Addressing Social Impediments to Health

The murder of George Floyd and the resulting national reckoning on race, along with the disproportional impact of COVID-19 on communities of color, galvanized creation of the Anti-Racism Curriculum Committee at Weill Cornell Medicine in the summer of 2020. The committee’s charge: to ensure that medical students gain a firm understanding of how social, economic and policy factors influence health outcomes.

These social determinants of health, which co-chair Dr. Joy Howell calls the “social impediments to health,” have been recognized by the Centers for Disease Control and Prevention and the World Health Organization to be more important than genetics or ancestry, health behaviors, and even access to care and the quality of that care.

“We need to impress upon the next generation of health care workers the power that societal factors have on population health, as well as an individual’s health, so that they can become well-rounded, comprehensive physicians,” said Dr. Howell, assistant dean for diversity and student life at Weill Cornell Medicine. “If you are just coming up with a medication to treat high blood pressure and not attending to the context in which this patient lives, I question your ability to effectively control that patient’s blood pressure.”

Comprised of Weill Cornell Medicine administrators, faculty, students and staff, the Anti-Racism Curriculum Committee, convened by Dr. Yoon Kang, senior associate dean for education, met throughout 2020–21 and quickly identified the need to encapsulate social justice and health equity in a new Weill Cornell Medical College foundational learning objective, which was formally approved last spring by the medical college’s Executive Medical Education Committee.

The goal, said committee co-chair Dr. Joseph Safdieh, was to develop a framework in which social determinants of health, including racism, are taught longitudinally, across all four years of medical school, rather than in a single course.

“We want to show [students] that understanding social determinants of health is relevant in heart disease, lung disease, kidney disease, brain disease, in all different organ systems. It’s a pervasive societal problem that impacts every patient’s experience,” says Dr. Safdieh, who is also the Gertrude Feil Associate Dean for Curricular Affairs and the Louis and Rachel Rudin Foundation Education Scholar.

The new learning objective builds on an expanded Social Justice, Policy, Advocacy and Community Engagement curriculum, conceived by Dr. Gwendolyne Jack, an assistant professor of clinical medicine. The curriculum, which is interwoven throughout the first-year Essential Principles of Medicine course, explores the history of racism in medicine, the local and global impacts of bias and structural racism, privilege, discrimination, health inequity, structural determinants of health, and community advocacy.