This week I am teaching a course in health disparities where medical students pick a group of people who are afflicted with disproportionately poor health outcomes and tackle the reasons why that is and think about what can be done to get rid of the disparity. The course always leads to very interesting discussions because so much of the material is an epiphany to both the students and myself. For the students, they see that so many of the things they thought were "just the way it is" are actually the intentional products of a rigged social system. For instance - any student who has ever walked into a dialysis unit has observed the high proportion of black patients receiving treatment. It's just the way things are. They are taught that blacks have disproportionately bad outcomes from hypertension (like kidney failure and the need for dialysis) for a variety of reasons - genetic, secondary to access to health care issues like poverty, being uninsured, etc. What they find out when studying health disparities is that in other countries, blacks don't have a worse outcome in hypertension than whites. They only do worse in America.
What is it about being black in America that makes them do worse? Well, when you put it that way, you realize we know the answer. Slavery, Jim Crow, The War on Drugs, Red-Lining, Mass Incarceration - America never lets Black people forget that their race is a problem. Being Black in America means existing in a state of chronic stress. It is, in a thousand different ways, a killer. So is being female and constantly having your legitimacy challenged in the work place while also being constantly reminded that your beauty is your only measure of worth. So is being gay or trans or Hispanic or anything other than mainstream. Why do young black men die at 3.5 times the rate of white men who live in the same city? Because our society makes life a literal struggle for anyone who is not white, male, educated and well off.
The reality of this situation really struck home for me when the students and I were discussing the plight of the homeless population in America. I'd given them an article to read - Malcom Gladwell's Six Million Dollar Murray. In it, Gladwell talks about how there are really very few chronically homeless people in this country - but even though there aren't many of them, they cost the health care system an enormous amount of money. The Murray in question cost the State of Nevada six million dollars one year (fell over drunk, hit head, bled into his brain, causing a multi-month stay in the hospital, etc) in medical bills. The very same Murray actually does well when he works with a social worker and has help managing his money and finding an apartment - but those services are only provided temporarily and when they go away Murray goes off the rails and inevitably ends up in either jail or the hospital. It would cost Nevada a lot less than six million dollars to simply provide Murray with help and housing permanently. So why don't they?
We don't provide people who are struggling with life with the help they need because our society has a problem with people getting something for nothing. As in - why am I working three jobs when that guy is getting everything for free?
There is this very strong sense in America that we get what we deserve, and we get that through hard work. If you see things this way, it seems completely unfair that someone who has opted out of making an effort just gets things handed to them. It's politically very difficult to obtain funds from the taxpayers for programs that aid the homeless for this very reason. It seems like we are giving things to some people for free that others are struggling mightly to obtain for themselves.
I could go on about how difficult it is to be homeless, and talk about all the different reasons there are that some people have a much harder time finding and keeping gainful employment than others, and talk about how cheap it would be for everyone concerned to end homelessness as opposed to the crisis management approach we have now, but I don't think any of that changes anyone's mind. Because what, in the end, I am really asking people to have is compassion. I am asking everyone to believe that people are trying as hard as they can to cope with life, and some are better at it that others but that everyone deserves to have access to the things that dignify them as human beings, and a place to live is one of those things. And there is a real resistance in many people to deciding to adopt a position of compassion.
This resistance to an attitude of compassion has always been a mystery to me. In a nation where the predominant religion is Christianity, why isn't there more charity and understanding for the plight of our fellow man? Is it that hard to understand that people are differently abled and that some people need more help than others?
This is where I had my epiphany. The problem isn't that Americans are "I got mine so screw you" jerks. The problem is that most of us live in fear of being homeless ourselves. Not in an existential way that you could see a therapist about. In a real way. It is a real fear. It is reality.
When people tell me that it is unfair for them to work three jobs when some homeless guy gets stuff for free, I focus on the lack of compassion towards the homeless guy. But why don't I consider the question of why in the hell anyone needs to be working three jobs? Having to work three jobs is crazy. Having to work three jobs is a desperate attempt to stay afloat. Having to work three jobs is killing yourself in order to live. Working three jobs is what you do when you are frightened that you're about 2 steps to losing everything. No wonder there's such resentment towards having some of your tax dollars go to someone else. You're barely surviving yourself.
Because in America you need to pay. You need to pay for health care. You need to pay for child care. You need to pay to get help when you are aged. You need to pay for a bloated defense that's fighting multiple unwinnable wars. You need to pay for private school. Hell, you need to pay for public school. You can only take vacation if you can afford not to get paid for the time you spend away. You have to choose between your job and spending time with your new born baby. You need to pay for every single one of your basic needs. You're only as free as your wallet can afford for you to be. And there is a very sparsely woven safety net.
If our social safety net was better - if we didn't all feel as if we were just about to drown ourselves - would we be more open minded about offering help to those of us who need a little more help to live life? If we felt that our society supported us by helping with education, child care, time off, health care - if we felt that society helped us live in a dignified way, could we afford to be more compassionate?
"Give a man a fish, he eats for a day," I hear people say. "Teach a man to fish, he eats for a lifetime." True enough. But we're in a drought. The river is shallow and the fish are dying. We will all benefit if it rains.
