Since John’s passing, I’ve been thinking about a lot of stuff, including where his friends have spent their lives since separating after college. His friends have spanned the great diversity of career options; but a common thread remains social justice work.
Naturally, I’ve stepped back to evaluate how I am spending my life, and how I’m taking care of my own health. My finding, in a nutshell, is the ‘real-ness’ of ethnic disparity, how it impacts our lives whether we recognize it or not, and how much more work is needed to advancing its elimination.
The idea behind ethnic disparity is that ethnic minorities (not long to be the case in California and other states as ethnic communities make up more and more of the overall population) live with lower quality of life, are stricken with a heavier burden of disease, and receive lower quality care than the mainstream population. This unequal treatment further leads to lower levels of quality of life, heavier burden of disease and lower health outcomes, and higher rates of early deaths; clearly, an insidious cycle.
The passage of Health Care Reform, the heightened awareness of the Patient-Centered Medical Home model, passage of Mental Health Services Act in California, and tremendous investments in health information technology are together pushing the momentum of disparity elimination forward.
Yet, something seems to make all this activity fall flat. And I believe the culprits are the following:
1) Disparity elimination work remains largely confined within the medical model framework. Put simply, how we define what ethnic disparity is and what of it we understand is driven by how medical providers view barriers to accessing health care, specifically primary care. Only in some marginal quarters are issues of mental health and dental care even taken into account when defining this issue. People who talk about ethnic disparities are still primarily doctors, public health advocates, and community clinic advocates. The lingo is esoteric and I admit I have been guilty of engaging in it. For this reason, the greater public has not been made welcome and invited into the party, so to speak. And as a result, there is no broad awareness and deeper grass-root engagement.
2) Human service providers are invisible in the disparity debate. Because ethnic disparity remains understood as ethnic health disparity, the field of Social Work, which primarily provides social services and mental health counseling, not health, has been marginalized. This is not good for many reasons. First and foremost, the very populations that disparity elimination is supposed to help (i.e., the linguistically-isolated, low-income underserved ethnic minorities) enter the social safety net primarily through non-profit community-based social service agencies. The Emergency room is also an entry point into the safety net, but a vast majority of those families and individuals who seek help — who access the safety net — do so through the doors of a social service non-profit.
From these two culprits, two important points:
A). Until disparity elimination embraces social work and breaks through its medical model world, the real world, the families and individuals receiving sub-par care and the non-profits that serve them, will remain marginalized. Doctors, community clinics, and their public health advocates cannot do this work on their own. The issue turf needs to be shared with community workers. Not doing so would waste an opportunity to do more with others. Regular folk need to know how they can get involved.
B). From a practice perspective, bridging the gap between public awareness and the esoteric world where ethnic disparity is well understood is strategic, therapeutic, and foundational. Bridging the gap leads to community engagement; in my mind, community engagement — true involvement from members of the public — is the highest level of treatment compliance we can expect from clients and patients.
Community engagement leads to self-management, self-care, and it ensures prevention is taken seriously and that it takes root at the grass-roots. It empowers, for example, those with weight and diabetes problems to change the conditions in their lives that routinely lead them to gain weight, not lose it, to give in to sweets, not avoid it. Community engagement, in a word, is reductive, in “disparity speak”.
In order for the field of disparity elimination, or at least disparity reduction, to advance forward in any meaningful and sustainable way, it is not enough that we the advocates, providers, researchers devise clever ways to address it. The community needs to be right there with us. We cannot do this for them; we need to do this with them.
Finally, until we can mobilize the demand-side of the disparity equation, all the resources we pour in justifying our professional efforts and careers will only achieve so much. Eliminating ethnic disparity is important in community work because in the end it is about making sure that society’s resources are shared equally, and that the neediest among us get their share. This, too, is social justice work.
So times a-wastin; let’s break open the field to the masses!