Dec. 19, 2022, 3:45 p.m. News Staff — To say that Monica Hahn, M.D., M.P.H., M.S., wears many hats is putting it mildly.
The recipient of the 2022 AAFP Public Health Award, Hahn carries almost too many titles to count: associate clinical professor in the Department of Family & Community Medicine at the University of California, San Francisco, clinical director and co-principal investigator of the Pacific AIDS Education & Training Center, co-founder of the Institute for Healing and Justice in Medicine, 2021 National Minority Quality Forum 40 Under 40 leader in minority health, author of several peer-reviewed articles, community volunteer and advocate for historically marginalized patients, to name a few.
Hahn’s roles and responsibilities illustrate the myriad ways family physicians can make a difference. At the same time, they show the unique place that family medicine has in the health care landscape. After all, what other specialty is flexible enough for someone to pursue all these interests while still giving her the opportunity to care for people on a daily basis?
She recently spent time with AAFP News to share her experiences of growing up as the daughter of Korean immigrants, her passion for justice and equity, her hopes for advancing health care and the specialty of family medicine, and much more.
AAFP News: How has your work been shaped by your early experiences?
Hahn: My decision to become a physician, public health professional and activist was shaped by my unique lived experience and intersectionality as a woman of color, a daughter of immigrants and the first in my family to go into medicine and public health. Witnessing family members and members of my communities struggle to navigate the complexities of the U.S. health care system planted a seed in my consciousness. I saw the myriad ways our systems and institutions are not built to protect these community interests, and often unfortunately serve to perpetuate inequities. I realized that these systems are not built with the well-being of historically marginalized communities in mind, and that unjust policies create conditions that make certain communities disproportionately vulnerable to harm and poor health.
I spent my undergraduate and graduate training years working to understand the complex intersections of power, privilege and oppression with health by immersing myself in ethnic studies, critical race praxis and community organizing for racial justice as a student activist at UC Berkeley. I focused my ethnic studies and M.P.H. theses on sexual health and HIV prevention methods for women of color and immigrant communities.
How did you apply these interests to medicine?
Prior to medical school, I worked as a community health educator and near-peer mentor at Asian Health Services Youth Program. Working there and engaging in community-centered work influenced my long-term career goals in community-engaged medicine and public health. I also learned about the history of the community health center movement and its connections to the racial justice movements of the 1960s. Learning this history and the connections between social change movements and health and medicine crystalized for me the idea that you can be a physician and an agent of social change simultaneously.
What made you choose family medicine?
Family medicine was the specialty where I felt a sense of belonging for myself and my vision for the type of whole-person care and healing justice I wanted to dedicate a lifelong practice to. Though I appreciated a lot of specialties during medical school clerkships, when I reflected on which specialties I felt I saw the most thought leaders in health equity, who were most involved in social justice movements and public health, who truly practiced community-engaged work and were involved in grassroots advocacy, family physicians always stood out.
Clinically, I find it incredibly rewarding that I can practice full-scope primary care and also care for patients living with and affected by HIV during pregnancy and through delivery. I can then continue to care for them and their children and other family members. I can have long-lasting, healing relationships with the entire family. I don’t know any other specialty where I would be able to do that.
What kind of positive changes have you been able to bring about as a family physician focused on this important work?
I became passionate about HIV/AIDS prevention and treatment early in my training, first through personal connections with friends, community members and patients affected by HIV, and later because of the disease’s interconnectedness with stigma and structural violence, and its disproportionate effects on communities of color and LGBTQ communities.
Years ago, I met a woman from Ethiopia living with HIV who sought my care because she dreamed of starting a family. I had just finished residency, earned my HIV specialist credentials and started at the HIVE clinic, which is based at Zuckerberg San Francisco General Hospital. She had previously been told that because she had HIV, she and her partner could never safely have healthy HIV-negative children. That message was devastating because we know with current treatments, perinatal HIV risk has been essentially eliminated.
Nothing is more rewarding to me than being able to affirm for patients like her that they can live healthy lives and safely build the families they always wanted with culturally affirming care that honors their reproductive autonomy. Since meeting that patient, and many other patients with shared experiences, I’ve been grateful that I can continue to care for their entire family. To me, being a family-centered HIV doctor means not only building caring relationships with patients and their families, but also addressing health inequities and the consequences of systemic oppression.
