Many healthcare systems around the world boast top class facilities, yet the health of their citizens does not reflect the standards. Most of this is due to huge disparities in income and a host of environmental, social, and other factors that powerfully influence an individual's possibility of getting sick and appropriate medical care.

Doctors often encounter patients who face poverty, housing insecurity, a lack of health insurance, and a multitude of other factors that affect their health. However, most do not know what to do with this information, or if they can make a difference at all.

These are social conditions that are not easily fixed, but doctors need to attempt to address these problems for better public health - advocating for a healthier and more equitable society could be a start.

Healthcare challenges linked to social factors

The major healthcare challenges that many countries face such as global poverty, disease to HIV/AIDS, healthcare reform, Zika and other pandemics, and the unmet health needs of their citizens, require a physician workforce that has both passion and skills to advocate for public policies that will improve health and health equity.

For example, Rudolph Virchow, a 19th-century German physician who is considered to be the father of pathology, believed that physicians have a responsibility to work on behalf of the less fortunate.

He was asked to investigate the cause of a local typhus outbreak and he identified poverty, famine and political corruption as the root causes of the spread of the disease. He consequently became a politician and developed healthcare reforms that became the foundation for the system of universal healthcare that currently exists in Germany.

In more recent times, Dr Mary Bassett, the health commissioner of New York City, called for physicians to speak out on racism in 2015. The rate of premature death was found to be 50% higher among black men than white men, reflecting disparities in many health outcomes, including cardiovascular disease, cancer and HIV. For black women, they were more than 10 times as likely as white women to die in childbirth.

Despite evidence of these researches, there is often a reluctance to address the role of racism in driving these gaps in morbidity and mortality between racial and ethnic groups.

A different approach to healing patients

Research has also found that the cost of treatment is usually higher than providing housing for the less fortunate. One such example was Stephen Williams, who suffered from a life-threatening staph infection and spent seven days hooked to an IV, a treatment that costs up to USD40,000.

However Williams did not pay out-of-pocket, but rather the bill was covered by government dollars in the form of Medicaid. He has also been to the hospital for infections, 21 times in the past four years, due to psoriasis flare-ups in a humid climate coupled with unsanitary conditions.

Cases such as these have prompted Senator Josh Green to introduce a bill to classify homelessness as a medical condition. Green also works in an emergency room, where he treats many homeless patients for basic conditions, but at great expense and no long-term benefit.

Green envisions that doctors could prescribe housing on a case-by-case basis, whereby the baseline criteria would be a patient who has been homeless for at least six months and suffer from mental illness or a substance addiction.

"We're already spending the money on homeless people, we're just paying for it in the most inefficient, expensive way possible," he argued. "We have a lot of capacity, but lack the political will."

Doctors to start healing the ills of society

For many medical students, a medical education means preparation for a career rooted in compassionately caring for people. Unfortunately, idealism, empathy and inspiration progressively wane during training. Incorporating lessons to develop advocacy skills and teaching about social determinants of health can help reverse that trend - so doctors will work for systemic changes to improve health upon completion of training.

The need for health advocacy is also greater than ever. With healthcare reforms in many nations and outbreaks signalling possible pandemics, doctors need to understand the social factors that affect health outcomes and work together to improve them.

The opportunity to help heal the ills of society as well as patients' bodies and minds can be rewarding and noble - it just needs to be recognised. MIMS

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