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, New York: Harcourt, Brace and World, Inc: pp
Checkhov, Anton. Letter to AF Koni, January 26, 1891, Letter to AS Survivor, March 9, 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. Public Health and Social Justice Website
Contact Information
Public Health and Social Justice Website