Notes and Information

Ethics - Disparities

Background- Causes

Specific moral issues- Distribution of resources

How to think about justice in a systematic way

__

Background for- health disparities found among racial and wealth groups and those undeserved- for one reason or another lack access to health care AND does not have the same health status- traditional measurements: vaccination- access to healthcare has minor effects on health status- more important: social determinants of health-- socio-economic factors: income, education, housing, employment- social gradient of health- richer = healthier- relative health, poor but relative to others-- due to social cohesion- another major factor: Race-- correlation to access to health care and correlation to other social determinants-- subconscious stereotyping By staff-- racial inequalities

Justice- whether these commonly observed health disparities is unjust- equality vs equity1st difference - Unjust vs Unfortunate- libertarians do not make this distinction1. Unjust - moral obligation to rectify; Unfortunate - illicit emotions but do not make a demand on us to alleviate the condition2. If we have a moral obligation than the factors responsible can be controlled

(Within the context of health insurance:If healthcare is completely based on unjust moral rectification than what if a child due to chance was born with health problems then should we not rectify this?)

Factors that determine unjust from unfortunate.- personal responsibility for health appears to undermine any social alleviation- vexed topic because hard to determine the line between personal and social- biological differences: avoidable or not? (low health of African Americans)

What we can say confidently: health is not simply the product of healthcare.There is an interconnection between health disparities and social determinants of health.

1. Is the disparity an injustice?2. If it is an injustice, what makes it so?3. What interventions?

--

Part 3 : How to answer?

Theory of Justice - John Raults:

Factors that make it unjust1. denies individuals basic human rights.2. Denies individuals true equal opportunity for success in life.3. Unjust if social distribution is focused in certain area.

Raults- does not advocate strict economic social rigidity- inequality is okay but this is given these factors:- however only if the inequality makes the society better- the inequalities must make the least well off as well off as they can be

1. A theory of justice should examine why health is not like another commodity2. Theory of justice must advance health status

Interview- best fit.- be prepared for different interviewers.

Dress to impress- look neat and serious

Why do you want to be doctor?- angle: research, clinal medicine, community service

this is where I see myself in 4 years 8 years.

What does it mean to have integrity?- give it some test and extrapolate.- that's a tough one. No second chance. Think about

Look about school stuff- first two years classroom and the second two years.- local area.- why us?

Ethical situation- don't take it lightly

Maturity- approach problems- what's important to you beyond medical school- make you you, what else is important

Outside of school

Know Your CV Over Again- and personal statement.

This is what I want to do. Don't stress out too much.NYMC-Interview and Application

AMCAS-New: most meaningful-Be responsible for everything you say!

Personal Statement-Why you want to be a doctor? Not who you are. (Woops)-Fully understand your medical jargon-No good doc vs bad doctor story-Be able talk about it in interview-Will not get you into medical school can keep you out.-Don't lecture about medicine-Don't say someone's name (good or bad)

Interview is Looking for:1-Most important: what have you done to feel your motivation?2-compassion and empathy3-Intellectual curiosity4-Critical Thinking5-professionalism

Interview-Long is okay, but don't take too long.-Some blind some non blind-Account for shortcomings-Obj: See how student answers questionsQ: Why are you interested in medicine?A: (Why did you do Pre med in college ie.)Q: Why did you choose that college?A: (No wrong answer?)Q: What did you like the most about your education and why?A: (Explore how an applicant learns and what you value)Q: What was your least favorite course and why?A: (How to approach difficult material and how you took responsibility?)Q: Major?A: (Applicant's decision making tools)Q: Research ?A: (Know your material and it's applicability to human health)

EC Activities-Long term experience which gets you out of comfort zone and shows commitment-Short experiences are ok but should not be seminal reason for medicine.-Research: know the question and role; explain clearly; know the translation from bench to bedside; symptoms and treatments.

Red Flag Question-Poor grades unique to blind interview-Permanent flag if not addressed

Common Qs-Ethics scenario-Current issues-What will you do if you're not accepted?-Why this medical school?

Religion and Health

The relationship between health and religion is rather interesting. The role of religion, especially from the video about the Seventh Day Adventists, seems to be that of a life coach and nutritionist. The values perpetrated by the religion are almost synonymous to what we hear from those understand healthy living: eat less meat and more greens, live an active lifestyle, etc.The question then becomes what can health providers do with this information? Well, one practical application of this would be to contact local religious community leaders and to ask them to emphasis this point in their sermons or simply remind their constituency of the overlap of faith and health.

The role of religious figures in the community brings be to my second point. One of the quintessential axioms of public health, is that ideas must developed and cultivated by community itself, i.e. top-down measures are not sustainable. Thus, one of the most efficient ways to bring the community together would be to identify the leaders of the community and ask them to participate in project; religious figures are one of these leaders.

Although HIV/AIDS affects all neighborhoods, it affects them differently. For example, even though the rate of new HIV diagnoses is higher in Chelsea/Clinton (Manhattan) than in Crotona/Tremont (Bronx), the AIDS death rate in the South Bronx is higher. This is likely due to differential access to life-prolonging medical care"

It's not newly acquiring HIV AIDS but rather surviving with the illness that us the problem.The issue is poverty.

Community Empowerment-Entrepreneurship: Consult firm targeting local community college-Scholarship: Offer scholarship pipeline programs to Masters programs if agree to work in the city for X number of years. College courses that highlight AIDs prevelance and need for it to be addressed.