"I believe we have a commitment to care for patients and keep them healthy beyond the time we spend with them in our offices or operating rooms. The future of health care in California relies on health professionals and future physicians to be aware of health disparities and be dedicated to eliminating them. " – Milli Desai, Medical Student
If we had advanced technology that could accurately predict health outcomes and longevity, I am convinced we would be learning about this in medical school to be used in our future practice. But we don't have to look far to find predictors of health - our communities can tell us how healthy we are. The neighborhood someone grows up in, the schools they have access to, the income they earn, their race and ethnicity, and many more factors have major implications on how healthy they will be. More importantly, these social determinants of health cause striking differences in the health outcomes between communities.
I was raised in a safe Southern California neighborhood with access to high-quality schools and healthy foods. For three months of the year, I spent my summers visiting my grandmother in Mauritius, the African island where my mother was born and raised. I watched my grandmother's health decline as the resources in her community were not equipped to deal with geriatric medicine, as I took for granted in my suburban Los Angeles community. The juxtaposition between my community and my mother's community in Mauritius sparked my interest in social and health disparities. After attending the University of California, San Diego (UCSD) for college, I studied public health in Baltimore for graduate school and wanted to attend medical school to continue learning about health disparities as a medical student. Today, that is just what I am doing, as a student in the UCSD Program in Medical Education (PRIME).
Traditional medical school education dictates that the first and second years are spent studying the biomedical and pathophysiological aspects of health. We medical students take the Hippocratic Oath to promise to treat all patients equally and learn how to provide compassionate and fair care. While we know about equality….we are not always taught about health equity. In an equal system, we care for all patients through evidence-based medicine. In an equitable system, we also understand patients' life circumstances and work to give patients the opportunity to attain their highest level of health.
The PRIME Health Equity Program at UCSD is uniquely focused on training medical students to help create health equity in our communities. Each year, PRIME Health Equity offers 10 medical students at UCSD the opportunity to take electives in health equity, participate in community engagement projects, have direct mentorship from our director and pediatrician Lindia Willies-Jacobo, M.D., and complete a Master's degree in any field that would help us learn about underserved medicine. PRIME Health Equity was a perfect match for what I was looking for in a medical education program.
San Diego has one of the busiest international borders, is home to the largest refugee resettlement in all of California, has both urban and rural areas, and has a huge variation in spoken languages. Health disparities are also rampant in San Diego, just as they are in California – the life expectancy in La Jolla, where UCSD School of Medicine is located, is much higher than in many other communities in San Diego county.
Before even beginning courses in medical school, the PRIME Health Equity cohort visited and learned about different San Diego communities. We visited Barrio Logan, where childhood asthma rates are much higher than rates in the rest of San Diego due to effects of environmental pollution. We met with leaders of City Heights, who shared with us their experiences of being refugees and building community infrastructure in their new homes. Immersing ourselves in communities in which we will provide health care services is tremendously important. UCSD is the only academic medical center in San Diego county, and the county does not have a public safety net hospital. Medical students at UCSD have a responsibility to know about the patients they will be caring for in their clinical years.
With UCSD's fantastic curriculum, all students learn about social determinants of health and cultural humility through case-based learning and lectures. PRIME Health Equity is unique because it offers students (both in PRIME and not) the opportunity to engage in community-based projects. One PRIME elective called “Healthy Minds Healthy Bodies,” which is open to all UCSD medical students, is a teaching elective in which medical students teach a high school science course every other week at Lincoln High School in Southeast San Diego. Through teaching and mentorship, we hope to build longitudinal relationships with students in underserved areas of San Diego who will be the future leaders of our communities.
PRIME Health Equity provides structure and mentorship for students to learn about health disparities and achieving health equity, through research, advocacy, social justice, education, and more. Some PRIME students are interested in state-level and federal public policy, so they work with political representatives to create better legislation for medically underserved communities. Some PRIME students are interested in social justice, so they serve as advocates for marginalized and vulnerable communities by raising awareness about structural injustices, like hosting workshops to learn more about immigration law and creating curriculum about implicit bias for medical students and police officers.
I believe we have a commitment to care for patients and keep them healthy beyond the time we spend with them in our offices or operating rooms. The future of health care in California relies on health professionals and future physicians to be aware of health disparities and be dedicated to eliminating them. There is much to be done, but I am thrilled to be at an institution that shares these values and supports programs such as PRIME.
Milli Desai is a first year medical student at UCSD School of Medicine in the PRIME Health Equity Program. She received a Master's degree in health science from Johns Hopkins Bloomberg School of Public Health.