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editorial
. 2006 Sep;98(9):1546–1552.

Rights, Bunche, Rose and the "pipeline".

Steven R Marks, Ada M Wilkinson-Lee
PMCID: PMC2569713  PMID: 17019927

Abstract

We address education "pipelines" and their social ecology, drawing on the 1930's writing of Ralph J. Bunche, a Nobel peace maker whose war against systematic second-class education for the poor, minority and nonminority alike is nearly forgotten; and of the epidemiologist Geoffrey Rose, whose 1985 paper spotlighted the difficulty of shifting health status and risks in a "sick society. From the perspective of human rights and human development, we offer suggestions toward the paired "ends" of the pipeline: equality of opportunity for individuals, and equality of health for populations. We offer a national "to do" list to improve pipeline flow and then reconsider the merits of the "pipeline" metaphor, which neither matches the reality of lived education pathways nor supports notions of human rights, freedoms and capabilities, but rather reflects a commoditizing stance to free persons.

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Selected References

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  1. Andrus Noelle C., Bennett Nancy M. Developing an interdisciplinary, community-based education program for health professions students: the Rochester experience. Acad Med. 2006 Apr;81(4):326–331. doi: 10.1097/00001888-200604000-00005. [DOI] [PubMed] [Google Scholar]
  2. Berlinguer Giovanni. Bioethics, health, and inequality. Lancet. 2004 Sep 18;364(9439):1086–1091. doi: 10.1016/S0140-6736(04)17066-9. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Braveman Paula. Health disparities and health equity: concepts and measurement. Annu Rev Public Health. 2006;27:167–194. doi: 10.1146/annurev.publhealth.27.021405.102103. [DOI] [PubMed] [Google Scholar]
  4. Butler W. T. Project 3000 by 2000: progress during tumultuous times. Acad Med. 1999 Apr;74(4):308–309. doi: 10.1097/00001888-199904000-00008. [DOI] [PubMed] [Google Scholar]
  5. Carmichael J. W., Jr Xavier University premedicine program's prescription for success: an interview with JW Carmichael Jr., MS, PhD. J Natl Med Assoc. 2005 Sep;97(9):1294–1300. [PMC free article] [PubMed] [Google Scholar]
  6. Cooper Richard A. Impact of trends in primary, secondary, and postsecondary education on applications to medical school. II: considerations of race, ethnicity, and income. Acad Med. 2003 Sep;78(9):864–876. doi: 10.1097/00001888-200309000-00004. [DOI] [PubMed] [Google Scholar]
  7. DeRosa D. A., Phillips C. Boston University's biosciences education program for Boston-area students. Acad Med. 1999 Apr;74(4):326–328. doi: 10.1097/00001888-199904000-00014. [DOI] [PubMed] [Google Scholar]
  8. Doyle Y. G., Furey A., Flowers J. Sick individuals and sick populations: 20 years later. J Epidemiol Community Health. 2006 May;60(5):396–398. doi: 10.1136/jech.2005.042770. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Earls F., Carlson M. The social ecology of child health and well-being. Annu Rev Public Health. 2001;22:143–166. doi: 10.1146/annurev.publhealth.22.1.143. [DOI] [PubMed] [Google Scholar]
  10. Erwin Deborah O., Henry-Tillman Ronda S., Thomas Billy R. A qualitative study of the experiences of one group of African Americans in pursuit of a career in academic medicine. J Natl Med Assoc. 2002 Sep;94(9):802–812. [PMC free article] [PubMed] [Google Scholar]
  11. Gadson Sandra L. The third world health status of black American males. J Natl Med Assoc. 2006 Apr;98(4):488–491. [PMC free article] [PubMed] [Google Scholar]
  12. Galea Sandro, Ahern Jennifer. Distribution of education and population health: an ecological analysis of New York City neighborhoods. Am J Public Health. 2005 Dec;95(12):2198–2205. doi: 10.2105/AJPH.2004.050617. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Geronimus Arline T., Hicken Margaret, Keene Danya, Bound John. "Weathering" and age patterns of allostatic load scores among blacks and whites in the United States. Am J Public Health. 2005 Dec 27;96(5):826–833. doi: 10.2105/AJPH.2004.060749. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Giordani B., Edwards A. S., Segal S. S., Gillum L. H., Lindsay A., Johnson N. Effectiveness of a formal post-baccalaureate pre-medicine program for underrepresented minority students. Acad Med. 2001 Aug;76(8):844–848. doi: 10.1097/00001888-200108000-00020. [DOI] [PubMed] [Google Scholar]
