My Moral Responsibility as a Physician: Addressing the Political Determinants of Health

August 11, 2020

Perspectives in Primary Care (formally the Primary Care Review) features perspectives from practitioners and students representing organizations, practices, and institutions across the country and around the world. All opinions expressed in this article are owned by the author(s).

A while back I was invited to attend a panel discussion on primary care at an area medical school. For 45 minutes the other two primary care doctors and I shared a lighthearted conversation about why we love primary care, interspersing various plugs for why the students should consider the field for themselves. After several stories about the satisfaction we derive from our jobs and the joys in the relationships we form with our patients, a student raised their hand to ask a question about how the current political climate was affecting our practice. “I’ll take this one,” I said, leaning forward and beginning to speak before my co-panelists had fully registered the question. “It has been terrible for my patients.”

As I shared my experiences, I felt like I was reliving them. I remember the increase in long-acting reversible contraceptive (LARC) visits in the weeks following the 2016 presidential election. Most patients were either switching to LARCs or wanted them replaced in order to “not take any chances,” as one woman put it.

The more disturbing pattern my colleagues and I noticed, however, was the effect the election of an anti-immigrant president had on our largely immigrant population: visits decreased dramatically. After I finished recounting how my workplace now felt the need to have an ICE (Immigration and Customs Enforcement) policy, the other panelists found their voices. They were quick to point out how health centers historically have enjoyed “bipartisan support” and some other safe comments about the importance of working together. In defense of my co-panelists, I was perhaps a little too aggressive in my comments and one could argue a medical student forum is not the best place to insert politics. Please excuse me while I argue the opposite.

I believe healthcare providers should be politically engaged. More appropriate time and energy is now being devoted to educating our health professions students on the social determinants of health (SDOH). SDOH address how issues such as poor air quality, food insecurity, and unstable housing (among others) can impact one’s health. These also help to explain why the burden of chronic disease falls harder on people with lower socioeconomic status. At Cambridge Health Alliance, we screen patients for SDOH inequities because we recognize that “lifestyle changes,” the cornerstone of prevention, are difficult for our patients who work two jobs and live in a food desert. It’s great that I can connect my patients with the fabulous Patient Resource Coordinator I work with, but this does not treat the root cause.

It is policies, or lack thereof, that make housing unaffordable for so many, that deny hard working people a living wage, and that threaten to remove the pre-existing condition protection for insurance. We do our patients a tremendous disservice when we attempt to be apolitical. In many cases, the diagnosis is inequity, and the effective treatment—justice—can only be achieved at a policy level. 

I’m proud to serve a majority immigrant, largely non-English speaking, publicly insured population. My patients, though, feel threatened by racist statements from elected officials and changes to ICE deportation policies. I’ve felt at a loss for how to address my patients’ fear. As a result, I’ve made phone calls to my legislators to encourage them to support the Massachusetts Safe Communities Act, a law to essentially make our commonwealth a sanctuary state. We’re taught in medical school to ask about safety when we conduct our social history, yet how can you feel safe when your own government is targeting you?

As I sit here reading what I’ve written, I recognize that I myself am not doing enough. This piece is as much to motivate me as it is to motivate others. Just as I advise my patients to focus on small, achievable goals as they seek to improve their health, I too need to choose one of these areas to focus on. As providers, we must choose an issue where we feel we can have the most impact while also lending our support to those who lead allied movements. The following are some simple things you can do today to take action:

  • Sign online petitions;
  • Donate to organizations and political action committees that address the health inequities of your patients;
  • Participate in state and national medical societies;
  • Call, email, or write letters to your local and state representatives about the health inequities your patients are experiencing (Massachusetts residents can find their legislators here);
  • Contact your local governments as well, as cities and towns exercise lots of influence over issues like housing and education;
  • Attend Town Hall meetings with your legislators;
  • Visit/lobby your legislators on Capitol Hill;
  • Volunteer to work with state, national, or international organizations;
  • Help your patients register to vote, and inquire about obstacles to voting; and
  • Advocate for your workplace to host a voter registration drive.

Lastly, ensure YOU exercise your right to vote! Our patients’ lives depend on it.

**Feature photo by Omid Armin on Unsplash


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jeremy stricsek

Jeremy Stricsek, MD, is a Family Medicine Physician in Somerville, MA. In addition to the variety Family Medicine has to offer, he also enjoys being a medical educator to resident physicians, medical students, PA students, and NP students.

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