Education

UCLA David Geffen School of Medicine
Selective in Social Medicine
Fall Course Director: Shamsher Samra, MD, MPhil

Social, economic, and political forces have significant bearing on the health and well-being of individuals and communities both locally and globally. For most physicians the link between the health and structural forces beyond the clinic walls, such as discrimination, inequity, and injustice, are clear. This connection explains how two individuals with the same disease in two different countries, or two neighborhoods of the same city, may experience vastly different health outcomes. Despite this, medical teaching and practice is heavily skewed toward the biomedical diagnosis, management, and treatment of disease with little emphasis on inequitable social and economic conditions that may underpin illness. The aim of this selective is to expose students to the field of social medicine, empowering future clinicians to engage with the social determinants of health as a part of their future practice.

Session 1 - Structural Violence and Vulnerability
Prof. Philippe Bourgois, Dept of Anthropology

Session 2 - Politics of Medicine and Medical Debt
Shamsher Samra, MD, Mphil, Harbor UCLA Dept of Emergency Medicine
Tarak Trividi, MD, UCLA Dept of Emergency Medicine

Session 3 - Violence and Violence Intervention Programs
Dr. Rochelle Dicker, UCLA Dept of Surgery

Session 4 - Culture and Language in the Clinical Setting
Dr. Kian Preston-Suni, and Dr. Breena Taira, UCLA Dept of Emergency Medicine

Session 5 - Intersection of Incarceration and health and Medical-Legal Partnerships
Jeremy Levenson, Dept of Anthropology UCLA
Mark-Anthony Johnson, Justice LA, Frontline Wellness Network
Shamsher Samra, MD, MPhil and Dennis Hsieh, MD, JD, Harbor-UCLA Dept of Emergency Medicine

Session 6 - Community Organizing and Health and the Practice of Liberation Medicine.
Dr. Linda Sharp Doctors for Global Health and the People's Health Movement

Session 7 - Immigration and Border Imperialism
Dr. Mary Cheffers and Dr. Todd Schneberk, LAC+USC, Department of Emergency Medicine

IDHEAL Suggested Reading List

Recommended reading to learn more about Social Emergency Medicine

Submit Entry to IDHEAL Suggested Reading List

Anti-Racism: Racism and Society

• So You Want To Talk About Race
  Ijeoma Oluo
  • This book is a great introduction to conversations about race, including explanations of basic terminology like intersectionality and microaggressions.
• How To Be An Antiracist
  Dr. Ibram X. Kendi
  • In this book, Kendi elaborates the concept of antiracism and interweaves anecdotes from his own experience to illustrate concepts how racist and antiracist policy impact our society.
• White Fragility: Why It's So Hard for White People to Talk About Racism
  Robin DiAngelo, PhD
  • DiAngelo describes how white racial insulation that leads whites to lack the stamina and skills to productively engage in conversations about race and racism. She then gives steps for how whites can build their own capacity and skills to begin to contribute to racial justice efforts.
• The New Jim Crow: Mass Incarceration in the Age of Colorblindness
  Michelle Alexander
  • Alexander describes how the U.S. system of mass incarceration is essentially a re-design of former Jim Crow laws in disproportionately targeting and impacting African Americans. She argues that disrupting mass incarceration must be a principle step in achieving racial justice. (There is also a Spanish language version available “El Color de la Justicia” with a preface on how the same phenomenon impacts Latinos.)
• Just Mercy
  Bryan Stevenson
  • This is the memoir of the early work of lawyer Bryan Stevenson who directs the Equal Justice Initiative. He describes his efforts to defend young black men who have been wrongly accused and held on death row and through his description reveals the racial injustice in our legal system.

