Last week’s column focused on how racial and gender inequities can impact medical access, diagnosis, treatment and follow up – even when the health professional involved is deliberately intending to offer high quality care equally to every patient. Implicit bias, built on unconscious racial and gender judgments, continue to shape the medical care people receive.
But it is not just the healthcare system that determines our health. It is every other aspect of society as well. Where we live. Where we work. How much we earn. How much our food costs. How we get around. How well our schools serve us. How we are treated before the law. How we feel about ourselves. All these things are powerful drivers of our health and well-being.
If you want to understand why Blacks are dying at twice the rate of Whites from COVID-19, or why women receive different treatment than men, even when presenting identical symptoms and having the same scores on standardized tests, then you need to take a hard look at society, not just the bias of doctors and the failures of access to the healthcare system.
What’s striking is how little has changed despite decades of activism, significant improvement of laws, and genuine social change. Today, there are more interracial families. More communities are mixed. Many people have diverse groups of friends. Yet, too many of us are still puzzled by why significant and often growing inequities exist between racial groups.
It’s because of those harder-to-see and glass ceilings, employment boundaries, public service disparities, lack of access to professional services, and more. These things are also much harder for well-minded citizens to adjust towards more equitable policies and practices.
Take education for a start. While we all may want every child to access the same high quality teachers and facilities, with equitable resources and challenging peer groups, unless we all come together, organize, enact policy change, and accept a reallocation of funds and effort, then little actually changes.
Take employment as another. While the well-to-do quibble about their benefit packages and vacation days, who is thinking about the career progression of the low-wage earners in meat-packing plants, or the retraining needs of redundant workers, or the youth who needs a first job? Some activists are, yes. But they know, from decades of trying, progress comes slowly to those in most need.
Like a rising tide lifts all ships, so too a strong economy can bring more wealth to all. But the evidence suggests the waves can be discerning and favour those who float well.
The racial unrest in the streets as a result of George Floyd’s murder is nothing new. Tragically, like gun violence, racial discrimination persists and follows predictable patterns.
If we really want an end to racial and gender inequity, then we all have a lot more work to do. We need to start taking much more concerted action on the social and economic determinants of well-being.
If we want fair access to good health outcomes for every member of our society, then we need to address the foundations of our education system. We need to make all our neighbourhoods more resilient. We need to ensure quality, nutritious, affordable food is accessible to all. We need to address employment systems and practices that suit the privileged and ignore the poor. All this and more. There is work to do.
Hats off the to tireless activists who have, for decades, been making the case. Time now for everyone else to get on board.