  15. Gruskin S., Plafker K., Smith-Estelle A. Understanding and responding to youth substance use: the contribution of a health and human rights framework. Am J Public Health. 2001 Dec;91(12):1954–1963. doi: 10.2105/ajph.91.12.1954. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Horton Richard. Rediscovering human dignity. Lancet. 2004 Sep 18;364(9439):1081–1085. doi: 10.1016/S0140-6736(04)17065-7. [DOI] [PubMed] [Google Scholar]
  17. Lovecchio Karen, Dundes Lauren. Premed survival: understanding the culling process in premedical undergraduate education. Acad Med. 2002 Jul;77(7):719–724. doi: 10.1097/00001888-200207000-00016. [DOI] [PubMed] [Google Scholar]
  18. Magnuson Katherine A., Waldfogel Jane. Early childhood care and education: effects on ethnic and racial gaps in school readiness. Future Child. 2005 Spring;15(1):169–196. doi: 10.1353/foc.2005.0005. [DOI] [PubMed] [Google Scholar]
  19. Mann J. Dignity and Health: The UDHR's Revolutionary First Article. Health Hum Rights. 1998;3(2):30–38. [PubMed] [Google Scholar]
  20. Mathews W. C., Booth M. W., Turner J. D., Kessler L. Physicians' attitudes toward homosexuality--survey of a California County Medical Society. West J Med. 1986 Jan;144(1):106–110. [PMC free article] [PubMed] [Google Scholar]
  21. Morgan R. C., Jr Impact of anti-affirmative action on medical school enrollment. J Natl Med Assoc. 2001 Mar;93(3 Suppl):8S–10S. [PMC free article] [PubMed] [Google Scholar]
  22. Murray-García Jann L., García Jorge A. From enrichment to equity: comments on diversifying the K-12 medical school pipeline. J Natl Med Assoc. 2002 Aug;94(8):721–731. [PMC free article] [PubMed] [Google Scholar]
  24. Rose G. Sick individuals and sick populations. Int J Epidemiol. 2001 Jun;30(3):427–434. doi: 10.1093/ije/30.3.427. [DOI] [PubMed] [Google Scholar]
  25. Schwartz S., Diez-Roux A. V., Diez-Roux R. Commentary: causes of incidence and causes of cases--a Durkheimian perspective on Rose. Int J Epidemiol. 2001 Jun;30(3):435–439. doi: 10.1093/ije/30.3.435. [DOI] [PubMed] [Google Scholar]
  26. Sorensen Glorian, Barbeau Elizabeth, Hunt Mary Kay, Emmons Karen. Reducing social disparities in tobacco use: a social-contextual model for reducing tobacco use among blue-collar workers. Am J Public Health. 2004 Feb;94(2):230–239. doi: 10.2105/ajph.94.2.230. [DOI] [PMC free article] [PubMed] [Google Scholar]
  27. Turner B. J., Laine C. Differences between generalists and specialists: knowledge, realism, or primum non nocere? J Gen Intern Med. 2001 Jun;16(6):422–424. doi: 10.1046/j.1525-1497.2001.016006422.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  28. Wear Delese, Aultman Julie M. The limits of narrative: medical student resistance to confronting inequality and oppression in literature and beyond. Med Educ. 2005 Oct;39(10):1056–1065. doi: 10.1111/j.1365-2929.2005.02270.x. [DOI] [PubMed] [Google Scholar]
  29. Williams D. R. Race, socioeconomic status, and health. The added effects of racism and discrimination. Ann N Y Acad Sci. 1999;896:173–188. doi: 10.1111/j.1749-6632.1999.tb08114.x. [DOI] [PubMed] [Google Scholar]
  30. Wilson J. E., Murphy L. Premedical and predental enrichment program for minority students, 1969-1996, at Meharry Medical College. Acad Med. 1999 Apr;74(4):400–407. doi: 10.1097/00001888-199904000-00036. [DOI] [PubMed] [Google Scholar]
  31. Woolf Steven H., Johnson Robert E., Fryer George E., Jr, Rust George, Satcher David. The health impact of resolving racial disparities: an analysis of US mortality data. Am J Public Health. 2004 Dec;94(12):2078–2081. doi: 10.2105/ajph.94.12.2078. [DOI] [PMC free article] [PubMed] [Google Scholar]
  32. Yom SS. Gay men and lesbians in medicine: has discrimination left the room? JAMA. 1999 Oct 6;282(13):1286–1286. doi: 10.1001/jama.282.13.1286-jms1006-2-1. [DOI] [PubMed] [Google Scholar]

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