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Using film as a resource to explore health equity

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Using film as a resource to explore health equity

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Film (movies, TV dramas, shorts, adverts) all entertain and have the power to edu-tain. Films are great resources in education because they help learners:

Broaden their experience and exposure to other worlds

See the world from different perspectives

Make sense of the world

Break down cultural barriers and explore biases

Deepen their understanding of the patient’s experience of illness

Develop observational, descriptive, and problem-solving skills

Explore the challenge of managing uncertainty

Learn through using a resource that does not require medical knowledge or experience

Reflect on real life (so take care as they can trigger powerful responses and emotions)

Read more about Art and Creativity in Medical Education on this link

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Irving Zola's Upstream- Downstream Parable

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Irving Zola's Upstream- Downstream Parable

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In our sessions we used this parable to shape our discussion about the role of the GP in individual patient care and in service provision.

Read more here.

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1. Identity

2. Domestic violence

3. Food poverty

4. Access to clean water

5. Period poverty

6. 'Double ACE' (adverse childhood/community events)

7. Men's mental health

8. Surviving (gangs, drugs and adolescence)

9. Inequitable health outcomes

10. The power of education

11. The stigma of diseases and lifestyle choices

12. Unequal impact of climate change

13. Alcohol, drugs and ACEs

14. Impact of war

15. Impact of belief on health

16. Positive coping strategies

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1. I Saw the TV Glow (2024, director Jane Schoenbrun)

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1. I Saw the TV Glow (2024, director Jane Schoenbrun)

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Synopsis

Teenager Owen is just trying to make it through life in the suburbs when his classmate introduces him to a mysterious late-night TV show — a vision of a supernatural world beneath their own. In the pale glow of the television, Owen’s view of reality begins to crack.

“I Saw the TV Glow” deals with the theme of transgender identity and dysphoria in a way that is beautiful and heartbreaking in equal measure.

Things to think about

Throughout the film Owen is being pulled by his need to assimilate in order to survive and his raw authenticity - have you faced something similar, and if so how did it feel? Or perhaps you know someone who has?

GPs play a vital role in providing care for transgender and gender-questioning patients - think about the standard of care you're providing or would provide, and how you could improve upon it?

Ideas for after the session

Watch the film

Other media to consider - Transparent (2014), The Danish Girl (2015), Disclosure (2020)

Toolkits are very helpful, check out this Gender Identity Toolkit for GP - https://dashboard.igpm.org.uk/wp-content/uploads/2023/11/Gender-identity-toolkit-for-general-practice-Template-2.0.pdf

Display LGBTQ+ friendly symbols (like rainbow flags) and show genuine understanding of LGBTQ+ issues – this could include lanyards for staff or lapel pin badges

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2. Refuge: Grow (2017, by BBH London advertising agency)

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2. Refuge: Grow (2017, by BBH London advertising agency)

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Synopsis

The video dramatises the real-life domestic abuse suffered by Refuge client Melanie Clarke. Singer-songwriter Frances lent her song to accompany the video.

Things to think about

Home is supposed to be a place of safety and comfort - how does the video make you feel?

How might it feel to be this woman, and what might stop her asking for help?

Ideas for after the session

Take a look at the whole video and explore the services Refuge offer victims of domestic violence.

Discuss what your role as a GP might be with your trainer or supervisor.

Link to video

https://www.youtube.com/watch?v=hZRoXz7hxcU

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3. I, Daniel Blake (2016, director Ken Loach)

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3. I, Daniel Blake (2016, director Ken Loach)

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Synopsis

The film lays bare the cruel realities for those who fall through the cracks of British society while highlighting the power of human compassion and connection. Daniel, a carpenter loses his job after a heart attack and in the process of seeking support from the benefits agency befriends Katie and her two children. Katie is a single mum who has been rehoused hundreds of miles from her family and support.

Things to think about

How many people in the UK need to use food banks to ensure they have enough to eat?

Have you ever visited a food bank?

Think about how you might feel standing in a queue.

What other issues does this scene raise?