Anti-Racism: Racism in Medicine

• Unequal Treatment: Confronting Racial and Ethnic Disparities in Healthcare
  Institute of Medicine
  • This is the landmark work of the Institute of Medicine documenting pervasive disparities in health care between racial and ethnic groups in the United States, rooted specifically in the clinical encounter.
• Fatal Invention: How Science, Politics and Big Business Re-create Race in the Twenty First Century
  Dorothy Roberts
  • This book is a detailed examination of the myth of the biological concept of race and how it continues to impact our society.
• Medical Apartheid: The Dark History of Medical Experimentation on Black Americans from Colonial Times to the Present
  Harriet A. Washington
  • This is a comprehensive history of medical experimentation on African Americans that provides context for the deep-rooted mistrust of the medical establishment.
• The Immortal Life of Henrietta Lacks
  Rebecca Skloot
  • This book chronicles the lives of the offspring of Henrietta Lacks, whose tumor cells, taken without her knowledge, became the famous HeLa cell line used throughout medical research. It is a deep dive into the repercussions of experimentation detailed in Medical Apartheid (above) on one family and its future generations.
• Just Medicine: A Cure for Racial Inequity in American Health Care
  Dayna Bowen Matthew
  • This book is an ambitious plan for a legal remedy to end racial disparities in U.S. health care. Bowen Matthew elucidates changes that could be made to Title VI of the 1964 Civil Rights Act that would hold health care organizations accountable for disparate health outcomes between racial groups.

Anti-Racism: Implicit Bias in Medicine

• Reducing racial bias among health care providers: lessons from social-cognitive psychology.
  Burgess D
  van Ryn M
  Dovidio J
  Saha S.
  • This article explains that physician bias contributes to health disparities and provides strategies to begin to address and mitigate physicians' biases.
• Physicians and implicit bias: how doctors may unwittingly perpetuate health care disparities.
  Chapman EN
  Kaatz A
  Carnes M
  • This article explains the cognitive origins of implicit, or unconscious bias, and why it is pervasive even among physicians with minimal expressed biases. These biases impact medical decision making, which can be addressed through conscious thought. Increasing the representation of African American physicians, who show less implicit racial bias, cannot be overlooked as a strategy to address health disparities.

Global Health

• Introduction to Global Health Ethics
  Pinto & Upshur
  Introductory
  • This is a case-based discussion of ethical challenges in global health. The chapter on perspectives from the global south is particularly insightful.
• Reimagining Global Health
  Farmer, et al.
  Introductory
  • This is one of the only complete introductions to the history and context of global health initiatives.
• The Lassa Ward
  Ross Donaldson
  Introductory
  • A memoir about a UCLA medical student's first experiences with global health and humanitarian work. Each chapter explores global health themes and problems (e.g. corruption, HIV, etc.)
• Lancet 2035: A World Converging within a Generation
  DT Jamison, et al.
  In Depth
  • The 2013 Lancet special commission's report on the future of global health, written by several very prominent thinkers. They project where global health programming could take us by the year 2035.
• The Bottom Billion
  Paul Collier
  In Depth
  • This work presents the idea of global economic "poverty traps" that countries fall into and how global institutions can help release them.
• Disease Control Priority Project
  DT Jamison, et al.
  In Depth
  • Using the Disability Adjusted Life Year (DALY) as the unit of economic analysis, this paper addresses how countries should approach disease control from a cost effectiveness standpoint. This is a good reference for global health students and an important economic concept to understand.
• Development as Freedom
  Amartya Sen
  In Depth
  • A landmark discussion of how individual freedoms and economic development are intertwined.

