Author: Zachary Robert Caverley

The Social Determinants of Health: Critique and Implications

Of all the healthcare topics in vogue these days, the phrase “social determinants of health” (SDOH) has enjoyed an increasingly prominent place in both practice and policy. First inspired by Geoffrey Rose’s 1992 book, The Strategy for Preventative Medicine, and then mainstreamed by the WHO in the early 2000s, the term is now ubiquitous in public health literature. The CDC has defined SDOH as “conditions in the places where people live, learn, work, and play that affect a wide range of health and quality-of-life risks and outcomes.” Under such a broad definition, it is difficult to disentangle the difference between SDOH and the mere happenstance of life, or to grasp why this is an area in which public health officials should be so heavily involved. While such factors undoubtedly matter for health outcomes, the slanted narrative in this brand of literature omits some important social influences on health. This is particularly puzzling given the widening net experts have cast around these problems. Without assessing such issues in SDOH literature, it is impossible to know if …

Dr. Norman C. Wang and Selective Outrage

Published by Zachary Robert Caverley

Back in March 2020, a University of Pittsburgh physician by the name of Norman C. Wang published an article in the Journal of the American Heart Association (JAHA) about the use of race and ethnicity considerations when recruiting for the US cardiology workforce. Wang argued that Diversity, Equity, and Inclusivity offices are ultimately unhelpful in promoting minorities in cardiology practice. He also pointed out that these offices may be unconstitutional and that they often make claims that may be unsupported by the relevant empirical evidence. Towards the end, he advocated race-neutral admissions and hiring practices as an alternative to the current model. The article attracted no controversy upon publication, but that all changed a few months later. A physician under fire Over the first weekend of August, a large number of professionals suddenly began condemning Wang online for promoting “historically racist stereotypes” and, as one physician put it, failing to account for the “structural biases” medical students of color face. An interventional cardiologist declared that Wang’s writing aligns with the kind of thinking that “defines …

The Problems with Discrimination Research in Medicine

Published by Zachary Robert Caverley

Like many professions in Western society, medicine is examining itself for the presence of racial inequities and strategies that can ameliorate these differences. Many publications have focused on the disproportionately poor outcomes of minorities in our healthcare system with an emphasis on systemic and structural forces that shape such inequities. As I concluded in my last article for Quillette, these discussions should proceed with the utmost scientific caution, as the answers and implications stand to affect the most vulnerable populations. With this in mind, there are limitations in the current literature on alleged medical discrimination and the associated health outcomes. In addition, much of the literature on this topic relies heavily on surveys and patient self-reports to assess bias and discrimination while downplaying or ignoring alternative hypotheses. The narrative that has emerged from the conclusions of these limited studies could inadvertently cause some populations to avoid medical follow-up and form an inaccurate view of healthcare practices. As background, the relevant literature appears to show that black and Hispanic patients tend to view medicine as more …

Rethinking Health Disparities

Published by Zachary Robert Caverley

In the last few decades, the proliferation of diversity, inclusivity, and equity literature throughout the medical profession has become institutionalized. Medical organizations such as the World Health Organization (WHO), the National Institute of Health (NIH), and the American College of Cardiology (ACC) have embraced this ideology and its accompanying bureaucracies and web-based material, and have called for cultural changes in some of our most important fields of study. Reforms are ostensibly intended to address healthcare disparities between groups, and new initiatives are frequently justified with reference to what the Sullivan Commission called the “ghosts of discrimination.” 1 The authors of reports like these will invariably go on to talk about implicit bias, the need for diversity in the healthcare workforce, and an examination of structural forces and power distributions that shape group disparities in health outcomes. In January 2020, the ACC published a cover story stating that healthcare group disparities and the lack of diversity in healthcare were a “national emergency” and strongly promoted the use of the Implicit Association Test (IAT).2 Even as late as …