Ideas for after the session

Watch the film

Use a tutorial or PLT slot to visit your nearest food bank

Look at the other films Ken Loach has produced in his career, they span 50 years of inequality starting in 1966 with Cathy Come Home, a BBC TV drama about the impact of homelessness

Link to clip

https://www.youtube.com/watch?v=s_n7o30Ra60

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4. Erin Brockovich (2000, director Steven Soderbergh)

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4. Erin Brockovich (2000, director Steven Soderbergh)

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Synopsis

This American film is a dramatisation of the true story of Erin Brockovich, portrayed by Julia Roberts, who initiated a legal case against the Pacific Gas and Electric Company over its culpability for contaminating the local ground water with chromium*. The pollution caused significant suffering to the local community who had no way to avoid using the water. *Chromium is an essential element for healthy body function but in excess is toxic and causes multi-organ disease resulting in morbidity and mortality (from a variety of causes).

Things to think about

Is access to clean water a universal basic human right?

Is everyone in the population impacted equally, if not why?

How would you feel if your tap water was contaminated and you knew it was causing harm to you and your family?

Ideas for after the session

Watch the film, and keep an eye out for others. There are lots of films based on incidents around the world where access to clean water has been compromised by corporate negligence. Dark Waters is another good example of edu-tainment about a problem that has global health consequences.

Link to clip

https://www.youtube.com/watch?v=tN85swq288U

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Learning About Hinkley's Poisoned Water -- Erin Brockovich

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5. Spotless (2021, director Emma Branderhorst)

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5. Spotless (2021, director Emma Branderhorst)

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Synopsis

This short film was produced in Holland and has won a number of awards.

When 15 year old Ruby realises she is having her period, she doesn't want to ask her mother to buy her period products, because she knows their financial situation doesn't really allow it. The film dramatises how she tries to solve the problem herself - her solutions include borrowing sanitary products from friends, making her own, and stealing from a local shop.

Spotless tells the story of many unheard women, and aims to open the conversation and break the taboo about period poverty.

Things to think about

What is period poverty?

What makes it such a taboo subject?

How might it feel to be at school with no access to sanitary protection?

What initiatives are you aware of to help alleviate this issue?

Are there other films about period poverty you are aware of?

Ideas for after the session

Watch the film

Keep an eye out for initiatives in public toilets to provide free sanitary protection.

Does your surgery/hospital provide sanitary protection for girls/women in need?

Watch 'Period. End of Sentence' about period poverty and creativity in India (available on Netflix)

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6. Precious (2009, director Lee Daniels)

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6. Precious (2009, director Lee Daniels)

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Synopsis

Sometimes when you hear a patient's story the phrase "Humankind cannot bear so much reality" comes to mind. The story of Precious is hard to hear.

The setting is Harlem in 1987, the central character the obese 16-year-old black girl Claireece Jones, known as "Precious". Precious is illiterate, aggressive, constantly tormented by fellow high-school pupils and abused, both physically and verbally by her alcoholic mother and father. She has a daughter with Down's syndrome by her father, who constantly rapes her with the mother's connivance and is pregnant again by him. Later, it's revealed that the father has died of AIDS.

Things to think about

How do you feel as a doctor when you hear a story like this?

How can you make sense of what you feel in order to care and help?

Ideas for after the session

This film is hard to watch, but it reflects what is happening around the world today, which is also hard to watch. Maybe the message from this film should be to consider how you find the sweet spot so you're aware of world issues, can hear tragic life stories and still function as an effective GP. Talk to GPs who work in Deep End practices and with the homeless/refugees and find out how they cope.

Link to clip

https://www.youtube.com/watch?v=L26bnfsPb2A

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Precious - Who was gonna love me? - Mo'nique

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7. Silent Men (2024, director Duncan Cowles)

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7. Silent Men (2024, director Duncan Cowles)

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Synopsis

Part therapy, part road trip, a deadpan filmmaker asks men how they show their emotions, to help him confront his own struggles with opening up to loved ones.

Things to think about

Why did Duncan make this film?

How do you respond as a doctor to a male patient who talks openly about their mental health?

Ideas for after the session

See if you can access this film online or find one with a similar theme, you could watch it in your PLT and discuss it in your tutorial.

Link to trailer

https://www.youtube.com/watch?v=WC7xi30KZ5E&t=48s

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SILENT MEN: The Awkward Art of Expressing Emotion - Official Trailer (2024)

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Synopsis

This new movie by Andrea Arnold is reminiscent of Ken Loach's Kes. The Guardian describes the film as 'a chaotic social-realist adventure, where tragedy butts heads with comedy'. It's the story of Bailey, unseen, making the transition from girl to woman in a world that is both brutal and loving. A world where identity, family and belonging are lost in the cruel and misogynistic behaviour of the adult characters. Magical realism is introduced into the film through the character of Bird who enables Bailey to feel seen. Bailey's love of the natural world and powerful imagination are shown as protective positive coping strategies for surviving in her brutal world.

