The Fight Against Systemic Inequalities

As part of the Psychology Essay Contest, hosted by RVU’s Mental Health and Wellness Counselors, students were given several questions to answer in an essay format. One of the winning essays, written by second-year osteopathic medical student Dellvin Nguonly, addresses issues of diversity, inclusion, equality, and anti-racism.

As future physicians, it is our duty to not only treat illness but also to change the environment in which this illness presents. Access to healthcare is a universal human right. Currently, underrepresented communities face inadequate access to resources for their own health management. As a medical student, I believe change in the medical education system, legislation, and the scope through which patients are treated, are all actions that can be implemented now as a means to address these inequities. Although I came to Colorado to learn how to be a physician, I’ve come to learn even more about myself and the role I want to play in society.

When I moved to start my new life as a medical student, I left the infamous “Los Angeles smog” for the first time. I was in my own bubble, passive to the ugliness that society carries. It wasn’t until I moved to Colorado that the smog of LA cleared, and so too did the facade that it upheld of society.

In Los Angeles, I really never felt out of place because of the abundance of diversity. However, in Colorado, I am truly a minority and oftentimes I do feel out of place. Here, I am vulnerable and overtime the cuts of microaggressions became gashes. Now, I put on my own façade and make sure that I look and act like I belong with the hopes that this cognitive dissonance will one day disappear. It shouldn’t be this hard to simply exist and be treated as an equal in this space, because diversity should be celebrated not scrutinized. Through my time here, I’ve seen how the experience of underrepresented populations can drastically differ despite simultaneously occupying this same space. Furthermore, my experience continues to show me how disparities like this are deeply ingrained, not only in the foundation of our society but also at all levels of legislation and the healthcare system.

In medical school, there is so much information to learn that I often find myself too preoccupied learning about the complexities of the human body and I miss the bigger picture. Studies show there is a disproportionately high rate of incidence of preventable diseases, such as hypertension, in minority communities which is appropriately conveyed in our educational training. Despite what we learn, the contributions to this phenomenon, including the disproportionate environmental injustice zoning of poorer areas, is unfortunately not taught and often overlooked. It has been shown that people with lower income, and less access to quality care or proper nutrition, tend to experience poorer health outcomes. As underrepresented and underserved groups epitomize this demographic, it is understandable that poorer overall health outcomes in conjunction with a shorter life expectancy is often seen. It is clear that socioeconomic factors play a significant role in health care and need to be integrated into the existing curriculum.

These socioeconomic factors, however, are not formed in a vacuum; they are directly a result of legislation. With major health insurance conglomerates influencing public policy, healthcare measures such as the Mental Health Parity and Addiction Equity Act may cover certain medications under insurance, but neglect other important aspects such as therapy. Clearly, policies are often ratified with the corporation in mind, not the patient. Although I am a minority, I will also one day be a physician; more specifically, a physician with the inherent privileges that come along with the title. It’s unfortunate, but socioeconomic inequities will persist for the foreseeable future, especially with the scarcity of these populations in positions of power. We as future physicians, need to use the privileges we are given to advocate for and represent those who don’t have the same opportunities within these institutions.

The idea of representation provides a sort of safety for the communities they embody. With diversification in legislation and medicine, there will always be someone advocating for those who are often overlooked and forgotten. Within the legislation, this entails combating the disproportionate incarceration of people of color or low socioeconomic status and subsequent destabilization of the home. Within the scope of medicine, this means that a patient of color is seen by a provider of the same community with the inherent social connections and understandings that would otherwise not exist. Although different approaches, both lead to better health outcomes, the ultimate goal we all hope to achieve.

However, for formative change to occur, it is important for everyone to fight systemic inequalities. One issue that hinders change is that the current systems and institutions in place are working for those who it doesn’t exclude. This warrants the question: how we can get people who are benefitting from the system in place to care about the issues of racial and socioeconomic inequalities in society and medicine? Much like the saying “if it’s not broken, don’t fix it”, these issues have been so deeply ingrained in our society that no one sees them as a problem anymore, and won’t care to fix them. As such, pushing for visibility of these inequalities in all institutions is a good first step towards change.

Although activism and pushing for legislation reform is no easy task, there is something that we can do regularly as a way to combat this. Within the scope of modern medicine, “treatment” can often be seen through the lens of a symptoms reduction model where we simply treat physiological symptoms of illness as they acutely arise. As humans, we are a product of our environment and so too is our overall health and wellbeing. Because experiencing systemic inequalities as a normalized day of life is trauma, I believe addressing these issues is equally as important as the symptoms that they manifest. Through a functional improvement model, we learn about the patient’s struggle with access to quality nutrition due to food deserts and poor urban planning. By providing an outlet for issues like this and validating their battles, we can better understand their experience as a means to better address all the issues they face.

Dana Torpey-Newman, PhD, says, “patients look their worst in poor fitting environments.” My experiences have given me some perspective on life. Like many other people of color, I’ve come to live through the context of a minority living amongst the majority, even if my experience is only a fraction of their truths. Ultimately, I am thankful because I now better understand why our environment must change and the part I play.