From Caregivers to Social Reformers

A quiet revolution in the practice of medicine in North America has taken place within the last decade. Professional associations, medical schools, and an increasing number of physicians no longer consider the primary duty of the physician to be care of the individual patient, but rather social reform—in particular, the urgent goal of achieving equity by addressing the social needs of identity groups perceived as marginalised. Evidence of this transformation of the physician’s role may be found in the express commitments and strategic plans of medical associations, admission requirements, curricula, and programes of medical schools, and the initiatives, statements, and actions of numerous physicians.

Individual behaviour and an individual’s genetic inheritance are significant causes of diseases and disorders. For example, several of the leading risk factors for cancer—obesity, alcohol use, and smoking—are behaviour-related. Hypertension is linked to both genetics and behaviour. Alzheimer’s has a definite connection to genetics, as do autoimmune diseases. Many more examples can be given. The list of maladies connected to either individual behaviour or genetics or both is long, encompassing most infirmities other than infectious diseases, and even with this last category, genetics can play a role in susceptibility to infection. Yet, the American Medical Association (AMA), the largest professional association of physicians in the United States, in its strategic plan for racial justice and health equity, exhorts physicians to turn their attention away from genetics and individual behaviour and instead move upstream to address the “root causes” of social inequities, which (the AMA hypothesises) are the underlying causes of poor health. And what are these root causes? The AMA’s list reads like a first-year college student’s rote recitation of DEI jargon: “white supremacy, racism, classism, sexism, homophobia, ableism, and xenophobia.”

One might think that this list of perceived social ills is just rhetoric paying obeisance to fashionable social-justice ideology. But this unfairly discounts the AMA’s commitment to the remaking of physician’s obligations. The AMA expressly states that physicians must purge themselves of “malignant narratives” such as “a narrow focus on individuals” and adds:

This shifting of the health outcomes narrative from the cause; solely from the individual and behavioral level to the causes of causes, the social and specifically the socioeconomic factors that influence the health narrative at the social and structural levels, is a central priority in health equity work. As anti-racist historian Ibram X. Kendi has argued, “one either believes problems are rooted in groups of people, as a racist, or locates the roots of problems in power and policies, as an anti-racist.”

This represents a sea change in the responsibilities of physicians, from a focus on the conditions and needs of individual patients to being agents of radical social reform.

The Canadian Medical Association (CMA) has likewise called on physicians to refocus on social reform, as evidenced by the topic of its 2023 Health Summit, “Unlearning and Undoing Systemic White Supremacy and Indigenous-Specific Racism.” One of the express goals of the CMA is to foster “a new culture of medicine that champions equity, diversity and inclusion.” Radical social reform is required because, according to an article in CMA’s research journal CMAJ, “Western medicine was founded upon the exploitation, medical experimentation, and dehumanization of free and enslaved Black people.”