Rallies by white supremacists in Charlottesville, VA and the subsequent milquetoast response from the White House shocked many Americans. These events invoked a national discussion about how many of our public monuments, built to celebrate triumphs and critical moments from our country’s past, can also exhibit appalling acts of malevolence and cruelty, treatment that today is unacceptable. Similarly, our understanding of medical history has evolved. While many of us are aware of particular atrocities, such as the Tuskegee study or the nonconsensual obtaining of Hela cells from Henrietta Lacks, these stories are by no means isolated, and there are times in our country’s history in which harm was bestowed upon vulnerable populations, especially African Americans. Medical Apartheid unveils the long history of medical experimentation performed on African Americans and highlights some of the origins of our country’s health disparities.
First and foremost, international emergency medicine (IEM) is a big tent. We’ve got clinicians with an interest in tropical medicine and trauma, systems experts, inventors, educators, missionary families, public health experts, thrill-seekers, and policymakers. A disaster response specialist who has a “go bag” packed at all times ready for deployment belongs in this tent, as does an epidemiologist based in the U.S. who analyzes data on cholera outbreaks in refugee camps. Because it’s a relatively new specialty there is the occasional squabble about what does and does not constitute IEM, but generally we agree that we are working together to improve the state of health for people in our world. Our specialty allows us to work in a multitude of settings and clinical environments, something that no other specialty can do.
My department chair recently forwarded me a provocative little video regarding how we should conceptualize “population health.” The video encapsulates a number of hot topics in public health, labeled here as “population health”. It appropriately emphasizes the importance of addressing not just prevention among healthy populations, but also improving the health outcomes of high utilizers.
Like it or not, many things that determine our daily satisfaction with our work are determined by policy. QI measures, the implementation of EMRs, the availability of cigarettes, the funding of GME positions, the strength of drunk driving laws, the availability of mental health care: these are all legislative decisions, with an intimate relationship to our work. Yet, only half of the practicing physicians in the U.S. report that they are actively involved in policy change/advocacy.
Think back to your last shift. How many of you saw someone whose chief complaint was “assault”? What did you do for the patient? If you’re like most of us, you ruled out acute life-threatening injuries, sighed loudly (especially if the person had been in the ED before for other fight-related injuries), and dispo’ed. But do you ever wonder if you should do more? Or why?
What is “Public Health“? According to the World Health Organization,
”Public health refers to all organized measures (whether public or private) to prevent disease, promote health, and prolong life among the population as a whole. Its activities aim to provide conditions in which people can be healthy and focus on entire populations, not on individual patients or diseases.”
Welcome to my inaugural post on ALiEM! My goal for this new series of missives is to inspire discussion about aspects of our life in EM, beyond the day-to-day clinical work. I chose emergency medicine not only for the clinical challenge, but also for the potential public health impact. After all, we are the only specialty to consistently care for the poor, the disempowered, the mentally ill.