Abstract
BackgroundThere is a growing understanding of the role social determinants such as poverty, gender discrimination, racial prejudice, and economic inequality play on health and illness. While these determinants and effects may be challenging to identify in parts of high-income countries, they are patently obvious in many other areas of the world. How we react to these determinants and effects depends on what historical, cultural, ideological, and psychological characteristics we bring to our encounters with inequity, as well as how our feelings and thoughts inform our values and actions.DiscussionTo address these issues, we share a series of questions we have asked ourselves¿United States¿ citizens with experience living and working in Central America¿in relation to our encounters with inequity. We offer a conceptual framework for contemplating responses in hopes of promoting among educators and practitioners in medicine and public health an engaged awareness of how our every day work either perpetuates or breaks down barriers of social difference. We review key moments in our own experiences as global health practitioners to provide context for these questions.SummaryIntrospective reflection can help professionals in global medicine and public health recognize the dynamic roles that they play in the world. Such reflection can bring us closer to appreciating the forces that have worked both for and in opposition to global health, human rights, and well-being. It can help us recognize how place, time, environment, and context form the social determination of health. It is from this holistic perspective of social relations that we can work to effect fair, equitable, and protective environments as they relate to global medicine and public health.
Highlights
There is a growing understanding of the role social determinants such as poverty, gender discrimination, racial prejudice, and economic inequality play on health and illness
Summary: Introspective reflection can help professionals in global medicine and public health recognize the dynamic roles that they play in the world
Such reflection can bring us closer to appreciating the forces that have worked both for and in opposition to global health, human rights, and well-being. It can help us recognize how place, time, environment, and context form the social determination of health. It is from this holistic perspective of social relations that we can work to effect fair, equitable, and protective environments as they relate to global medicine and public health
Summary
There is a growing understanding of the role social determinants such as poverty, gender discrimination, racial prejudice, and economic inequality play on health and illness While these determinants and effects may be challenging to identify in parts of high-income countries, they are patently obvious in many other areas of the world. At least in the collective consciousness of medicine and public health, is an emergent understanding of both the roles these determinants play and the dimensions of their effects [8,9] This understanding is in part due to a mounting sense of shared vulnerability [10]; infectious diseases such as HIV/AIDS, SARS, Ebola, and dengue fever cross international borders and threaten people in low- and high-income countries alike [11]. It is due to a conviction that the world is an ever-smaller place because of increasing population density, rising rates of international migration, and the rapidly accelerating pace of information transfer [4]
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