Intersections — Structures, Power, and Access

My book cover.

Over the next weeks, I’m going to be sharing insights from my book, Health Care of a Thousand Slights, in this article series. Health Care of a Thousand Slights launched on 12/07/2020 on Amazon, here is the link to buy it! If you want to connect, you can reach me here via email (anjana.sreedhar@nyu.edu) or connect with me on Instagram or LinkedIn.

Since the election of Barack Obama in 2008, identity as a way to understand lived experience has become more prominent than ever. Perhaps it was because that was when I was old enough to follow a presidential election, but to hear about identity groups and their voting patterns was utterly fascinating.

To me, what was more fascinating was why these groups were choosing to vote the way that they do.

We’ve seen that analysis play out similarly in the 2020 election, especially when talking about the Latinx vote in Florida go to Trump. One of the explanations was that a majority of Latinx people in Florida are Cuban, and are therefore wary of anything perceived as socialism. Other political commentators argued that more Latinx men than women voted for Trump, perhaps pointing to a sense of machismo that resonates with that population.

In mainstream society, we use identity as a vehicle to talk about a lot of things — voting behavior, where people can afford to live, the kind of music people like to listen to, and others.

What we don’t talk enough about is how identity is closely linked to health — both health care access and outcomes.

And how identity is primarily impacted in two ways: policy and cultural narrative.

This has become especially relevant in the time of the COVID-19 pandemic. The pandemic did, if nothing else, reveal how the health care system was not designed for those it has historically left out. What this meant was low-income Black, Latinx, Indigenous, and Asian people were struggling with making ends meet while putting their lives on the line as essential workers without sufficient health insurance coverage. What this also meant was that those living in rural areas — far from the nearest hospital or emergency room — faced health care access challenges that were compounded by the pandemic.

One would ask: why are these communities so challenged in their health care access? It is not due to the individual choices that members of these communities are making, although cultural narratives may make us believe otherwise. How often have we seen stereotypes designed to inspire antipathy — Black people as lazy, Latinx people as job-stealers, Native Americans as chronically drunk, Asians as a foreign menace, poor people as unwilling to change with the times — make appearances in conversations about changing people’s lives?

It is due to the historical legacies of the past — revealing the structural nature of these types of challenges. When terms like “structural racism” are bandied around, know that it’s not just a buzzword — it’s an indication that racism is at the root of why so many of our social systems are lacking in the ways that they are.

For BIPOC — Black, Indigenous, and People of Color — we have seen lack of health care access and outcomes play out in serious ways from policy standpoints. Many generations after the end of slavery, Black Americans still have to deal with the “slave health deficit” — the intergenerational impacts of coming from a community that was routinely physically and mentally tortured, denied food, and brutally mistreated. Native Americans suffer from the intergenerational trauma of being from a community that was constantly shunted across the United States for the benefit of European settlers. Latinx people are the most likely to be working low-income, manual jobs — and the most likely to suffer from associated health consequences. Due to the model minority myth — the idea that Asians are the “perfect” minority group by education and income levels — Asians are often left out of important health disparity conversations and actions.

While there is no good terminology for it, the American societal relationship with wealth also indicates why our health care system does not adequately provide for the poor. With outdated notions of who is considered “poor” — mostly based on federal poverty guidelines — there are many who are caught between the government’s definition of poverty and the inability to afford basic necessities, including health insurance coverage and associated costs. Beyond policy, we have our own cultural narratives and stigmas associated with poverty. As Americans, we pride ourselves on “pulling ourselves up by our bootstraps,” which has unfortunately turned into reducing resources for the most economically vulnerable in this country.

Other -isms continue to be threaded throughout America’s health care, housing, food, and schooling systems. Women and other female-identifying people were not permitted to go to certain schools, work certain jobs, and open bank accounts without the permission of a male family member. This institutional lack of trust of women has manifested in the “trust gap” that women experience with their medical providers — not having their pain taken seriously and not being properly cared for, among other things. For LGBTQ-identifying people, fear of medical providers due to historical legacies of being labeled as mentally ill and being mistreated has made healthcare very difficult to approach. Concerns about things that many of us take for granted — being called the right name, not having rude assumptions made about our life styles — are legitimate challenges LGBTQ+ people face.

What sits at the nexus of policy and cultural narrative is not just people’s lived experiences. It demonstrates more concretely the intersections of structures, power, and access.

Different groups in the United States have been challenged with health care access for multiple reasons. In my next few articles, you’ll learn more about each community — some key insights, some things that didn’t make it into the book, and some other goodies — along the way.

Interested in learning more? Feel free to purchase my book, drop a review on Amazon or Goodreads, and follow along my social media journey on LinkedIn or Instagram.