Jan 17 2012
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Health Care, Inequality & Dr. King: Reflecting on our Priorities

By Jamila Michener, PhD, Robert Wood Johnson Foundation (RWJF) Scholar in Health Policy Research at the University of Michigan, Ann Arbor and assistant professor of government, Cornell University.

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“Of all the forms of inequality, injustice in health care is the most shocking and inhumane.”-Dr. Martin Luther King Jr.

As controversial as the topic of health care is these days, most Americans agree with Dr. King on this one. Intuitively, we believe that everyone should have access to health care.

In a recent article examining perceptions of fairness in the health care system, former RWJF scholars Julia Lynch, PhD, and Sarah Gollust, PhD, find that more than 70 percent of Americans think that disparities in health care quality or access are fundamentally unfair. Unfortunately, Lynch and Gollust also find that Americans’ widespread agreement about fairness in health care crumbles in the face of tougher discussions about the causes and appropriate remedies for inequality. Despite a lack of consensus over the details, the optimist in me still believes that it is possible to find common ground in American politics for addressing racial and economic health care disparities. Nevertheless, there are (at least) two factors that work against this.

First, many people have little idea of the extent to which race and class determine health outcomes. To social scientists, public health scholars and policy makers, the statistics are both daunting and pressing. To everyday people, they are remote at best. Largely unaware of the extent of the problem, it is no wonder that the public is torn over what (if anything) to do about it.

Truthfully, however, I suspect that the obstacles to public action on health care inequalities go beyond a general lack of awareness. Perhaps even more critical is widespread inattentiveness to the underprivileged, an unspoken chasm that lurks in the subtext of our politics and disconnects the lives of the poor from the lives of everyone else. Many people do not think, do not care, or do not believe themselves (or the government) to be responsible for the economic or corporeal well being of the disadvantaged.

There are several potential explanations for this including prejudice, stereotypes, the influence of media, the American political culture of “rugged individualism” and much more. Regardless of the reason, it ultimately boils down to inconsistent and weak political commitments to the poor. As contentious battles over health care policies continue to unfold, there is scant discussion of what is at stake for those at the bottom of the economic totem pole. Although a lot of folks, not just the least privileged, are feeling the crunch of the current recession, the depth and gravity of the situation is amplified in the lives of those who were teetering on the edge of subsistence even before the “hard times” hit. Ideological stances aside, the fact is that people in the United States are literally living and dying in the face of relatively severe impoverishment.

So, as the nation honors the legacy of Dr. King, perhaps too few of us actively remember the people and the causes that he gave his life defending. Notwithstanding the still riveting replays of his “I have a dream” speech, what about King’s Poor People’s Campaign? What about his admonition that, “injustice anywhere is a threat to justice everywhere?” I’m not on a soapbox here, as I’m asking myself these questions too. MLK day will likely be comfortable and relaxed for me. I might not think about the many poor people and people of color who sit unattended in emergency rooms or never even go to the emergency room because they cannot afford it. I may forget about the residents of neighborhoods in Southwest Detroit who endure such bad air quality and high levels of pollution that they have to fight for the “right to breathe.” I might not think enough about these fellow citizens this MLK day.

But perhaps, in the spirit of truly honoring Dr. King’s legacy, I should.

Dr. Michener is currently writing a book examining the significance of Medicaid to the politics of the poor. Read more about the Lynch/Gollust study here and here.

Tags: Diversity, Health & Health Care Policy, Health Care Workforce, Health Disparities, Scholars in Health Policy Research, Voices from the Field