Inequity: Can we fix it?
It is no shock to anyone that our healthcare system has been in collapse. We have hospitals run by businessmen and those who have sacrificed their lives to heal are entering a space that does not allow them to do so. We see increased spending, more admin positions, greater asks from our regulatory bodies, and yet for the first time in decades, we see life expectancy going down and not up (CDC, 2023). In Massachusetts, we see more and more young people suffering from obesity, anxiety, and depression (MDPH, 2023). In Massachusetts, the state that is supposed to set the precedent for the country, the state where the wealth disparity between white and Black families is astronomical and your zip code is a major predictor in whether you are thriving or surviving.
The context of all of these things makes it hard to be in the equity space. Since 80% of our health is determined by social determinants of health, meaning your housing, your food, your access to transportation, and safe walkable spaces, as healthcare and public health practitioners we have to think about that 80% (WHO, 2022). That 80% needs to inform how our clinicians practice, speak, and care for patients.
It seems impossible to care for patients in the context of all of this. It feels impossible to think through equity when Medicaid reimbursement is ions lower than commercial insurance (KFF, 2023). It feels impossible to care for patients when concierge services allow patients to buy their way into seeing providers first, before those that may need it more (NEJM, 2022). It feels impossible to do this work when primary care providers and all providers for that matter are burnt out by everything I have already described (AMA, 2023). It feels like our equity efforts are futile in these instances. I try to remember Adrienne Maree Brown’s words, “small is all” (Brown, 2017). But I am beginning to think, is it? Especially when the small seems to be one never-ending band-aid after another.
And on top of this, being in this space as someone Black, it often feels like this is not my fight. My ancestors did not do this. My ancestors did not intentionally create a system to keep the poor, the colored, and the women out. My ancestors were the first to abolish slavery in the Western Hemisphere and are currently paying the price for it as Kenyan forces deplane and set up shop to enforce U.S. interest as I type this. The words that my best friend has been spewing for years is going through my head: “We need to go back to Africa.” A place where I will not have to experience racism. A place where I do not have to teach white people how their whiteness offends and makes others uncomfortable. A place where systems are not built on racist ideology. A place where I do not have to prove that disparities exist and push white people to care about them. A place, although I have not been, where I feel like I can finally breathe. I know it would not be perfect, but breathing is life.
Is it idealistic to think that we can get to a place where I really shouldn’t have a job because equity is the norm? A place where everyone operates from love. I think it is. Is America, as an institution, so far gone that it is too much for even well-hearted people to create a collective fix?
Acknowledging our power and privilege is acknowledging that we have to be uncomfortable and give something up. Is anyone willing to give anything up? What are you willing to sacrifice for community, for the collective, for the whole? In the words of bell hooks, are we willing to ask ourselves, “What would love do?” in each and every moment (hooks, 1999). I do not think most white people in this country are really ready to do the work that they say they are willing to do, and why, as people of color, are we subject to do it for them?
The context of it all feels so dire. It feels like only radical shifts can change the outcomes of the interconnected collective catastrophes happening all around us. And is that radical move for us as Black people to jump ship (no pun intended) and rebuild the nations that were stripped of our greatness?
As Toni Morrison says, “The very serious function of racism…is distraction. It keeps you from doing your work. It keeps you explaining, over and over again, your reason for being. Somebody says you have no language and so you spend 20 years proving that you do. Somebody says your head isn’t shaped properly so you have scientists working on the fact that it is. Somebody says that you have no art so you dredge that up. Somebody says that you have no kingdoms and so you dredge that up. None of that is necessary” (Morrison, 1975).
I have never known a life without this distraction.
Citations:
CDC. (2023). Report on life expectancy.
Massachusetts Department of Public Health (MDPH). (2023). Health statistics in Massachusetts.
World Health Organization (WHO). (2022). Social determinants of health.
Kaiser Family Foundation (KFF). (2023). Medicaid and commercial insurance reimbursement rates.
New England Journal of Medicine (NEJM). (2022). The impact of concierge medicine.
American Medical Association (AMA). (2023). Survey on healthcare provider burnout.
Brown, A. M. (2017). Emergent Strategy: Shaping Change, Changing Worlds.
hooks, b. (1999). All About Love: New Visions.
Morrison, T. (1975). A Humanist View, speech at Portland State University.