Though the focus on this blog series tends to be on social determinants of health (SDOH) curricula or related efforts in education, I’d like to deviate for a moment to focus on our own community of SDOH champions. Those of us who advocate for a SDOH approach in education, research, administration, policy and/or clinical practice are often pushing against the tide in this country. As healthcare slowly evolves away from an antiquated fee for service model, we find ourselves as a lone voice or a voice among a chorus for change. In reflecting on each of our individual efforts in the space of SDOH, it occurs to me that each of us is a leader in a movement that is greater than any one of us alone.
In a world of countless books, websites and resources dedicated to building leadership skills, I was surprised to find myself thinking of this topic while reading The Education of an Idealist: A Memoir by Samantha Power. I had my first encounter with Samantha Power’s work over 15 years ago. I attribute reading her Pulitzer Prize-winning book, America in the Age of Genocide: A Problem from Hell, as the inspiration for my decision to pursue a Masters in Human Rights at the London School of Economics. Since then, I have made it my professional mission to promote equity and justice, serve vulnerable populations and immunize learners against the hidden curriculum.
Leadership in SDOH can start with what we do for an individual. I think of times that I have reached out of my clinical comfort zone by calling the authorities, meeting with community members, liaising with community organizations and visiting my patients in their homes. When I was building an education and patient centered medical home model clinic, there were many success and mistakes made along the way. However, it wasn’t until reading Samantha Power’s most recent memoir that I started seeing parallels between her thoughts on leadership with what I have learned from my own SDOH journey thus far.
As a former wartime journalist who became an academician, then served as US Ambassador to the United Nations during the Obama administration, Samantha Power chronicles her unique career path with amazing clarity and self-examination.
Without revealing the content of the book, below are a few lessons that I extracted from her description of life in advocacy and civil service that can be applied to our work in advancing SDOH:
1. Lead with humility
Be open and honest about our own intentions, limitations and biases. Create an environment conducive to critique and dissent by encouraging open dialogue and discourse. Be mindful of one’s own emotional reactions and cultivate emotional intelligence. Seek input from everyone regardless of rank.
In my education and patient centered medical home model clinic, some of the most meaningful input came from the staff who encountered patients in the clinic and on the phone on a daily basis. Their insights tuned the team into patients who may be rescheduling countless appointments due to financial or transportation barriers. Listening to their concerns brought SDOH issues front and center to the care of the individual patient.
2. Build coalitions
Be a part of something. Join existing organizations or form new ones. Build a coalition of diverse individuals around a common high-level goal. Ensure that the team is composed of highly skilled individuals with different skill sets, approaches and ways of thinking. Trust the collective genius of the coalition and create reinforcing processes.
Having recognized that a traditional medical team would be ill equipped with addressing the large burden of SDOH of our patient population, we set out to collaborate with any well vetted organization that would be willing to allow our foot in the door. In the end, we were able to provide our patients with mental health services, counseling resources, adverse childhood experience screens, food pantry assistance and much more.
3. Seek counsel of those with a reliable compass
Identify people in your life who know you well and are fierce advocates of the same goal. They can serve as a sounding board and, more importantly, as a reality check. Check in with them regularly and empower them to call you out if you are acting in ways counter to your values.
I count myself lucky as I have a few trusted mentors that know who I am, who I want to be and what kind of impact I want to make in the world. They reflect the mirror of truth back to me and keep me grounded.
4. Take care of those in our charge
Most people are icebergs – only a small piece of them are visible to the eye. Check in frequently with those in your coalition, network or community. Spend time and be present for them. Celebrating individual personal and professional successes go a long way.
The core clinic providers and staff supported one another during working hours and during off hours- taking time to celebrate personal milestones and checking in after a tough day. In fact years after the clinic closed, we still share a bond, find time to see one another and support one another.
5. Build a toolbox
Change can take place through incremental small steps or via giant leaps in a positive direction. Consider the existing formal and informal mechanisms for change and how to create new ones. Reach out to allies, potential allies and fierce opponents to understand needs and points of view. Look for win-win scenarios where multiple vested interests overlap. Create the toolbox of options for advancing goals in multiple spheres. Share your experiences with others and leverage expertise.
Every experience is an opportunity for growth. After the closure of the clinic, I was devastated. It took me some time to collect myself to salvage the lessons we had learned to apply them to different populations and situations.
6. Change what you can, where you can, how you can:
The microenvironments where we work are different. Each poses a unique set of challenges. Focus on the avenues of change that can be made with the resources in your hand to move the needle in a positive direction.
Over the past 5 years, I’ve been able to work with excellent educators to integrate SDOH curricula in various places into the curriculum in medical education at my institution moving the needle where I could.
7. Keep the attention on the actual people that are affected:
Remember that statistics are comprised of real people. In our discussions about SDOH, sometimes we can get so focused on the numbers and the complexities of policies that the individuals who are affected are forgotten. Keeping the emphasis on the lived experiences and voices of those who are impacted will reenergize you and remind you of why you are advocating for change. Elevating their voices in the discussion will give them dignity and their input will make interventions more meaningful.
During this past year, we integrated an LGBTQI patient panel into our introductory course for the first year medical students. Hearing from real people about their own experience allowed students to feel connected to those who were otherwise thought to be different. The participating panel members were able to tell their own stories in their own words in their own voices.
8. Bear witness, walk alongside:
It takes zero resources to bear witness to the struggles of individuals and walk alongside them. That means showing up when it matters, meaningfully engaging with your community and earning their trust.
When all else fails, each of us can be there for our patients with our time, energy, support, kindness and patience.
Lastly, for the days when the weight of the boulder you are moving up the mountain is too great, remember the words of Samantha Power:
“People who care, act, and refuse to give up may not change the world, but they can change many individual worlds.”
-Premal Patel, MD Community of Practice Member
Dr. Premal Patel is a board-certified Physician and an Associate Professor in the Department of Internal Medicine. She also serves as the Associate Director of the Global Health Education Program at UTMB and is co-coordinator of the Global Health Inter-Professional Core Course.
Power, Samantha, The Education of an Idealist: A Memoir. New York, NY. HarperCollins Publishers, 2019