On Justice & Healthcare

At a bioethics conference two years ago, I heard the Surgeon General of the state of Florida say that one’s zip code was a more accurate determinant of one’s health than one’s DNA.  It took a while for that statement to sink in, but when it finally did, it was nothing short of shocking. Her comment significantly raised my awareness of some of the disparities in our healthcare system.

I was reminded of this experience when reading a recent editorial by Dr. Audiey C. Kao, editor-in-chief of the AMA Journal of Ethics, entitled, “Motivating Health Equity”. He addresses the issue of justice in healthcare by starting with an account of an interaction he had with a man sitting on a park bench with a sign asking for money.vvKao then cites a study of his city (Chicago) that compared two neighborhoods, one primarily black and the other primarily white, finding that they “had a life expectancy gap of 30 years.”  “This,” he concludes, “is a justice problem and cannot be fixed without tackling social, political, and economic root causes that advantage some of us and disadvantage some of us.”

As the 2020 election cycle is now in full swing and candidates are once again addressing the healthcare concerns of the electorate, there will undoubtedly be much talk about justice.  What does a more just healthcare system look like? Despite the promises of the candidates, it seems that the divisiveness of the current political climate does not give great hope that a solution for these concerns is easily within reach.

I think it would be a mistake, however, simply to give up on justice.  The divide between the “haves” and the “have nots” is too great to completely ignore it.  I appreciate Kao’s affirmation of the Journal’s commitment “to catalyzing greater appreciation for and understanding of health equity and to motivating ‘assurance of the conditions for optimal health of all people.”  

Kao gives us a good reminder to examine our first principles and to consider those who have been overlooked by our current system.

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