A New American Era

All of our lives changed when ill health fell upon the patriarch of my mother’s side of the family. Power dynamics changed among my relatives. Obligations and responsibilities among my mother and her siblings shifted. And my grandfather was no longer the resolute and persevering provider of our family.

My grandfather’s change in health was immediately followed by the death of my mother’s oldest sister. The fact that my papa had to bury his own child took quite the opposite effect than we expected on his state of mind regarding his own health. When he first got sick, we all just knew that my determined, stubborn, shoot-now-and-ask-questions-later grandfather would overcome his sickness. But he didn’t. We thought the sudden death of my aunt would be a wake-up call. But it wasn’t.

As U.S. citizens today embrace a new American era marked by the adoption of universal health care we must be able to see through the one-dimensional debates over cost and too much government expansion. And while I do admire that the Affordable Care Act (ACA) will offer all US citizens health insurance or pathways to affordable and adequate insurance, I find that the beauty of the legislation lies in how it can address health outcome and health care disparities that plague racial and ethnic minorities in this country.

Blacks and first indigenous populations suffer disproportionately from diseases like high blood pressure, diabetes, high cholesterol, obesity and stress. While personal behavior plays a huge role in this, vast epidemiological research suggests that social determinants account for the majority of health disparities. How can we expect people to be healthy in neighborhoods that feature no areas where children can go outside and play and where fresh fruits and vegetables are miles away? Built into the ACA are initiatives to transform communities into places that are conducive to safe and healthy lifestyles. This means building parks in communities, providing adequate lighting at night and bringing in more grocery stores and farmer’s markets among other things. The health of the  individual is inextricably linked to his or her place of upbringing so it makes perfect sense to start making changes to American communities.

Another goal of the ACA is to have more minority and female physicians, nurses, counselors, etc. Having a doctor or a nurse that looks like you fosters better health care and outcomes and allows for a beneficial patient-doctor relationship. More minority doctors will also eliminate many of the biases and stereotypes that patients and physicians hold against each other as well as historical distrusts that certain minority communities—like the first indigenous and blacks—hold against medical doctors and researchers. Research shows that minority and female doctors tend to carry out less unintentional and subconscious racial or ethnic discrimination when diagnosing illness or prescribing medicine in the examination room. It will take a highly diverse health care workforce to address the health needs and concerns of an increasingly diverse nation.

While America’s historical fear of paternalism and big government naturally did apply to the adoption of universal health care we must always remember the stand behind Rawls’ veil of ignorance when adopting policies that will benefit all instead of some. And we should always fight for policies in this nation that can help redress pass injustices whenever they arise. And while genetic predispositions may explain some of the phenomena I discuss in this piece, there is a fallacy and danger in always adopting this view and ignoring the social and structural determinants of health.

When I reminisce about my aunt’s premature quietus and especially my grandfather’s debilitating sickness I simultaneously think about the environments they grew up in. My grandfather owned several businesses in the south from the 50s to the 70s–a time when it was even harder than it is today to be a black businessman. I’ve been to doctors appointments with my grandfather where I witnessed very little communication come from my grandfather or the physician; the entire session was void of any real understanding of each other. How can someone improve their health if they and their doctor rarely speak (if they even have one). Sometimes I cannot help but think that I lost my aunt and the man that my grandfather used to be to the eternal and unyielding stress of being a minority in this country. This stress overtime degenerates the body and brings on a sense of hopelessness. As I finish college and begin my working life during the inception of universal health care in the U.S. I will be happy to be living in an era where such a sweeping policy will be making this nation a better one for racial and ethnic minorities to live in.

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