Medical Schools’ Social Mission Critical for Societal Health Equity

The health of millions of Americans depends on medical schools embracing a social mission committed to enhancing health equity and reducing disparities, a policy expert argues in a recent issue of JAMA.¹

“That medical schools have varied missions is a strength of the medical education community, but for schools to consider social mission to be an elective aspect of their program weakens national efforts to augment health equity and reduce health disparities,” argues Fitzhugh Mullan, MD, professor of health policy at the Milken Institute of Public Health at George Washington University in Washington, DC.

The social mission of a medical institution is its commitment to enhancing health equity and addressing the notable societal disparities in healthcare access, outcomes, cost, and medical coverage, Dr Mullan writes.

“Given these enormous societal challenges, the health professions community must be knowledgeable in dealing with — even leading — the changes needed to reconcile the potential of US health care at the individual level with the clinical, demographic and financial realities of the United States,” he urges.

Schools vary widely in their dedication to a social mission, as 1 study Dr Mullan cited found.

The study, which was conducted in 2010 and included 141 US medical schools, looked at graduates’ employment choices as 1 measure of social mission. Schools with more graduates who chose primary care or who worked in areas with a shortage of healthcare professionals, or who came from underrepresented minority groups, had higher scores.

State schools, excluding urban schools and schools outside of the Northeast, scored highest on this measure of social mission, whereas private schools tended to score lower.

“Many of these schools have robust scientific and educational capabilities that could make enormous contributions to understanding health disparities and the teaching of social mission,” Dr Mullan writes.

One reason some medical schools lack a focus on social mission is the legacy of Abraham Flexner, the American educator whose thinking dominated the US medical education system through the 20th century. 

In 1910, Flexner published recommendations for medical education that urged collaboration with research universities to enhance scientific standards, but did not mention the role schools should play in social reform. That omission resulted in a “marginalized social mission in health professional education,” Dr Mullan argues.

Since Flexner’s time, a growing body of research has detailed the social determinants of health that have led to current and widely documented health disparities, and the situation calls for a move “beyond Flexner,” Dr Mullan writes.

“These concepts provide academicians and others with tools that make social mission more concrete and actionable, and allow an institution to examine health equity in its community and region with greater precision,” Dr Mullan says.

Given this situation, he calls for “academic health centers, and teaching hospital[s] to place their commitment to social mission alongside their dedication to education, research, and service in pursuit of a healthier and fairer society.”

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Reference

1. Mullan F. Social mission in health professions education beyond Flexner. JAMA. 2017;318(2):122-123. doi: 10.1001/jama.2017.7286

This article originally appeared on Medical Bag