When Nancy Angoff, MD ‘90, MPH ‘81, MEd, professor of medicine and then associate dean for student affairs, and Ann Williams, EdD, RNC, a former Yale School of Nursing (YSN) professor, founded Power Day 20 years ago, some individuals in power in the health care system were opposed to it. One tried to get them to focus instead on professionalism, but they did not change course because the concern was power.
Twenty years later, hierarchy in medicine still can be problematic. Power Day, Angoff explained to the Yale School of Medicine (YSM) MD and Physician Associate (PA) students present at this year’s event on November 19, is an opportunity for students to shift their focus from how they have experienced power being used, to thinking about how they will use power, since soon they all will be practicing medical professionals.
Assistant Professor Shefali Pathy, MD, MPH, moderated the day and welcomed YSN Dean and Linda Koch Lorimer Professor Ann Kurth, PhD, RN, CNM, MPH, who introduced the keynote speaker, Kinari Webb, MD ’02. Webb, Angoff says, exemplifies someone who uses power well and Webb’s focus on the health of the planet is important for health professional students to learn about because the environment is a key social determinant of health, for example, impacting access to healthy food, water, clean air, and green space.
In her recently-published book, Guardians of the Trees: A Journey of Hope Through Healing the Planet, Webb stated that although humans love to categorize everything, she “was becoming more and more certain that separating out artificial constructs, like ‘health,’ ‘poverty,’ ‘psychosocial well-being, and environmental conservation,’ had played a role in getting us into so much trouble on the planet. It truly is all one, and removing these divisions allows for holistic solutions.”
On Power Day, Webb described the alarming challenge facing the planet: humans must halve atmospheric carbon by 2030, if we are to survive. She approached the issue optimistically, both sharing that she recently had a child, which she described as “a radical act of hope,” and telling about the work she and others are doing to address global warming and, simultaneously, improve health care.
After explaining the significant role rainforests play in absorbing pollutants and CO2 —and how harmful deforestation therefore is—Webb shared how when she was an undergraduate studying orangutans in Indonesia, she realized communities were cutting down rainforests illegally because they needed money for health care. Since the problems were intertwined, she wanted to find a connected way to address them, and went to medical school with this goal in mind.
On a rotation in Indonesia during residency, Webb witnessed how large aid organizations were not listening to the needs of the local communities they were supposed to be helping. To succeed in addressing deforestation and improving health, she explained to the students, “we need to partner with indigenous communities in a way that recognizes power.” Using this model, Webb founded Health in Harmony, an international nonprofit. Engaging in “radical listening,” the staff in Indonesia, Madagascar, and Brazil—which are all local to each country and primarily women-led— meet with local communities. The listeners explain to the communities that the communities are guardians of the precious resource of the rainforest, and ask what they see as the solutions to protect it.
Health in Harmony then provides funding and support to implement exactly what each local community wants, with every detail of the solution being community-designed. For example, in Madagascar, the communities designed mobile health care clinics since villages are isolated, creating long travel times to access health care. Health in Harmony-supported efforts in Indonesia led to a 90% decline in illegal logging, protected over 100 million pounds of CO2 from being released into the atmosphere since 2017, and enabled 120,000 people to access health care, among many other positive impacts.
Angoff believes Health in Harmony’s model of using power well by listening to what people in communities need is an important lesson for students to apply to patient care, that health care professionals need to listen to patients. Webb led an interactive radical listening exercise with students toward the end of the day, to provide them with helpful tools for listening effectively.
Angoff scheduled Robert Dubrow, MD, PhD, professor of epidemiology, and faculty director, Yale Center on Climate Change and Health, Environmental Health Sciences, School of Public Health, to follow Webb on Power Day, to bring the environmental issue to the local level. Climate change is the “greatest public health threat of our time,” Dubrow told the students, before discussing why the health care sector, which is responsible for 8.5% of U.S. greenhouse gas emissions, must play a leadership role in reducing emissions. He shared a variety of steps the industry can take to do this, from using electric power generated by renewable energy, to switching from single-use to re-usable products, to increasing the use of telemedicine, to providing universal access to health care, which would reduce the use of high-intensity emergency room care. He emphasized that sustainability provides a quadruple benefit of reduced pollution from the health care sector, improved public health, improved patient care, and reduced costs. On a more microlevel, he discussed how individual health care professionals can model sustainability in their clinical practice, advocate for climate action, and serve as trusted climate change messengers.
A traditional element of Power Day is recognizing residents nominated by medical students for modeling the responsible, positive, and beneficial use of power in health care relationships.
This year, two residents were honored:
Rebecca Fine, MD ’19 (nominated by Aishwarya Pillai)
Nishant Pandya, MD, MPH (nominated by Chigorziri Konkwo)
In the PA Program, second-year students selected graduating student Dao Ho for this award.
Since 2018, Power Day also has included the presentation of the Robert Rock & Tehreem Rehman Medical Student Activism Award. Students nominate peers who “in service of equity and social justice, have taken a professional or personal risk and whose work has led to important or lasting change.” The award is named after Robert Rock, MD ’18 and Tehreem Rehman, MD ’18, who started the US Health Justice elective and contributed to cultural change at the medical school.
Two MD students were recognized, Olamide “Ola” Olawoyin (nominated by Chinye Ijeli) and Abrianna Tasillo (nominated by Chigorziri Konkwo), as well as PA student Maria Dalzell (nominated by the second-year PA class).