hi all,
as a us citizen myself, i am acutely aware of this country's history regarding race/ethnicity, gender and class (and religion, age, sexual orientation, health status etc etc). for all our all men (sic) are created equal and endowed with inalienable rights, the powers that be have found lots of ways to divide people and either exploit or neglect them.
it is clear that racial/ethnic minorities have had to struggle in distinct and difficult situations that persist to this day. but it is not true that "white people" in the us constitute a homogeneous population such that it makes sense to compare "whites" against other race/ethnicities as the sole benchmark of social justice. social class (linked with ethnicity/regional identity, gender and religion), in particular, drives a wedge between white folks. if i have my facts straight, in absolute numbers, white folks make up more then 50% of people living in poverty in the us and probably the bulk of the working class too. but our racialized approach turns these folks invisible- so pale as to be transparent. studies examining the distribution of ill health in the white community are almost non existent.
this in not to say that race/ethnicity (or gender etc) are unimportant. for example, the histories of the people are different because of race/ethnicity, and that historical experience affects how people see things. not only that, its true that people occupy different places in the world- and these places have different qualities that effect health. but the absense of money and political power limit the possibilities of all communities and peoples.
regarding health, class matters because it is tied to critical issues that effect health- such as access to resources, respsonsiveness of institutions, family and community burderns, resources to resist oppressioin or marginalization. these issues are much deeper then access to health care or its quality. as dennis notes, health is only partially a product of health care. it is much more a product of the circumstances in which a people live. this concept is exceptionally difficult to get across to folks in the us, where its the health care crisis (not the health crisis) or a problem of health care disparities rather then health inequities.
most folks in the us, i find, have a great deal of difficulty grasping the last few sentences in what i wrote above.
ken
-----Original Message-----
From: Social Determinants of Health on behalf of Dennis Raphael
Sent: Sun 2/18/2007 4:38 PM
To: [log in to unmask]
Subject: Re: [SDOH] The Trouble with Diversity : How We Learned to Love Identity and Ignore Inequality (Hardcover)
I wrote this in a paper that was published in Health Policy: :The state's
role in population health..."
The focus on racial and ethnic health differences represents a carryover
from the civil rights activities of the 1960s and intellectual and
political barriers to addressing issues of income and social class (V
Navarro, 1994). The effects of this is remove increasing income and wealth
gap among Americans and issues important to the majority of Americans such
as wages, employment security and working conditions, as public health
issues. The focus on health care represents a reasoned response to an
egregious situation whereby over 45 million citizens are not insured for
health care costs. But again, the effect of this focus is to divert
attention from a variety of health determinants whose quality is rooted in
the public policy process.
Terry Schleder <[log in to unmask]>@YORKU.CA> on 16/02/2007 05:48:46 PM
Please respond to Social Determinants of Health <[log in to unmask]>
Sent by: Social Determinants of Health <[log in to unmask]>
To: [log in to unmask]
cc:
Subject: Re: [SDOH] The Trouble with Diversity : How We Learned to Love
Identity and Ignore Inequality (Hardcover)
Dennis,
I appreciate your knowledge, wisdom and analyses and I want to understand
more about this critique. I live and work in public health the US, and have
never worked outside the country (sadly). I am part of local efforts in
NM, the poorest state in the US, to address racial health disparities or
inequalities in health access/outcomes because I see evidence that a focus
on income or class is insufficient in dealing with institutionalized racism
in our healthcare and other politically informed structures.
For example, even within our privately insured classes we see inequalities
by race in treatment, outcomes and access measures. So, one theory I
gather from this is that "equalizing" the health access systems by income
(private insurance as a proxy since poor folks do not have it here, and the
US doesn't measure "class") still produces racism in aggregated pop. health
outcomes.
Our focus on racial health disparities is therefore a strategy to increase
access to healthcare systems in a more equitable manner, but it is not the
end-goal of the movement for universal access, as I see it. Are you and
this author saying that we should not be concerned with persistent racial
inequalities because an economic levelling will normalize them? If so,
that sounds intriguing (coming from you) to me but also worrisome given our
country's history with the institutionalization of racism and with the high
present-day rates of poverty and disease within racial minority
communities.
Your thoughts are appreciated!
Thanks for all you do.
Terry
Terry Schleder, MPH
Community Health Consulting Services
402 Girard SE
ABQ, NM 87106
505.401.1328
"The opposite of war isn't peace; it's creation."
