Equity

Health care for Americans is a privilege, not a right.

What is equity? Equity is the experience of justice: of treatment or behavior that is fair to all concerned, without bias or discrimination towards any. Health equity is likewise the experience of justice, in this case regarding access to clinical care and the achievement of medical outcomes.

Heath equity doesn’t guarantee “good” outcomes. Outcomes are only as good as medicine can make them under circumstances that medicine doesn’t necessarily control. After all, most illness is caused and complicated by genes, behavior, culture, environment and chance. Heath equity doesn’t excoriate those causes and complications. I think it’s vital to acknowledge that justice per se doesn’t make anybody well. It just levels the playing field. Outcomes depend more on the hands that individuals are dealt in life and how their cards are played.

Because of extreme economic and racial disparities, there is less health equity in the United States than in any other industrialized nation, or even in many developing nations. Health care for Americans is a privilege, not a right. The privilege entitles individuals to varying standards and quality of care based not on medical science but on social determinants like their ability to pay for diagnosis and treatment, the communities where they live, the benefits offered by their employers, the constraints imposed by their health insurers, their level of education and their race. Health care for Americans is a privilege, not a right. We get only what we pay for, not necessarily what we want or need; and not necessarily what cures or heals.

Take for example Thomas McKeller, a young African American elevator operator in Boston just after the Spanish Flu pandemic slaughtered 675,000 of his fellow Americans. By virtue of his race, socioeconomic status and lack of health insurance, he had access to inferior, substandard health care even though he was within walking distance of one of the best hospitals in the world (Massachusetts General). Contrast McKeller with John Singer Sargent, the eminent society painter whose portrait of McKeller is “humagined” at the bottom of this page. Sargent had access to state-of-the-art care in Boston or anywhere in country he needed it. Both men were Homo sapiens: specimens of the same species and endowed with the same biochemistry and physiology. Yet one was far more likely to contract, suffer and die from illness. Not because of medicine, but because of injustice. Their society lacked health equity.

Health inequities common in the early 1900s are still common a century later. This was brought into startling contrast by Covid-19, which has infected and killed our McKellers far more than our Sargents. The same was true of other maladies before the current pandemic and will likely still be true a hundred years hence. Why? The reason is mostly the disparities previously mentioned. Health care for Americans is a privilege, not a right. Health care in the United States is an industry that for sure exists to create equity, just not health equity. It exists to create the equity known as shareholder value.

That kind of equity is the experience of wealth, not justice. That kind of equity is what Donald J. Trump had in mind when he said that the murdered George Floyd was having a great day. The unemployment rate had dropped slightly and more importantly the stock market indices had inched upward. Trump’s wealth had increased, therefore Floyd can be happy in heaven. He did not die in vain.

It is easy to recoil from the obscenities of Trump in disgust, but hold on. Isn’t his exuberance what most of us feel and even say when it comes to health care? Americans have some of the worst health care and health insurance among all advanced economies, but our providers and insurers are among our most valuable corporations. The industry that produces inequitable outcomes is also fabulously wealthy. Coincidental? I don’t think so.

American health care thrives on inequity. Its business models, from hospital corporations to big pharma, earn revenue and profit from sickness and death. That being so, we must not expect “big structural change” any time soon. Health equity is a good idea, for others, but it will not make America great again.

What will? In my opinion, not the profiteers and their minions. Health equity may increase as people become smarter about their bodies, have more health literacy and health acumen, gain more control of their spend and outcomes. In other words, things may improve when folks can take better care of themselves and rely less on the medical-industrial complex.

That is the foundation of Humaginarium’s business model. Health equity is baked into our technology and philosophy. Our customers — our McKellers and Sargents — will benefit the same from what we do and no industry mugwump is ever going to change that.

Scientific entertainment. Nude Study of Thomas E. McKeller (1917-1920), by
John Singer Sargent. McKeller, a rare African American subject of society portrait painting, is pictured here with neurons that are exactly the same for all races.

Solace of Art

People do what is good only when they want to.

Last week, when I found myself in times of trouble, Mother Mary didn’t come to me. She was in a different neighborhood of Minneapolis with other matters to attend.

The trouble I found that day was not racist murder in the street, but mass murder in the air. Not perpetrated by four deranged police officers, but thousands of passive-aggressive shoppers and sales associates at The Home Depot. Most of whom were utterly indifferent to Covid-19. I watched as they crowded into and out of the big box emporium, with checklists and parcels, without face coverings or hand sanitizers — NIH and CDC be damned! I watched and wondered: have I witnessed a more convincing demonstration of ingrained stupidity? Ever? I have not.

I sometimes refer to regular folks like those at The Home Depot as Joe and Ms. Sixpack — thus trying to dignify a condescending meme coined by a political moron more than ten years ago. I have claimed — without much evidence — that the Sixpack clan will overcome their acute health illiteracy and risky habits, their blimpy form factors and medication maladroitness, and they will take better care of themselves and their families, if only they are better informed about the science of the body and nudged to wellness. My self-appointed job is to inform and nudge; their job is to be happy and live in peace.

As a passionate health promoter, I have watched for months as governments and the fourth estate flooded the entire population with health information (scientific and otherwise), across all media, at all times of the day and night, from every conceivable point of view. A sentient adult cannot by now be ignorant of the incurable and unpreventable Covid-19, nor of the potentially mortal consequences of being infected or infecting others, nor of the ONLY ways to control it: social distancing and personal hygiene. According to my understanding of the Sixpacks, this worldwide tsunami of health promotion delivered more than enough information to warrant their high health literacy and acumen from coast to coast, at least when it comes to communicable disease.

To judge by my observations in Minneapolis, I was wrong. The Sixpacks were blithely committing mass murder in public and private spaces like The Home Depot in Minneapolis, where coronavirus can freely swirl into faces and smear onto the hands of every incautious person who happens to be present, and afterwards into and onto everybody else they meet. Given the quality of health promotion that preceded this dreadful historical moment, the pandemic should not be continuing now. Yet more than 100,000 deaths and more than a million infections later, with dire predictions of a nasty resurgence coming in the autumn, the evidence so far seems to show that health promotion doesn’t work and doesn’t matter in the United States.

I don’t accept that conclusion, but at the same time concur that it’s reasonable. After all, Humaginarium was founded on a premise that traditional health promotion — including health education — doesn’t work and has never worked well; that a different approach is needed to produce a different outcome. The rationale being that people will do what is good for them and others only when they want to. This new approach is conditioned by the solace of art.

Art is using the imagination to create and experience beautiful things. Art has existed as long as Homo sapiens; it is arguably what makes us human. Solace is the comfort we give or seek in grief, the alleviation of pain or fear or anger or anxiety. As a word for being cheered up and amused despite sorrow, solace has been around since the 12th century.

A few hundred years after solace entered the Middle English lexicon, a poet named John Donne wrote his Devotions Upon Emergent Occasions (1624). In these lines, he both defined and exemplified the solace of art: its power to heal and encourage, no matter what the circumstances are.

How does art do this? By writing a prescription? No. By telling the Sixpacks what to do? No. By making them oblivious or stupid? No. By improving their healthcare? No. Art works by facilitating understanding, choices and decisions to do what is right and good for ourselves and for others we rely on, and who rely on us.

I’m giving you a particular Devotion below without further explanation; you’re an adult, you’ll figure out what it means without my help, if you want to. But I’m giving it to you with an earnest request in these times of trouble: that you read it slowly and slowly think about its meaning. What it means not to me or to society or history or Ernest Hemingway, but to you individually and personally, right now.

Because believe it or not, you yourself are the most beautiful and wonderful thing in all of creation, and you deserve to be happy and healthy, and you have the right to demand it, and the power to achieve it. And now in memory of George Floyd and with love for every person who will someday come to Humaginarium with an illness that may never end, I declare and insist that no person is an island; and that even one person’s needless suffering or death diminishes us all.

For Whom the Bell Tolls, by John Donne
No man is an island,
Entire of itself.
Each is a piece of the continent,
A part of the main.
If a clod be washed away by the sea,
Europe is the less.
As well as if a promontory were.
As well as if a manor of thine own
Or of thine friend’s were.
Each man’s death diminishes me,
For I am involved in mankind.
Therefore, send not to know
For whom the bell tolls,
It tolls for thee.