GU minor in health equity connects health and justice

Gonzaga University's minor in health equity invites undergraduate students to realize that health, illness and health care are about more than doctors diagnosing and treating individual patients.

This year, Gonzaga started the multidisciplinary minor to explore social dynamics of health, health care inequities and social influences on medical science.

Andrea Bertotti Metoyer, professor of sociology and director of Gonzaga's solidarity and social justice department, said that the minor mixes social sciences, humanities and experiential learning. It explores cultural and structural forces that influence individual's health information, choices and care, and implications of health care processes, science and ethics for communities.

As director of the health equity minor and a clinical instructor at the University of Washington School of Medicine, Andrea teaches courses on the sociology of health and medicine. These courses explore the social context of health and health science.

Health equity courses look at various topics, including women in science, patriarchal roots of science and economics, and industry influence on health-care workers, systems, insurance and decisions on cost effectiveness.

Courses also explore ethical issues related to reproduction, sex, environment, health care and food.

Andrea, who grew up in Susanville, a rural community close to nature in Northern California, came to Gonzaga from 1992 to 1996 for undergraduate studies in sociology and Spanish, drawn by Gonzaga's Catholic culture.

Originally thinking she would be a physical therapist, she realized she was asking questions about social justice.

Andrea took graduate classes in sociology at California State University, Northridge, for one year and completed a doctor of philosophy in sociology at Loyola University Chicago in 2003.

She chose Loyola because it delved into social justice and how sociology can create a more just system for health, gender, medical and scientific knowledge.

In her three years teaching at Marian University, a Franciscan college in Indianapolis, Andrea developed a peace and social justice minor.

When a position opened at Gonzaga, she, her husband and their two children moved to Spokane in 2006.

As she developed the multidisciplinary solidarity and social justice minor at Gonzaga, she saw a need for more courses on the social context of health and medicine.

"It fits Gonzaga's mission to develop people for others," said Andrea, noting the health equity minor furthers Gonzaga's connection with the University of Washington School of Medicine.

Gonzaga's Jesuit, Catholic, humanistic mission is to educate students to promote human dignity, social justice, intercultural competence, care for the vulnerable and care for the earth.

"It's important to offer education on the structures and cultures of the medical profession," she said. "Health equity calls for exploring how health care and science are filtered through human biases and embrace assumptions of race, gender and class."

Those assumptions can lead to belief that people are poor or ill because of genetic, gender or racial inferiority or their immorality, she added.

"I ask why there are health disparities. Health equity addresses what is going on in society that makes some people sicker," she said. "It invites us to look upstream at causes and look at prevention rather than just treatment.

"As we look upstream, we see that health outcomes of diabetes, cancer, infant mortality or asthma intersect with residential segregation policies and environmental injustice. When we see what affects health, we can prevent the damage to health," Andrea said.

"As society emphasizes diagnosis over prevention, we spend time and energy detecting diseases. That takes imagination, resources and energy from prevention," she continued.

About 30 undergraduates are taking courses for the minor. This year, two students will do internships on how theories play out in the real world.

The program extends across social sciences and humanities because there are injustices everywhere, said Andrea, who expects interest in the minor to grow, especially among students going into medical school and public health.

One course that looks at "upstream" issues is "Organizing for Health Equity," taught by Luis Manriquez, a physician who does street medicine with Community Health Association of Spokane (CHAS) and is an assistant clinical professor at Washington State University. It applies community organizing skills and tools to address social justice issues.

Andrea explained that issues raised in the program are layered, and she in an hour could only offer a glimpse of some layers.

"Americans think on an individual level rather than as social beings. Our current health care targets consumers. That leads us to treat individuals' bodies, not whole human beings who live in communities with social hierarchies of race, class and gender," she said.

"Many health-care decisions are based on what benefits some over others, not what benefits all," she noted.

"Media emphasis on individuals and minutiae over structural issues feed the focus on biological and psychological causes. Media do not ask questions that would lead to looking at social causes or prevention. They help create partisan vitriol and the vilification of others that damage health," she said. "A healthy democracy is good for everyone's health."

Andrea, who attends St. Aloysius Church, said Gonzaga's emphasis on Catholic social teachings, Ignatian discernment and humanism drive her to look for bigger causes, deeper reasons and spiritual issues.

"We seek to be caring, not only because there is a God, but also because it is the humane thing to do. We don't sit by and watch people suffer," said Andrea.

Courses ask such questions as:

• What does feminism offer health science?

• What is cultural competency in health care?

• How do market interests influence health care?

• What are the ethical dimensions of human sexuality?

• How do politics affect environmental policies?

• What are ethics for relationships of health care professionals to patients?

• What ethics relate to food consumption and production?

"We can get out of trenches we have dug ourselves into," she said. "We can see how some litmus tests are rooted in different philosophies. There is much we can agree on if we go deeper into issues without othering."

Andrea believes academics can help students interested in health care professions be aware of biases so they can better see and hear their patients. They can also practice beyond the one-to-one level and act as citizens to make changes to health care structures.

For information, visit gonzaga.edu/college-of-arts-sciences/departments/health-equity.