Things to think about

Imagination is an under-utilised coping strategy, how would you implement it e.g., in a mental health consultation with a patient under a lot of stress?

Ideas for after the session

Watch Big Fish (2003), which explores a strained father-son relationship, and the boundaries between reality and fantasy.

Link to trailer

https://www.youtube.com/watch?v=2y0iJkT97Jc

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BIRD | Official Trailer | Now Streaming Exclusively

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9. Aftershock (2022, directors Paula Eiselt and Tonya Lewis Lee)

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9. Aftershock (2022, directors Paula Eiselt and Tonya Lewis Lee)

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Synopsis

This documentary film is about discrimination in American maternity health care which sadly mirrors women's experience of birth in NHS care.

The story followed the lives of two families impacted by discrimination who become ardent activists in the maternal health space, seeking justice through legislation, medical accountability, community, and the power of art. The film views the inequity from a number of perspectives; the women, their children, their surviving Black fathers/partners, and the midwives and physicians. Through their collective journeys, the film brings us to the front lines of the growing birth justice movement that is demanding systemic change.

Things to think about

Why?

Are you aware of the statistics about maternity outcomes in the UK?

What is your role as a doctor in this situation?

Ideas for after the session

Find out more about maternity care in the UK - maybe have a tutorial about it.

Think about what might help you to be a positive advocate for your patient and an active bystander.

In her review of UK maternity services, Dame Donna Ockenden said one of the things that would make a positive difference is for women's voices to be heard. How might you ensure this happens in your care of patients?

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10. Girl Rising (2013, director Richard E. Robbins)

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10. Girl Rising (2013, director Richard E. Robbins)

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Synopsis

This is a documentary film that tells the stories of nine girls from nine countries: Sierra Leone, Haiti, Ethiopia, Afghanistan, Peru, Egypt, Nepal, India and Cambodia. Each girl had her story written by a writer from her country and voiced by renowned actors. Their stories reflect their struggles to overcome societal or cultural barriers to access education.

Things to think about

Why is access to education so important (for everyone)?

What is your experience of accessing education?

What are the barriers to access to education in the UK?

What is the doctor's role in this?

Ideas for after the session

Watch the film

In your care of patients think about these questions: If your next patient is a child - are they attending school? If not what are the reasons and how might this impact on their health and wellbeing? If your next patient is an adult - is their ability to cope with a life event or health issue the result of a lack of access to appropriate education?

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11. Dallas Buyers Club (2013, director Jean-Marc Vallée)

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11. Dallas Buyers Club (2013, director Jean-Marc Vallée)

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Synopsis

This American film tells the story of Ron Woodroof, a cowboy diagnosed with AIDS in the mid-1980s, a time when both the aetiology and the treatment of AIDS were poorly understood and its sufferers were stigmatised. As part of an ongoing experimental AIDS treatment, Woodroof smuggles unapproved pharmaceutical drugs into Texas to treat his symptoms. He ends up distributing them to fellow people with AIDS establishing the "Dallas Buyers Club", all the while facing opposition from the FDA and the medical establishment.

Things to think about

What assumptions might you make about Ron?

Why was/is HIV/AIDS such a stigmatising disease to have?

Are there other diseases which are socially stigmatising?

Ideas for after the session

Watch the film

Next time you see a patient with a disease/circumstance/lifestyle choice that you think might be stigmatising, remember to explore the impact this is having on them.

The Channel 4 series It's a Sin also explores this topic effectively.

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12. Snowpiercer (2015, director Bong Joon Ho)

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12. Snowpiercer (2015, director Bong Joon Ho)

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Synopsis

“All animals are equal, but some animals are more equal than others.” George Orwell, Animal Farm

Snowpiercer is a post apocalyptical film based on the French climate change fiction graphic novel Le Transperceneige by Jacques Lob. The film brings George Orwell's quote to life in a story about climate change where the survivors exist on a train, segregated by social status causing inequitable access to resources. Like Orwell's book the film explores the tensions created by inequality and the consequences that result.

Things to think about

How do you think it would feel to be this child knowing that others are living in luxury just a few feet away?

