A Different Kind of Doctor: Seeking Social Justice through Medicine

The practice of medicine changes rapidly, and with new advances in medical technology, the overall state of health of Canada’s children is arguably the best it’s ever been. Despite numerous advances in the field of pediatrics, however, not all Canadian children are better off. According to Dr. Gilles Julien, a professor of social pediatrics at McGill University and University of Montreal, many children remain left behind. In his recent book A Different Kind of Care: The Social Pediatrics Approach, Dr. Julien argues that even in a country with one of the world’s best healthcare systems, the health of many Canadian children remains at risk. The reason? Not all Canadian children experience and interface with the healthcare system in the same way. As a social pediatrician, the children about whom Dr. Julien is most concerned are those who are at the greatest risk of failing to reach their potential in life, those who, often because of the effects of living in poverty, require a different kind of pediatric care than that provided by more conventional pediatric practice. Dr. Julien writes that even today, a quarter of Canadian children live in poverty. Healthcare inequalities are problematic in Canada despite a relatively accessible and enviable healthcare system. As Julien writes, “In recent years, diseases that could more aptly be called ‘social’ have replaced a number of infectious diseases that have practically disappeared. While…disease control systems are much more sophisticated, the fact remains that the socioeconomic gradient of disease has remained relatively stable, particularly for children.” In A Different Kind of Care, Julien outlines the theory and approach of social pediatrics, and provides a number of examples of patients who have benefited from such an approach. In synopsis, social pediatrics involves widening the lens through which one views a child’s health, and diversifying the players involved in promoting and maintaining that child’s health. When considering the most vulnerable and disadvantaged children, one cannot separate health status from socioeconomic status, family background, and living conditions. The children at the greatest risk of “social” diseases require care from more than just a single social pediatrician; they require the integrated care of a community network created with the children’s best interests in mind. Social pediatrics recognizes the importance of this contextualized community approach to child well-being and seeks to facilitate the involvement of family members, teachers, social workers, friends, and anyone else relevant to a child’s mental and physical health. In practice, social pediatrics borrows a bit from the field of psychiatry, a bit from public health, and a bit from community health. It is easy to understand Julien’s theories on social pediatrics and why the approach works. Furthermore, it’s clear from the cases which he presents that the application of these theories benefits a great diversity of vulnerable children. These vulnerable children may be more likely to suffer from all sorts of illnesses, everything from asthma to headaches to sleep disturbances to eating disorders. I found myself inspired by Julien’s work, yet left with many questions about how he actually accomplishes what he does. Easily convinced of the importance of a broader, more global approach to the health of the most socially disadvantaged children, I wanted more details on the day-to-day practice of social pediatrics. What are the best ways to integrate various community members in the care of a single child? What are the logistics of maintaining clear communication among so many players? What does a typical day look like for a social pediatrician like Dr. Julien, if there is a typical day? And how do social pediatricians interface with the more conventional health care system? Regardless of my lingering questions about the details and logistics of exactly how social pediatrics works, A Different Kind of Care successfully conveyed the value of the social pediatrics approach. Julien’s work is a refreshing reminder about the importance of service in medicine, and a testament to the role physicians can play in fostering social justice.

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