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I frequently meet with idealistic UCSF medical students who want to influence health policy in order to help those who are less fortunate. I am impressed by their talent and idealism. But a nagging worry persists: Has our political fabric become so corrupted that introducing these bright young people to health policy puts them on a path that will break their hearts, make them cynical, and waste their time?
For those who care about social justice, these are troubling times. Here are some recent examples:
In wrestling with how to reconcile my intrinsic belief in activism with my despair at the current situation, I revisited one of my favorite sayings: “The moral arc of the universe is long, but it bends toward justice.”
Dr. Martin Luther King made these remarks on March 25, 1965 on the steps of the Alabama State Capitol, having completed the third march to Montgomery. He told the crowd:
I know you are asking today, how long will it take?....
I come to say to you this afternoon, however difficult the moment, however frustrating the hour, it will not be long, because truth crushed to earth will rise again.
How long? Not long, because no lie can live forever.
How long? Not long, because you shall reap what you sow....
How long? Not long, because the arc of the moral universe is long, but it bends toward justice."
As I pondered those words I reflected upon the amazing changes that have occurred since I entered medical school 52 years ago. In my graduating medical school class, there were 145 men and five women, one “negro,” as African Americans were then called, and three students of Asian descent. My medical internship was a similarly homogeneous cohort of 16 white men. By contrast, photos of today’s graduating classes look very different.
We assumed that all our medical school classmates were heterosexual, because those who were not were too embarrassed or too ashamed to declare openly their sexual preference.
So much has happened in this country since 1960 concerning racial relations, the status of women, and gay rights. A few personal examples:
Now, it would be fatuous to assert that all the problems surrounding issues of race, gender, and sexual preference have been solved. But few would want to roll back the clock, because in these domains, the moral arc has bent toward justice. And polls show a much higher rate of acceptance of these changes among the younger generation. Those who promote hateful and mean-spirited policies and rhetoric are fighting a rear guard action. They are on the wrong side of history.
There are other areas of progress. The rights of all people to receive basic medical care advanced with the passage and enforcement of Medicare, Medicaid, the SCHIP program, and the ACA. Yet, because our country remains fundamentally divided on this issue, it will not be easy to sustain — let alone expand — gains in access to care.
In public health, we have witnessed impressive gains against the scourges of tobacco, alcohol, motor vehicle fatalities, and HIV/AIDS.
The clinical science we now employ offers many more ways to help our patients, and despite such emerging challenges as obesity and physical inactivity, people live longer and healthier lives than ever before. But those benefits are not uniformly distributed. They are concentrated among the most fortunate, so that there is a widening health gap between the better off and those on the lower rungs of the social class ladder.
And, of course, the daily fabric of our clinical practice as general internists is fraught with obstacles that require both professional and political changes to ameliorate.
Thus, the central challenge remains: how to sustain hope in the face of what can seem like overwhelming obstacles. Here I want to share a quotation from Thomas Carlyle, which inspired William Osler:
“Our main business is not to see what lies dimly at a distance, but to do what lies clearly at hand.”
Here are six suggestions, gleaned from watching many people over the years, some of whom really made a difference, and others who fell short of their potential:
I hope that you have come to the same conclusion that Martin Luther King did:--the moral arc of the universe does bend toward justice, even if it might take an unseemly long time to do so.