“We know what makes us ill”
By: Colleen Farrell
Tags: Poverty, Poetry, Medical Humanities, Homelessness, Healthcare

Poverty, Homeless, and Health in the Poetry of Bertolt Brecht

#MedHumChat №6

In my first year of medical school, a health policy professor showed us a slide with pie chart and pointed to one little sliver. The pie represented patients’ health. That sliver, between ten and twenty percent, was the impact that modern medical care is thought to have on our patients’ health. I was shocked. Wasn’t I in medical school to prevent and treat disease? How could our impact be so small? And what was the other eighty to ninety percent?

The vast majority of the pie is the social determinants of health (SDOH)—factors like structural inequality, poverty, homelessness. I received several data-filled lectures on SDOH in medical school. But it wasn’t until I began caring for patients that I had any visceral understanding of the SDOH.

I care for a man who immigrated to the US some thirty years ago, leaving his wife and toddler behind. He labored for decades, sending money to his family. In his loneliness and isolation, he drank. After decades apart, he’s been reunited with his family and no longer drinks. But the damage to his liver is irreversible and will cut years off his life. What might his life have been had he not been borne into poverty? How much pain and suffering could have been spared had he been able to be with his family whilst earning enough to live?

In this chat, we read two poems by Bertolt Brecht, the German poet and playwright, that humanize the social determinants of health and call on those with power and resources — including doctors — to advocate for change. Brecht wrote from a time and place different from our own. His poem A Bed for the Night was written between 1929 and 1933, as Hitler was coming to power in Germany. And yet, the themes of his work are so relevant to our current times. We were joined in this discussion by Dr. Kelly Doran and Dr. David Rosenthal, both of whom care for patients facing poverty and homelessness, research SDOH, and advocate for change

#MedHumChat №6 | February 20th, 2019

Theme: Poverty, Homeless, & Health in the Poetry of Bertolt Brecht

A Worker’s Speech to a Doctor

A worker challenges a doctor to see how a detached biomedical analysis fails to recognize the social and economic factors that drive disease.

A Bed for the Night

A man on a New York Street corner finds beds for people experiencing homelessness. This goodness counts for something, is it enough?

Special Guests: Dr. Kelly Doran & Dr. David Rosenthal

Photo by Matt McNulty on Unsplash

A Worker’s Speech to a Doctor

1. The poem draws us into the clinical encounter — naked body, ragged clothes. How does it speak to the root causes of illness?

“And you listen all over our naked body.

As to the cause of our illness

A glance at our rags would be more

Revealing”

2. The poem is critical of advice from doctors. When have you given, received, or overheard medical advice that was out of touch with social context? How did you feel about it?

“Too much work and too little food

Make us weak and scrawny.

Your prescription says:

Put on more weight.

You might as well tell a fish

Go climb a tree”

3. The ending of the poem is especially evocative. Especially for those who practice medicine, how can we avoid defensiveness and learn from these lines?

“You’ll no doubt protest

Your innocence.

The damp patch

On the wall of our apartments

Tells the same story.”

A Bed for the Night

4. The poem has a really interesting structure, with repetition of lines, interrupted by the direct statement: “Don’t put down the book on reading this, man.” What meaning is conveyed with this structure?

5. What role do you think physicians and the broader healthcare system should play in addressing poverty, homelessness and other social determinants of health?

Responses to Question 1: