Often in the United States of America, there is a rigid dichotomy between communities of color and the systems that serve them. Many diverse communities present to health systems that are staffed by few clinicians that look like them.
They live in communities with inadequate resources to ensure equitable care and can walk into vulnerable situations already at a disadvantage. This dichotomized phenomenon is seen in our judicial system, where moral depravity in the public discourse on race was on display recently. A defense attorney attempted to malign Ahmaud Arbery, a young Black man who was murdered for literally "running while Black," because of his supposedly "dirty toenails." Kyle Rittenhouse, a young White male who fatally shot demonstrators with an AR-15, was acquitted.
Rittenhouse hopes to one day be a nurse; his choice of a profession may be questioned by many, but it highlights the privilege he has as a young, cis-heterosexual, able-bodied, White male in America.
The notion of privilege was on my mind when I hosted the 3rd Annual Women's Heart and Vascular Symposium, an event I pioneered to centralize discussions about disparities in cardiovascular care. I opened the symposium with an Albert Einstein quote: "Those who have the privilege to know have the duty to act." This prompted a discussion on privilege, as defined by the Merriam-Webster dictionary as one's right, benefit, advantage, or opportunity, and how we must recognize it as a social determinant of health (SDoH).
SDoH are "the conditions in the environment where people are born, live, learn, work, play, worship, and age" that impact nearly 80% of our health. As it stands, poor SDoH disproportionately affect Black, Latinx, and low-income populations, leading them to carry much of the burden of chronic conditions — including cardiovascular disease, which remains the leading cause of death. Privilege as an SDoH is a meaningful concept because it can positively impact all other SDoH.
This led one of our esteemed faculty presenters to ask, "Why do disparities persist and how can we eliminate them?" His intent was not to be facetious, but to highlight that most individuals, healthcare systems, and training programs don't go past explaining the science behind bias and discrimination and its cost. A fatal flaw of this approach is to think we can reduce outcomes by just being aware that they exist. It would be like having a weight loss program that told participants to step on the scale and left it at that.
Despite countless scorecards and call to actions to strengthen and improve the delivery of care, many clinicians of color are not convinced that we will see any meaningful progress in the near term.
The same esteemed physician — internationally known, a guideline committee member for the American College of Cardiology and the American Heart Association, and an endowed chair at his academic university — told us that while heading back from the symposium, his Lyft driver, an elderly, White man, made it very apparent that he did not expect to see a Black man step out from the luxury hotel as his ride.
Although disheartened by this information, I am not shocked. How can I be? My career is not as seasoned, but I have encountered my fair share of discrimination, be it exploitive bigotry, implicit bias, or microaggressions. As a Black female in healthcare, I have been called the social worker, the nurse, the janitorial staff — all worthy professions, but I deserve to be referenced for what I worked hard to be, which is a medical doctor. I am not naive and understand the reason I am not recognized as such is because society's perception of what a medical physician should be is not me. If we as physicians within the healthcare system are being underestimated, disrespected, ignored, marginalized, and repeatedly traumatized, I can only imagine what our patients of color go through.
The reason blatant disparities continue to exist is because our systems are broken; however, it's important to acknowledge they were probably intentionally built this way. How can a system built to fail the most vulnerable ever truly be changed?
There is no easy solution, and it's easy to fall down a rabbit hole of despair, especially in light of events like the Rittenhouse and Arbery cases. With that being said, I do believe that there is light at the end of the tunnel. I have personally experienced heroes from all sex, gender, race, ethnicity, creeds, and backgrounds chipping away for the good of our nation.
This returns us to Einstein's concept of privilege that those with more privilege should help the less privileged. If members of the healthcare community who have the privilege to effect positive change work alongside the less privileged who have voiced these concerns, I am hopeful that slowly but surely, these gaps in care can and will be closed.
The opinions expressed in this blog are solely my own and do not necessarily reflect the views and opinions of my affiliations.
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Cite this: Rachel M. Bond. The Rittenhouse Case And Privilege in Healthcare - Medscape - Nov 30, 2021.