By Raymond Rendleman
The Lund Report (Portland, Ore.), Nov. 23, 2012
When you Google “public health and social justice,” the first thing that comes up is Portland Dr. Martin Donohoe’s expansive website.
Now Donohoe, 49, is turning his go-to resource into a book that also compiles the major advances in the public health field, but in a handy best-of format of a mere 656 pages for $85.
Although throughout the book there are suggestions for change, this content is often a “real downer,” he acknowledged, so he included an optimistic section about achieving social justice in healthcare through education and activism. Stephen Bezruchka promotes public understanding of population health, Carolyn Raffensperger and Peter Montague offer ideas for a common agenda to eliminate health disparities and provide universal healthcare, and Robert Weissman sees mechanisms to defeat corporate power.
Donohoe’s own methods for combating corporate control include advocating for publically financed political campaigns, increased funding for education, a national single-payer comprehensive health plan and a reconfiguration of tax systems to discourage companies’ toxic waste generation.
“You can make a huge difference simply by addressing the social factors that relate to illness, but that requires a social and governmental commitment,” Donohoe said. “The first step is factual awareness of the social factors, and as a society we have to prioritize what’s important to us based on ethical standards of fairness. In the U.S., government is very efficient in providing healthcare, although it’s excessively demonized.”
On a broader scale, he’d like to see people work toward a cleaner planet by working with environmental groups, and groups providing standards of housing that contribute to social and environmental health.
“You’ll be much more efficient working with groups than working by yourself,” he said.
While the book is being marketed for colleges and universities, it’s accessible to lay audiences. His hope is that the first volume is successful enough to merit a volume two that would also hopefully “nudge students in the direction of hopefully doing some type of service during their careers.”
He’s also raising money to develop a national program to train healthcare activists. His long term vision is to develop an annual, weeklong colloquium for medical students and residents interested in obtaining the information, skills and professional contacts to help them become social justice advocates and leaders. In a “highly competitive,” two-year program, academic experts and leaders from nonprofit organizations would impart basic knowledge surrounding major progressive social justice issues. People can contact him for more information about his national program concept at martindonohoe@phsj.org.
“It’s a passion to use what I’ve learned in my medical training and put it to the betterment of humanity,” he said. “The gift that I have to give is my teaching, and my real goal is to re-forge that schism between medicine and the humanities of public health professionals that occurred in the early 20th century.”
Healing this schism will occur through once again emphasizing public health principles in the training of health professionals. Groups such as Physicians for a National Health Program already provide some of this advocacy, but there’s no formal program in which progressive healthcare professionals join together to provide comprehensive education and training. Donohoe likes the 25-year-old group because he sees data-driven volunteer members looking at costs and outcomes of healthcare models, who truly care for their patients.
“Physicians for a National Health Program is committed to a very specific goal that I also like, which is providing single-payer healthcare for everyone from cradle to grave on a national level,” he said.
Origins of Concept
Phsj.org has gotten 575,000 hits since inception in 2007, nearly 20,000 a month, for its thousand of links and hundreds of original articles, slide shows, syllabi and other documents relevant to topics in public health and social justice.
For the past five years, Donohoe has accumulated his 150 talks in Powerpoint on the open-access website, and invited others to submit presentations and key documents. He’s now got more than 1,000 links on the website to external organizations working on various social justice issues organized in categories such as access to reproductive care and the pharmaceutical industry.
Donohoe’s original concept of the “Public Health and Social Justice Reader” was meant just to include his own articles, but he and his publisher at Jossey Bass worked together to make it more comprehensive.
“The tough part was to figure out what to exclude, because there’s so much good writing out there on these subjects,” Donohoe said.
He started the “Reader” with the human rights declaration adopted by the United Nation in 1948, as what he calls the “fundamental document on the rights of humanity,” which demands everyone have free elementary education and a standard of living “adequate for the health and well-being.”
As a member of the social justice committee of Physicians for Social Responsibility, he’s delivered lectures across the country on the public’s responsibility to address heath issues. He’s concentrated that effort at Portland State University since 2001, where he’s an adjunct associate professor at the School of Community Health.
