Why the physician voice is key to public health

AMA Wire
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Physicians bear the right to speak up for themselves and their patients. That’s a principle Mary Travis Bassett, MD, public health commissioner for the New York City Department of Mental Health and Hygiene, said guides her work and commitment to speaking out against health disparities—even if it means being bold in her convictions. Here’s why she says a physician’s voice is always one of the most valuable assets in public health and addressing health disparities.

Learning to speak up: A lesson from the AIDS crisis in Zimbabwe

After completing her medical training, Dr. Bassett moved to Harare, Zimbabwe, where she served on the medical faculty at the University of Zimbabwe for 17 years and learned the value of advocating for patients.

“When I moved to Harare in 1985, social justice was at the core of Zimbabwe’s national health policy,” Dr. Bassett said at a recent talk during TEDMED 2015. “The country’s government had emerged from a long war of independence and immediately proclaimed a socialist agenda in which health care services and primary education became essentially free for residents. A massive expansion of rural health centers placed roughly 80 percent of the population less than a two hour walk from health care facilities.” 

“It was truly a remarkable accomplishment,” Dr. Bassett said. “Working side by side with brilliant Zimbabwean scientists ...  I felt connected not only to an African independence movement but to a global progressive health movement. But there were daunting challenges. Zimbabwe reported its first AIDS case in 1985 .... I had taken care of a few patients with AIDS in the early 1980s when I did my medical training at Harlem Hospital, but we had no idea what lay in store for Africa.”

She said when she first arrived on the continent, AIDS infection rates stood at two percent. “These would soar to 1 in every 4 adults by the time I left Harare 17 years later,” Dr. Bassett said. “By the mid-1990s, I told hundreds of people in the prime of life that they were HIV positive. I saw colleagues and friends die, my students [and] hospital patients die.”

Responding to the AIDS crisis

Dr. Bassett said she and her colleagues set up HIV clinics, conducted research on HIV, gave condom demonstrations, hosted school and workplace intereventions, and counseled the partners of people infected with HIV on how to protect themselves. She said she worked exhaustively and did “everything she could” for each of her patients no matter how limited her resources. Still, she wishes she had done more.

“At the time I believed I was doing my best,” Dr. Bassett said. “But I was not speaking up about structural change.” For instance, she said she didn’t voice her concerns about the early stance on AIDS that Zimbabwe’s government adopted or how it tried to deal with the epidemic. 

Dr. Bassett said she rationalized her silence because she felt that as a clinician and “guest in the country,” her role was to combat the AIDS crisis using strong technical and medical skills—not necessarily her voice as a patient advocate.

“I felt I was doing my best ... but I realize now that there was more I could have done to rally for change and support,” she said.

Taking the first step to improve public health

Today, Dr. Bassett keeps her lesson from Zimbabwe top of mind, especially as she encounters national statistics showing the deeply rooted connections between social determinants of health and grave outcomes for communities.

“Inequities are embedded in the political and economic organization of our social world, often in ways that are invisible to those with privilege and power,” she said. “We do little for our patients if we fail to recognize these social injustices. Sounding the alarm is the first step toward doing public health right, and it’s how we may rally support to break through and create real change together …. These days I’m not staying quiet. I’m speaking up about a lot of things, even when it makes other people uncomfortable, even when it makes me uncomfortable.”

 “As health professionals in our daily work, whether in the clinic or doing research, we are witness to great injustice: The homeless person who is unable to follow medical advice because he has more pressing priorities, the transgender youth who is contemplating suicide because our society is just so harsh, the single mother who’s been made to feel that she’s responsible for the poor health of her child,” Dr. Bassett said. “Our role as health professionals is not just to treat our patients but to sound the alarm and advocate for change. Rightfully or not, our societal position gives our voices great credibility, and we shouldn’t waste that.”

“I regret not speaking up in Zimbabwe, and I promised myself as New York City’s health commissioner I will use every opportunity I have to sound the alarm and rally support for health equity. It’s time to rise up and collectively speak up about structural inequality,” she said. “We don’t have to have all the answers to call for change. We just need courage. The health of our patients—the health of us all depends on it.”

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