Health and Human Rights

• Health and Human Rights
  Mann, et al.
  Introductory
  • This paper introduces a framework for understanding how work in health and human rights can be collaborative and are interdependent in the advancement of either field.
• No Más Bebés
  Tajima-Peña
  In Depth
  • This documentary shares the story of a group of immigrant women who sued LAC+USC for involuntary sterilization during childbirth. This is a particularly important to understand the local history of community trust in Los Angeles County public hospitals.
• Pathologies of Power
  Paul Farmer
  In Depth
  • This work uses examples from the work of Partners in Health to illustrate the correlation between the lack of social and economic rights to illness and the relationship to human rights.
• Structural Racism and Supporting Black Lives - The Role of Health Professionals
  Hardeman, et al.
  In Depth
  • A brief description of structural racism and its role in medical care that serves as a call to action for physicians. The impact on health outcomes for minority patients is discussed.
• Is it worth risking your life? Ethnography, Risk and Death on the US-Mexico border.
  SM Holmes
  In Depth
  • A physician anthropologist and ethnographer from Berkeley, who has written extensively on migrant issues and has actually crossed the border with undocumented research subjects, gives an account of border crossings and the health risks associated with them.
• Public Health and Human Rights
  Beyrer and Pizer
  In Depth
  • Instead of the more traditional legal approach to health and human rights, this book emphasizes the interplay of human rights and impact on health from a public health/epidemiological perspective, and explores evidence-based approaches to addressing abuses. Many of the book's chapter writers are currently working in the field, as opposed to in academia, lending the work a distinct perspective.

Social Determinants of Health

• Unnatural Causes
  Introductory
  • This four-part series of documentaries by PBS focuses on shattering the assumptions and beliefs that individuals have about what contributes to our overall well being. It eloquently illustrates that health is inextricably tied to the environments in which we are born and how power and wealth - and their lack thereof - affect not just access to care but also our ability to be healthy at a cellular level.
• The Health Gap: The Challenge of An Unequal World
  Michael Marmont
  Introductory
  • Marmont synthesizes his prior work and that of others to argue that not just poverty but inequality drives ill health.
• Levels of Racism: A Theoretical Framework and a Gardener's Tale
  CP Jones
  In Depth
  Sub Category: Race
  • The author presents a theoretical framework for understanding racism and guides the learner on the application of this framework to health disparities. Students with little background on conventional theoretical frameworks for evaluating disparities will find this useful.
• Race, Racial Inequalities, and Health Inequalites
  Smedley, et al.
  In Depth
  Sub Category: Race
  • A basic overview of health disparities, race, and institutional and structural racism is given.
• The New Jim Crow: Mass Incarceration in the Age of Colorblindness
  Michelle Alexander
  In Depth
  Sub Category: Race
  • A forcefully -written account of how America has merely replaced the racial caste system with and equally devastating system of social control and mass incarceration. What separates this book from others is the evidence that the author uses to support her claims.
• Racial Microaggressions in Everyday Life
  DW Sue, et al.
  In Depth
  Sub Category: Race
  • Racial micro aggressions, ubiquitous in nature, are defined and classified and their contribution to the perpetuation of inequalities discussed.
• Ghettoside: A True Story of Murder in America
  Jill Leovy
  In Depth
  Sub Category: Violence
  • Account of the epidemic of homicide in South Central Los Angeles and its impact on the community.
• Comparative Cost Analysis of Housing and Case Management Program for Chronically Ill Homeless Adults Compared to Usual Care
  Anirban Basu, et al
  In Depth
  Sub Category: Homelessness
  • A great randomized controlled trial that examines the cost-efficacy of providing housing for homeless people with health problems versus the standard of care.
• Effect of a housing and case management program on emergency department visits and hospitalizations among chronically ill homeless adults: a randomized trial.
  LS Sadowski, et al.
  In Depth
  Sub Category: Homelessness
  • A randomized controlled trial conducted in Chicago that shows the effects of housing on health and healthcare utilization.
• USDA Food Desert Map
  In Depth
  Sub Category: Food Security
  • Interactive map that allows you to look at specific areas in the United States and evaluate for food access indicators for low income populations.
• The Spirit Catches You and You Fall Down
  Anne Fadiman
  In Depth
  Sub Category: Culture
  • Anthropologic account of a Hmong child with seizures that demonstrates the disconnect between treating physicians and parents and the value judgement behind labeling patients or family non-compliant.