September is Women in Medicine Month as designated by the American Medical Association (AMA). While women have made gains in medical school applications and enrollments over the past five years, and have comprised over fifty-five percent of first-year medical students in 2022, the equation for health equity and social justice demand greater diversity and inclusion at every level of medical education and healthcare and public health practice and leadership. To solve the current and future complexities of medicine and beyond and to innovate with unbridled creativity, people who identify as women are pivotal to driving such competitive change. But performative diversity without appropriate power sharing across all groups, especially those who have been historically disenfranchised or excluded falls flat of the promise of calculated majorities. As we hopefully use this moment to celebrate and amplify women across public health and preventive medicine, it’s important for us to advocate for the professional concerns of women physicians and the health issues and social needs of women patients. Both the literature and lived experience have taught us that pay inequities, bias and discrimination in life and the workplace, and the challenges of high quality, affordable childcare have presented sturdy barriers to gender and intersectional justice.
To advocate and disrupt effectively will require a deeper understanding of how race, ethnicity, gender, socioeconomic status, and sexual orientation, among other identity descriptors intersect and impact health and life outcomes. In reflecting on this month, I recall a recent Lancet publication by Bajaj, Tu, and Stanford which spotlighted the plight of Black women in healthcare in their aptly entitled piece, “Superhuman, but never enough: Black women in medicine.” As the authors note, Black women only comprise 2.8% of the physician workforce, and fewer still are in academic leadership roles. Yet, it is increasingly understood that race and gender concordance are paramount to whole-person, human-centered care for Black populations and other historically excluded groups. With historical and contemporary barriers stacked against the eventuality of Black women entering the field of medicine, pipeline programs to medical education and academic and professional leadership are imperatives alongside community-wide and systematic efforts to wrestle the political and social determinants of life to conspire to equity and justice. And if those odds weren’t staggering enough, once the threshold has been crossed and she earns her way into medical school and residency and then into her professional practice and development, the “closed door” signs and aggressions encountered in White, male dominated spaces are formidable to her culminating success. Still, she rises. Otherwise, we all fall.

While the truth is sobering, these celebratory months present a triple aim. To celebrate success, diagnose systemic failures, and plot present and future change. And though so much more can be said, this is a pinpoint opportunity to consider the future of our own field across three dynamic parameters: 1) how to identify, recruit, and sustain the most diverse and inclusive people to enter medicine and the practice of preventive medicine and public health; 2) how to position preventive medicine as a key component of health ecosystems change to achieve health equity and social justice; and 3) how to advocate, agitate, and disrupt in socially and culturally fluent ways that drives hubs of individual and population-level healing. And we need women in positions of power and influence, and allies and co-conspirators to do be able to do that.

Chris Pernell, MD, MPH, FACPM
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