UBC Objectives: Family Medicine & UBC Objectives: Health Advocate

By the end of postgraduate training, using a patient-centred approach and appropriate selectivity, a resident, considering the patient’s cultural and gender contexts, will be able to... ​

• Demonstrate awareness that illness and disability makes patients vulnerable
• Facilitate access to services for all patients, being mindful of the patient with social, economic, and/or health barriers
• Address determinants of health as it pertains to the health status of an individual or community

Social determinants of health. What about social determinants of illness? Or illness that is socially determined? Here is how the World Health Organisation (2018) frames these social determinants:

"The social determinants of health are the conditions in which people are born, grow, live, work and age. These circumstances are shaped by the distribution of money, power and resources at global, national and local levels. The social determinants of health are mostly responsible for health inequities - the unfair and avoidable differences in health status seen within and between countries."

"The unfair and avoidable differences in health status seen within and between countries."

These differences in health status - driven by factors such as employment conditions and early child development - are determining the health of populations and the individuals they are composed of. And the more risk factors one has with regards to the social determinants of health, the more likely  one is to have multiple (Best Science Medicine, 2017). There is cumulativeness. How unfair is that? 

The dictionary built into my laptop tells me the definition of vulnerable is "Exposed to the possibility of being attacked or harmed, either physically or emotionally" and "(Of a person) in need of special care, support, or protection because of age, disability, or risk of abuse or neglect." It also tells me the word itself was derived from the Latin word vulnerare, meaning "to wound."

My synopsis of all of the above is that patients who society considers to be "marginalised" are those who have more socially-determined wounds that make them more vulnerable to illness. So yes, while I am aware that illness and disability makes patients vulnerable (by extension of the very fact that every additional negative social factor influencing health increases the likelihood that more will be at play in any individual's life), it also the degree of vulnerability that increases one's risk of illness, disability, and death.

(It gets much more complicated than this, as one may consider disability, and perhaps even illness in some contexts, as a social construct in and of itself, but deconstructing this concept warrants its own blog entry, and I have to get back to clinic OMG.)

The take away point for me is that the reasons for why one individual is more at risk for illness are  frequently socially determined and therefore modifiable. Three Bridges Community Health Centre in Downtown Vancouver has a mandate to serve those patients who are marginalised, at the greatest risk of poor health, and is an exceptional example of efforts to rectify social inequities. It is a privilege to be training in a program that provides opportunities to train in organisations such as this, to learn how I can use my position of privilege as a physician to promote social justice in theory and practice.