I cannot count how many of my patients have experienced bias or discrimination in health care settings. Caring for them has fueled my advocacy work.
I have strived to leverage my privilege and platform as a nationally recognized public health and clinical HIV expert to raise awareness and advocate for an end to the discriminatory policies that prevent gay and bisexual men from donating blood.
I have also written journal articles drawing attention to the manner in which medication adherence, a huge topic in HIV treatment, can be fraught with provider bias and stigma.
My experience caring for a transgender man through his pregnancy, and witnessing him face numerous instances of micro- and macro-aggressions, motivated me to lead an advocacy effort for advancing gender-affirming prenatal, peripartum and postpartum care for transgender patients. My team created policy recommendations and guidelines that clinics and hospitals can undertake at various levels to improve the care of transgender patients.
I also have volunteered at St. James Infirmary, an occupational health and safety clinic run by and for sex workers in San Francisco, where I have learned about honoring the wisdom of community members with lived experience to lead efforts to dismantle stigma and champion harm reduction. This experience strengthened my insight into how to responsibly advocate for health equity when our health systems have missed the mark.
How have you been able to lead on these issues with an eye to system-wide change?
I am proud to be a co-founder of the Institute for Healing and Justice in Medicine. IHJM has served as an organizing hub for advocates interested in challenging structural racism in medicine while centering voices historically excluded from medicine.
I’m constantly inspired by the leadership of student mentees when it comes to advocacy in this realm. In 2020, my IHJM student co-founders independently published a report, Towards the Abolition of Biological Race in Medicine: Transforming Clinical Education, Research and Practice, which has been accessed more than 70,000 times. The IHJM houses national working groups with over 400 participants from medical and health institutions, and individuals further analyze how to put forth equity, justice and anti-racism in clinical algorithms, workflows and patient care.
I have been an active member of the eGFR working group at the IHJM, which has focused its advocacy on removing the use of race correction in kidney function measurements. Our working group led a successful petition and advocacy campaign at San Francisco General Hospital and UCSF, one of the first institutions to eliminate race-based eGFR. Our efforts helped lead to a national policy change in 2021, and we are continuing these advocacy efforts in other areas.
What is family medicine’s unique role in improving public health?
I think that family physicians are some of the most fierce and caring patient-centered advocates out there. They know their patients and families extremely well on a personal, individual level. They also can understand the complex multitude of social, structural and political challenges that lead to differential health outcomes, especially for historically and contemporarily marginalized communities. They hold this information and their patients’ best interests at heart. However, due to the fee-for-service model, with 15-minute visits and the lack of reimbursement for complex chronic care management, and the many structural barriers our patients face before they even make it into our exam room, we are missing the mark.
We need to organize and fight for structural changes to dismantle oppressive systems that prevent us from being effective in improving the health and well-being of our patients and communities.
Structural problems require structural solutions. We can’t “implicit bias” train our way out of systemic racism in health care. We can’t treat health conditions when our patients are struggling to afford care. We can’t help our patients thrive when they lack sustainable housing options and other basic human rights protections.
If we can ensure that people have access to the care they need, then we can more effectively tackle the challenges of dismantling health and health care inequities. I believe this starts with clearly naming and holding ourselves, our Academy and our institutions accountable to advocating for anti-oppression and anti-racism in all that we do. A more compassionate and equitable world is possible, and I am optimistic that we can take the lessons from past social justice movements to make this a reality in the future.
What do you hope to achieve through all these projects for you, your patients and family medicine?
I hope my efforts to advance dialogue about challenging systemic oppression and structural racism in medicine through my involvement as a medical educator and trainer will continue contributing to systems change.
I strive to hold true to my guiding values of cultural humility, lifelong learning and social justice, while maintaining my deep passion for mentoring trainees, especially those historically excluded from and marginalized by the field of medicine.
I truly believe in the value of the unique perspectives family physicians bring to advancing health justice. These perspectives are indispensable when searching for solutions to modern challenges in medicine that go beyond the individual level, all the way up to the systems level.