Using Literature to Teach Activism for Public Health

1. Using Literature to Teach Activism for Public Health Martin Donohoe, MD, FACP Portland State University Oregon PSR

2. Public Health Education Principles of public health rooted in social justice Importance of social, cultural, and economic factors in health and disease Public health issues are stories Teaching/vicarious experience Analysis

3. Harvey Cushing �A physician is obligated to consider more than a diseased organ, more even than the whole man. He must view the man in his world.�

4. Rudolph Virchow �Doctors are natural attorneys for the poor � If medicine is to really accomplish its great task, it must intervene in political and social life��

5. Issues in Teaching Humanities/Activism Students Highly motivated Negative attitudinal changes / cynicism Faculty Curricular Time Institutional Support

6. Goals Educate students and practitioners about social justice issues Promote activist-oriented research and writing

7. Goals Translate knowledge into practice through volunteerism and service Encourage lifelong learning Heal schism between medicine and public health; encourage interdisciplinary learning and collegial practice

8. Issues Access to care Racial, sexual and SES discrepancies in outcomes The effects of poverty on health

9. Issues Corporatization of academic and clinical medicine The role of the pharmaceutical industry Drug promotion and advertising Drug pricing Conflicts of interest Balancing responsibilities to self, patients, insurers, colleagues, and community

10. Issues Women�s rights issues: Violence against women Teen pregnancy Female genital mutilation Political, legal, and educational marginalization Sexual harassment

11. Issues Homelessness Substance abuse Tobacco industry Privacy: Genetic testing Drug testing

12. Issues Physician mistakes Impaired physicians Physician fraud

13. Issues Human subject experimentation Nazis, Japan�s Unit 731 Tuskegee Syphilis Study Willowbrook Hepatitis Experiments Henry Beecher U.S. government-sponsored radiation experiments Nuremberg Code, Helsinki Conventions

14. Issues Human Subject Experimentation - Contemporary Issues: Special populations (e.g., prisoners, cultural minorities, the mentally ill Internationalization of research Use of placebo controls The role of for-profit IRBs cloning

15. Issues Environmental degradation Overpopulation Air and water pollution Deforestation Global warming Unsustainable agricultural and fishing practices Species loss

16. Issues Environmental degradation � social justice contributors: Overconsumption (�affluenza�) Maldistribution of wealth Rise of the corporation Third World debt crisis Human rights abuses

17. Issues War and Militarism: Weapons of mass destruction Diversion of economic resources and intellectual capital Prejudice/hate crimes Erosion of civil liberties

18. The Role of Literature Vicarious experience Explore diverse philosophies Promotes empathy, critical thinking, flexibility, non-dogmatism, self-knowledge Encourages creative thinking Allows for group discussion/debate

19. Why Use Literature Encourage appreciation of non-medical literature Develop reading, analytical, speaking and writing skills Promote ethical thinking (narrative ethics) Identification with doctor authors (e.g., Keats, Chekhov, Maugham, Williams)

20. Stigmatization John Updike �From the Journal of a Leper.� Am J Dermatopathol 1982;4(2):137-42

21. Homelessness Doris Lessing �An Old Woman and Her Cat� From the Doris Lessing Reader (New York: Knopf, 1988)

22. Race and Access to Care Ernest J Gaines �The Sky is Gray� in Gray, Marion Secundy, ed. Trials,Tribulations, and Celebrations: African American Perspectives on Health, Illness, Aging and Loss. Yarmouth, Maine: Intercultural Press, 1992

23. Poverty Orwell, George. How the Poor Die. In Sonia Orwell and Ian Angus, eds. The Collected Essays, Journalism and Letter of George Orwell, IV; In Front of Your Nose, 1945-1950. New York: Harcourt, Brace and World, Inc: pp.223-233. Checkhov, Anton. Letter to AF Koni, January 26, 1891, Letter to AS Survivor, March 9, 1890. In Norman Cousins, ed. The Physician in Literature Philadelphia: WB Saunders, 1982. Eighner, Lars. Phlebitis: At the Public Hospital. In Travels with Lizbeth. New York: St. Martin�s Press, 1993.

24. Domestic Violence Michael LaCombe �Playing God� In LaCombe M, ed. On Being a Doctor. Philadelphia: American College of Physicians, 1994

25. Human Subject Experimentation / Human Rights Abuses Shusaku Endo The Sea and Poison (New York: Taplinger Publishing Co., 1972)

26. Conflicting Responsibilities of Physicians Pearl S. Buck �The Enemy� In Far and Near: Stories of Japan, China, and America (New York: The John Day Company, 1934)

27. Mental Illness Anton Chekhov Ward Number Six in Chekhov A. Seven short novels (New York: Bantam, 1976)

28. Single Motherhood / The Welfare System Grace Paley �An Interest in Life� In We are the Stories We Tell: The Best Short Stories by North American Women since 1945, Wendy Martin, ed. (New York: Pantheon Books, 1990)

29. Suggestions Use literary selections in courses and community work Interdisciplinary education Share stories with colleagues, patients/clients

30. Suggestions Create dedicated reading and writing groups Encourage conferences Read activist journals

31. �Activist� Journals American Journal of Public Health Public Citizen�s Health Letter PNHP Newsletter Mother Jones Harpers Z Magazine Hightower Lowdown

32. �Activist� Journals Rachel�s Environmental Weekly Sierra The Amicus Journal Bulletin of Atomic Scientists Multinational Monitor Some articles in NEJM, JAMA, JGIM, SSM, Policy, Politics, and Nurs Prac, others

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

34. Contact Information Public Health and Social Justice Website http://www.phsj.org martindonohoe@phsj.org