My school did have a course that brought up the gender pay gap. The professor in the same course taught the unsubstantiated claim that “rape is not about sex—it is about power.” This idea also made its way into an exam question. Having had the opportunity to examine and treat many people with paraphilias, it’s obvious that this statement is completely false. Rape is usually motivated by a sexual drive and is only sometimes also about arousal by the idea of power. It is exceedingly rare to have a patient where these behaviors are motivated more by power than by sexual drive.
Then I don't see why that should be in the curriculum. Unless the argument was made that the gender pay gap somehow plays into health outcomes. Rape is something different, which you're conflating with the gender pay gap here. You start off with the pay gap then somehow veer off into rape as though that's a coherent argument. If the gender pay gap doesn't play into health outcomes (and I don't see how it does except in a very indirect way), then it has no place in a medical school curriculum. That's not a problem with including social justice in curricula - it's got to do with including completely irrelevant stuff in the curricula that have no connection with health whatsoever except through a very tortuous path.
My residency had a didactic session on a social justice topic. Demographic data about differences in practice setting and length of practice between physicians of different races was presented. There was no discussion about hypothetical reasons for this. The lecture went on to describe various types of struggles minority physicians might have leading to the implication that the difference must be due to discrimination or implicit bias. I think this is a disingenuous way to present information and my experience has been that this is a common problem surrounding topics of social justice.
Do they make the assertion that the differences are due to racism? It sounds from your statement that this is your inference, not what was said. If they present it as a finding and then hypothesize ways in which racial challenges might play into that, then I don't see a problem with that. I think that you're smart enough to know when something is presented as a
potential explanation and when something is presented as a link in the causal pathway. All data is biased, some more so than others.
With regard to your last point, that is a completely unrealistic hypothetical. Which two people have you ever met that differ on only one variable? Also, in practice, how would you ever measure these types of outcomes to assess how we are performing with respect to this type of equality? In reality, you can’t measure this. What people actually do is measure the comparative outcomes between different groups of people.
That's the point. That's why, in my opinion, most reasonable people don't go around thinking that equality of outcomes is the goal. The goal is equity in starting point and lifting those who are disadvantaged to a starting point that levels the playing field. What people do is measure comparative outcomes and draw inferences about starting points. I think most reasonable people are okay that people end up in different places as long as they started on a similar footing. So measure things like access and measures that get at access. If you're measuring things like heart failure exacerbations, you can look at that in one of two ways - the simplistic view is that this is an outcome. If that's the case, then you reach the conclusion that people want equality of outcomes which is not really appealing. The other way, which is the way I think most reasonable people think about it, is that this is an indicator of access and thus starting point. It's an indicator that people don't have equal access to care and therefore that results in different outcomes. Then the conclusion is that we need to work on leveling the playing field,
provided that access is actually the issue.
The important question is not whether equal outcomes with regard to health would be desirable in an ideal, resource-unlimited world. Of course people would agree with that. The important practical question is at what cost is this ethically defensible?
Suppose hypothetically that we could raise the worst performing demographic in terms of X health measure up to the national average. If this group comprises 20% of the population, but it would require expenditure of 80% of the health care resources on that group to achieve that goal, is it ethical to do so? What if doing so means that, although groups wind up with roughly similar outcomes at the end, some groups experience worsening outcomes due to restrictions on their access to resources? This is far closer to the problems we are actually trying to solve in health policy than the simplistic “wouldn’t it be good if people had equal health outcomes?”
Ah, finally we get to the question about starting points. I agree, these are the difficult questions. Once you have determined the disparities in access exist, then you face this question of how much can you affect that and how much
should you affect that. That gets into value judgements and cost-benefit analyses where two completely reasonable people will come to different conclusions. I don't think that this is what is at issue in medical school curricula. Med school curricula present the disparities in outcomes and make the inference that it is due to disparities in access (if you want to dispute this claim, then go out and do research that makes for a better explanation. Most of the evidence I've seen weighs in the other direction).
Hint: Don't do this in the abstract. If you think that the observation that racial minorities have worse outcomes is due to something other than access, then evaluate the work that pulls in either direction, much like you've done above for the pay gap.
That's where they pretty much stop because from here, people will vary widely on their values-based judgement on what should be done. I might think it's justifiable to spend more resources on the most disadvantaged whereas someone else might say that's not fair and we should apportion the resources equally. That gets at the equity vs equality debate with respect to starting points.
