While I was working on creating a health equity resource toolkit for providers, I came across a wonderful Ted Talk  from 2011 by British public health researcher Richard Wilkinson.

The talk focused on the wide-ranging impact of income inequality on individuals. Wilkinson identifies health as one of the biggest areas affected by income inequality. Wilkinson’s body of research is fascinating, and it’s really helped me build a framework for understanding how health disparities occur, and why they persist.

Wilkinson’s observations are not new — his research has long implicated inequality as a leading cause of poor health. It seems intuitive, but his research leads to some surprising conclusions. Wilkinson’s findings suggest that there is a negative health impact on all socioeconomic classes — not just the poorest — in societies with large gaps between the rich and the poor.

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It’s alarming how little attention the impact of income inequality on health gets in the training of physician assistants, nurse practitioners, and other providers. Often labeled as “political” or “non-clinical,” this evidence remains far from the mainstream of medical teaching and curriculum.

It’s ironic, because evidence suggests the social causes of poor health may play bigger roles on the health of our patients than any of our diagnostic and pharmacological finery. And what if that’s true? What if it turns out, like many already assert, that what happens outside the exam room is a bigger determinant of health then what happens inside?

Will historians centuries from now look back, shake their heads, and say, “can you believe that they ignored all the things that were really making their patients sick, and in fact made them even worse with their medicines and operations?”

As providers committed to protecting and improving the health of our patients, we must ask ourselves some key questions: do we believe that social forces harm our patients? And if we do, is it our job to address these causes? And if it’s not, then whose job is it?

Jim Anderson, MPAS, PA-C, ATC, DFAAPA, is a physician assistant in Seattle, WA.