262802 People in More Equal Countries Enjoy Better Health: What Should Clinicians Do?

Tuesday, October 30, 2012 : 2:50 PM - 3:10 PM

Charles Wright, MD , American Association of Community Psychiatrists. Past: 25 years in hospitals, medical schools and clinics, Philadelphia, PA
I.When citizens of a country succeed in making incomes more equal, the health of nearly everyone improves. Clinicians interested in being part of movements for greater income equality have two roles,as a citizen and as a professional. In the second role, they may ask whether professions themselves have at times opposed greater income equality. If so, how could professions be changed? These are old questions, still new. II. I will answer these questions by making four arguments. 1) A key obstacle to achieving greater income equality is a small corporate class. They persuade the majority to consent to extreme inequality. 2) Many professions, including medicine and psychology, inadvertently help in this persuasive effort. 3) However, clinicians in several traditions, such as social medicine, liberation psychology and democratic psychiatry, have helped to reform professions and democratize health care systems. These actions have supported broader movements toward greater equality. 4) One can think about a strategy for a more democratic health care system in two steps. First, consider the most feasible type of change, reform of an existing structure or creation of a new structure, such as a cooperative, beside the old., Second, imagine the system as an irregular pentagon. At the points of the pentagon are theories about illness, clinical practice, institutional structure, laws and groups of patients and different professions, such as nurses and doctors. Robert Castel suggests that changing the relations among these points is essential. This is a good starting point for a discussion.

Learning Areas:
Social and behavioral sciences

Learning Objectives:
Identify two effects of extreme income inequality, material deprivation and decreased social cohesion and trust. Describe the obstacles to achieving greater income equality, including at times professions themselves. Describe past professional reforms that have supported greater income equality. Discuss two steps in considering strategies for reforming health care systems, including professions, in support of greater income equality.

Keywords: Social Inequalities, Professionalism

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have used social theory in clinical work over the past 25 years. For example, I taught emergency psychiatry using ideas from Italian democratic psychiatry. I wrote an article for The International Journal of the Health Services in 1998, " Psychiatric Hospitals and Instrumental Rationality", applying the ideas of Jurgen Habermas. In 2011 I organized a workshop at the Institute for Psychiatric Services, "More Equal Societies Have Less Mental Illness: Implications for Psychiatry."
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.