https://www.city-journal.org/article/medical-doctors-or-social-workers
Can your doctor cure poverty? How about homelessness? Food insecurity? For that matter, does your doctor treat the legacy of slavery and racial discrimination?
Most people answer this question readily: No. Doctors are trained to treat medical conditions, helping patients lead healthier, happier, longer lives. Yet the medical elite think the answer is “yes.” For years, health disparities between white and minority communities have been attributed to the so-called social determinants of health (SDH), which include the effects of poverty on communities, the residue of historic discrimination, and purported ongoing discriminatory practices in health care. But do these factors really determine health—or are they more properly termed “social factors affecting behaviors associated with health status”? That’s not nearly as catchy as SDH. It just happens to be more accurate.
In a 2017 report, “Perspectives on Health Equity and Social Determinants of Health,” the National Academy of Medicine went further, presenting the issue through the lens of critical race theory. As the report frames it, no social comity exists to characterize human social interactions, only a dyad of oppressor and oppressed. The goal of eliminating disparities in the social determinants of health would be the achievement of true health equity, defined as “The optimal conditions for all people by valuing everyone equally, rectifying historic inequities, and distributing resources according to need.” The last phrase evokes a certain nineteenth-century social and economic philosophy. The report goes on to tie health disparities, among other factors, to the portrayal of black men in the media and to the expulsion and suspension of black children in early education.
The report’s clearest message: no one should attribute any health-care disparities to individuals’ self-determined actions. The report also decries “getting distracted by the alleged ‘deficits’ or ‘individual behaviors’ of marginalized communities” and calls for moving away from a “decontextualized, biomedical framework.”