Hundreds of thousands of lives would have been saved between 1994 and 2004 if black and white mortality ratios were equalized, whereas advances in medical technology, where most of the government and corporate investment is, realized much smaller gains. Equalizing the mortality rates of whites and African-Americans would have averted 686,202 deaths between 1991 and 2000, a 2004 study in the American Journal of Public Health showed, while medical advances averted 176,633 deaths during the same time period.
Social, economic, environmental and cultural factors especially contribute to health and disease in the Third World, so he sees “the real heroes” of public health as the doctors who work there. But all healthcare professionals “share a responsibility to recognize the causes and health consequences of environmental degradation and social injustice.” In what he calls a moral obligation to take up the mantle of opposing these forces, people should contribute to public health education, speak out against poverty and inequality, and make positive changes in their own health.
“So much illness is caused by environmental factors, so the best way people can help themselves is to eat low-fat foods and avoid environmental toxins like smoking,” Donohoe said.
One of the early inspirations for Donohoe, now a part-time senior physician at the Kaiser Sunnyside Medical Center, was the Social Medicine Portal at Montefiore Medical Center (Albert Einstein College of Medicine). While attending UCLA for college and medical school, he received a small grant in 1988 from the psychology department to look at what physicians had written about the physician-patient relationship. He then explored the topic of literature as a means of vicarious experience into homelessness and alcohol dependence through a Robert Wood Johnson Clinical Scholars Program Foundation-funded fellowship at Stanford before serving in St. Lucia, in rural medicine and at a homeless shelter.
‘Essential Reference’ Topic Areas
“Reader” has received positive feedback. Dr. Shafik Dharamsi, professor of medicine at the University o
f British Columbia, called Donohoe’s work an “essential reference” for students, teachers and practitioners in the health and human services.
“This compilation unifies ostensibly distant corners of our broad discipline under the common pursuit of health as an achievable, non-negotiable human right. It goes beyond analysis to impassioned suggestions for moving closer to the vision of health equity,” wrote Dr. Paul Farmer, chairman of the Department of Global Health and Social Medicine at Harvard Medical School.
Part two of the “Reader” covers special populations, and it’s nearly impossible to see who’s left out. Topics include homelessness, migrant farm workers, American Indian health disparities, prejudice in the medical profession, gender minority health, mental disorders and our “incarceration nation.”
An entire section devoted to women’s health includes an essay titled “The Way It Was,” by Eleanor Cooney, describing the options that women faced in the 1950s and ‘60s. Most of the students who read the book will have only lived in the post-Roe-v-Wade era, so Donohoe hopes it will be “eye-opening” for them. He also sees that work as a necessary reminder for old timers.
“Especially in an era where governments are trying to take away access reproductive care, this is mandatory reading,” he said.
The environmental health topic areas bring some surprising associations, culminating with his essay “Flowers, Diamonds, and Gold: The Destructive Public Health, Human Rights, and Environmental Consequences of Symbols of Love.” Most purchasers are unaware, Donohoe said, that gifting their lovers with these aesthetic symbols supports industries that damage the environment, use forced labor, cause health problems and contribute to violent conflicts.
Another passion of his is exposing how corporations profit off of unnecessary testing and the general suffering of social health. In an essay about combating corporate control through education, media, legislation and healthcare, he delves deeper into the reason medical ethics overemphasizes dilemmas involving expensive technologies such as gene therapy, cloning and face transplants at the expense of global bioethics and human rights.
“This is in part due to the availability of funding for ethics projects related to high-technology interventions, but also due to the perceived intractability of public health problems and fear of criticizing corporate structures,” he says.
Donohoe supports gene therapy, but not cross-species gene splicing. Face transplants can be literally lifesaving for someone in certain cases, Donohoe says, because getting a face back after an injury is equivalent to getting back your identity. But even gene therapy and face transplanting could be a much smaller portion of the nation public health agenda, he argues.
Order the book at http://www.josseybass.com/WileyCDA/WileyTitle/productCd-111808814X.html or by phone 800-956-7739. It’s also available on Amazon.com and BarnesandNoble.com.
http://www.thelundreport.org/resource/dr_martin_donohoe%E2%80%99s_new_book_cites_major_advances_in_public_health