A big question but why do you think inequalities exist?

Or your thinking could be to explore the unequal impact of climate change.

Ideas for after the session

Watch the film, and maybe you have already seen another one of Bong Joon Ho's films, Parasite, which is a wonderful voyeuristic film about the inequality that exists in societies across the world.

If you have not yet explored the work of Kate Pickett and Richard Wilkinson then do read The Spirit Level: Why Equality Is Better For Everyone.

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13. The Arbour (2010, director Clio Barnard)

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13. The Arbour (2010, director Clio Barnard)

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Synopsis

This is a docu-film (a mix of fact and fiction) that tells the story of growing up on an infamous Bradford housing estate. The film's main characters span three generations, Andrea Dunbar, her daughter Lorraine and granddaughter. Lorraine's relationships with her family are dysfunctional and she uses alcohol to excess. The film explores the impact of this on the young lives of her child and grandchild, and how history has a habit of repeating itself. Lorraine, neglected as a child went on to experience racism and violence in adult life which caused her to take refuge in drugs in the same way that Andrea took refuge in alcohol.

The film brings to life the concept of 'adverse childhood events' and the impact of these on adult life choices and opportunities.

Things to think about

Imagine you are sitting on the sofa in this scene, what might you be thinking?

What do you understand by the term Adverse Childhood Event?

Ideas for after the session

Watch the film

Next time you see a parent as a patient consider how their health seeking behaviour and lifestyle choices might be influencing their children - look for both positive and negative factors.

The classic film Trainspotting is worth watching to observe the impact of drugs on the lives of individuals, their family and community.

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14. Hunger Ward (2020, director Skye Fitzgerald)

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14. Hunger Ward (2020, director Skye Fitzgerald)

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Synopsis

​In March 2018 the UN reported that 10 million Yemenis were one step away from famine and that hunger was threatening an entire generation. Filmed from inside two of the most active therapeutic feeding centres in Yemen, the film provides an unflinching portrait of Dr. Aida Alsadeeq and Nurse Mekkia Mahdi as they try to save the lives of hunger-stricken children within a population on the brink of famine, against the backdrop of a forgotten war.

Things to think about

What if this child was a member of your family?

What is the impact of war on innocent civilians?

What is the role of a GP in the UK?

Ideas for after the session

Watch the film and take a look at Fitzgerald's other work about refugees.

Do you ever ask if your patient has been impacted by war?

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15. You Will Die at Twenty (2019, director Amjad Abu Alala)

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15. You Will Die at Twenty (2019, director Amjad Abu Alala)

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Synopsis

A folk tale turns existential in “You Will Die at Twenty,” the rapturous debut feature by the Sudanese filmmaker Amjad Abu Alala. In a sun-dappled village by the Nile, a holy sheikh tells Sakina that her newborn son, Muzamil, will live only two decades. The prophecy becomes too heavy a cross for their family to bear: Muzamil’s father soon abandons them, admitting softly to Sakina that he isn’t as strong as her. She’s left to raise their son alone, condemned to misery by her unshakable belief. Dressed in all black even while Muzamil is alive, she counts down his days on the walls of their hut.

Things to think about

Do you know how to identify thoughts that are holding you back? Everyone has self-limiting beliefs, but few know how to change them.

Personal beliefs and cultural practices are central to the lives of doctors and patients. Think about how you can practise in line with your own personal beliefs without breaching the rights of your patients.

Ideas for after the session

Films help us 'face and confront' our core beliefs, so I encourage you to watch films that cover a topic or issue that you have limited understanding of or perhaps have developed biases against.

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A very positive film for us to end with - recently shown at the Aesthetica Short Film Festival in York. Do look out for it at a community cinema.

Synopsis

Plunge tells the real life story of Katie (Kathleen Wotton) who found empowerment, friendship, and healing by plunging into frigid waters of the sea. As her voice relates to us the physical and mental struggles that have plagued her for decades, her animated form darts confidently through kelp forests on the ocean floor. She tells us about her strong community and the tremendous physical benefits of cold-water swimming. Through Katie’s story this beautiful, animated film addresses themes of isolation and connection, mental health and wellbeing, and empowerment.

Things to think about

How important are non-medical interventions and coping strategies for people's health and wellbeing?

What is your role as a GP in helping patients identify what works for them?

Ideas for after the session

Read about Katie's story here - https://tykefilms.com/plunge