Medicine is a social science, and politics nothing but

Tackling Social Inequalities in the
Lisa Fitzgerald & Allyson Mutch
School of Population Health
University of Queensland
Setting the scene for our teaching
Medicine is a social science, and politics nothing
but medicine on a grand scale...
The improvement of medicine would eventually
prolong human life, but improvement of social
conditions could achieve this result even more
rapidly and successfully
(Rudolf Virchow, 1821-1902)
Our role in public health …
Our role as sociologists...
Our role as teachers…
Challenging current approaches:
within public health
“Public health success is as much
about imagination as evidence:
challenging what is accepted as the so
called normal, or business as usual.
Public health must regain the capacity
and will to address complexity and dare
to confront power. This demands a
new mix of interventions and actions
to alter and ameliorate the
determinants of health.”
(Lang and Rayner, 2012;BMJ
Challenges within our classroom
Our Students
• Postgraduate Students doing the MPH/MIPH
• Core course PUBH7620: Social Perspectives
• Graduate students doing the MBBS
• Undergraduate students doing the BHlthSc
• Core course PUBH1103: Health Systems and Policy
Critical challenges
Diverse MPH/MIPH audience – local/international; internal/external
Frequently privileged MBBS students often disengaged
Young undergrads, new to University and academic methods
Unfamiliar, uncomfortable, sometimes unnecessary to many students
Needing to engage the students in critical thinking and reflection
on the social determinants
Flipping the classroom to facilitate active
TEDI Exemplar of the flipped classroom
Our Postgraduate Classroom
• Aligning curriculum: learning
objectives + activities + assessment
• Stripping back
• Space and tools to relate course
content to existing/everyday
• Active learning- using real examples,
case studies and problem based
• Structured use of BB (pre class
activities and post class engagement)
• Technology enhanced – prerecordings, blackboard smorgasbord,
videoed class discussions, adobe
Our Undergraduate Classroom
Aligning curriculum: learning objectives +
activities + assessment
Stripping back
Active learning- using real examples, case
studies, current policy issues
Structured lectorials, group focused
discussion, assessment based
Use of multi-media and technology
Structured use of BB (pre class activities
and post class engagement)
Translating these changes into teaching
social determinants
• Description renders students powerless - so what can we
do about it?
• Deeper understanding, that moves beyond description, of
social inequalities to draw connections and make it real
• Focusing on engaging and empowering students with
tools for critical analysis and tools for action
Critical Health literacy framework for
the Social Determinants
• Knowledge:
– Smorgasbord of evidence
– Case based examples – the patient journey
• Compass
– Activity focused - Last straw, budget, privilege walk
– Reflective journaling
• Skills
– Tools that consider upstream and downstream approaches
– The ‘Walk’
• Action
Mogford, Gould and Devoght (2010)
Developing Skills
• “In my opinion, we were able to learn about social, cultural,
environmental determinants of health and what the
community feels about the problems at hand. It enabled us
as students to appreciate and internalize what we are
studying in class”
• “Blending with the community helps the community to
openly share their problem with us and strengthens their
trust with us. In addition, it allows us to plan from a better
informed point of view on matters pertaining to the
community; in this case, strategies and activities will reflect
what the community wants to see besides reducing if not
closing health inequalities”.
Supporting Action
An Integrated Classroom?
and Advocacy