor Some articles in NEJM, JAMA, JGIM, Some articles in NEJM, JAMA, JGIM,

SSM, Policy, Politics, and Nurs Prac, SSM, Policy, Politics, and Nurs Prac, othersothers

Nurse Margaret SangerNurse Margaret Sanger

Books have been to me what gold is Books have been to me what gold is to the miser, what new fields are to to the miser, what new fields are to the explorer. the explorer.

Contact InformationContact Information

Public Health and Social Public Health and Social Justice WebsiteJustice Website

http://www.phsj.orghttp://www.phsj.org

martindonohoe@phsj.orgmartindonohoe@phsj.org