- Mark Cohen, Rent
On 2/16/07, Dennis Raphael <[log in to unmask]> wrote:I
finished this book and recommend it highly. His analysis of America's
obsession with race and neglect of inequality is consistent with my sense
that focus on racial and ethnic "disparities" in health serves to
depoliticize the issue of class inequalities and the skering of public
policy priorities towards the interests of the wealthy.
The problem by this dominant discourse is outlined as being not that there
are a lot of poor people but that the rate for non-whites is greater than
that for whites, not that poverty levels are strikingly high in the USA.
dr
-------------------
Problems/Questions? Send it to Listserv owner: [log in to unmask]
To unsubscribe, send the following message in the text section -- NOT the
subject header -- to [log in to unmask]
SIGNOFF SDOH
DO NOT SEND IT BY HITTING THE REPLY BUTTON. THIS SENDS THE MESSAGE TO THE
ENTIRE LISTSERV AND STILL DOES NOT REMOVE YOU.
To subscribe to the SDOH list, send the following message to
[log in to unmask] in the text section, NOT in the subject header.
SUBSCRIBE SDOH yourfirstname yourlastname
To post a message to all 1200+ subscribers, send it to [log in to unmask]
Include in the Subject, its content, and location and date, if relevant.
For a list of SDOH members, send a request to [log in to unmask]
To receive messages only once a day, send the following message to
[log in to unmask]
SET SDOH DIGEST
To view the SDOH archives, go to:
https://listserv.yorku.ca/archives/sdoh.html
--
------------------- Problems/Questions? Send it to Listserv owner:
[log in to unmask]
To unsubscribe, send the following message in the text section -- NOT the
subject header -- to [log in to unmask]
SIGNOFF SDOH
DO NOT SEND IT BY HITTING THE REPLY BUTTON. THIS SENDS THE MESSAGE TO THE
ENTIRE LISTSERV AND STILL DOES NOT REMOVE YOU.
To subscribe to the SDOH list, send the following message to
[log in to unmask] in the text section, NOT in the subject header.
SUBSCRIBE SDOH yourfirstname yourlastname
To post a message to all 1200+ subscribers, send it to [log in to unmask]
Include in the Subject, its content, and location and date, if relevant.
For a list of SDOH members, send a request to [log in to unmask]
To receive messages only once a day, send the following message to
[log in to unmask] SET SDOH DIGEST
To view the SDOH archives, go to:
https://listserv.yorku.ca/archives/sdoh.html
-------------------
Problems/Questions? Send it to Listserv owner: [log in to unmask]
To unsubscribe, send the following message in the text section -- NOT the subject header -- to [log in to unmask]
SIGNOFF SDOH
DO NOT SEND IT BY HITTING THE REPLY BUTTON. THIS SENDS THE MESSAGE TO THE ENTIRE LISTSERV AND STILL DOES NOT REMOVE YOU.
To subscribe to the SDOH list, send the following message to [log in to unmask] in the text section, NOT in the subject header.
SUBSCRIBE SDOH yourfirstname yourlastname
To post a message to all 1200+ subscribers, send it to [log in to unmask]
Include in the Subject, its content, and location and date, if relevant.
For a list of SDOH members, send a request to [log in to unmask]
To receive messages only once a day, send the following message to [log in to unmask]
SET SDOH DIGEST
To view the SDOH archives, go to: https://listserv.yorku.ca/archives/sdoh.html
-------------------
Problems/Questions? Send it to Listserv owner: [log in to unmask]
To unsubscribe, send the following message in the text section -- NOT the subject header -- to [log in to unmask]
SIGNOFF SDOH
DO NOT SEND IT BY HITTING THE REPLY BUTTON. THIS SENDS THE MESSAGE TO THE ENTIRE LISTSERV AND STILL DOES NOT REMOVE YOU.
To subscribe to the SDOH list, send the following message to [log in to unmask] in the text section, NOT in the subject header.
SUBSCRIBE SDOH yourfirstname yourlastname
To post a message to all 1200+ subscribers, send it to [log in to unmask]
Include in the Subject, its content, and location and date, if relevant.
For a list of SDOH members, send a request to [log in to unmask]
To receive messages only once a day, send the following message to [log in to unmask]
SET SDOH DIGEST
To view the SDOH archives, go to: https://listserv.yorku.ca/archives/sdoh.html
|
