On the Eve of the SCOTUS Ruling: Panel on Social Determinants of Health Disparities; Moving the Nation to Care About Social Justice

By: Megan Antonetti-Elford

At the edge of the cliff of good health...
(slide taken from the presentation of Dr. Camara Jones)

I tweeted for everyone to tune in to webcast a few weeks ago to hear discussion about topics that I think are mostly missing from the health care debate. We often hear complaints about constitutionality and the economic pitfalls of controlled markets, but these discussions miss the point with regard to the state of health care in this country. On the eve of the SCOTUS ruling on the Affordable Care Act, we should refocus on the goal of achieving health care equity in America and the impact of social determinants like racism that are at the root of this issue. We have analyze why health disparities arise in the first place.


An archived webcast of the University of North Carolina Minority Health Project's presentation can be viewed here: http://www.minority.unc.edu/institute/2012/. Some points stood out for me particularly and I hope they inspire others to watch the webcast in full and, of course, to tune into the discussion next year, after we have seen the outcomes of the upcoming health care ruling play out.


Dr. Camara Jones, MD, MPH, PhD, Medical Officer for the CDC, opened the program with a electrifying talk setting up a framework for talking about social determinants of health disparities.  She spoke about three levels at which we can approach the problem of health care equity as the "cliff" pictured above -a great metaphor for addressing how health care resources are spent and also how health disparities arise. Dr. Jones argues that disparities arise in quality of care, access to care, and differences in opportunity, exposure, and stress in daily life.  To keep people away from the cliff (getting sick and needing health care), the third level, the differences in opportunity and exposure, must be addressed.


Racism can be difficult to talk about in this context but Dr. Jones pinpointed it quite well, defining it as "a system of structuring opportunity and assigning value based on the social interpretation of how we look." Like all of the other power structures at play, from sexism to capitalism, racism  "unfairly disadvantages some individuals and communities" while providing a reciprocal unfair advantage for others outside those populations.  This may contribute to the fact that knowledge of a persons perceived race and zip code can accurately predict his overall health or BMI. Identifying and correcting the mechanisms of institutionalized racism in decision making in this country may be the most important way to achieve health equity.


What is health equity? According to Dr. Jones, it is "the assurance of the conditions for optimal health for all people." It is a process guided by reason and social morality requiring these three tactics:

• Valuing all individuals and populations equally
• Recognizing and rectifying historical injustices
• Providing resources according to need

How did the U.S. get so behind in looking after the health of its citizens? We have to look at how the system of racism, in its history, in its manifestation outlined by Dr. Jones, and in its limiting of access to health care colors the opposition to the health care law. Racism is a component in this debate we can't be afraid to talk about, especially because it is institutionalized at levels beyond the availability of health care, to public education, protection of reproductive rights and access to accurate sex education, and even the prison system. We have to look at the motivations and actions of the unfairly advantaged because they hurt us all.


*hyperlinked text links to relevant films, viewable online for free