Health Equity: Bubbles of Healthcare Privilege
First installment of a series on health equity
By Natasha VanWright, RN, MBA, MS, MA, CCM
Before the COVID pandemic struck in 2020, plenty of us had taken much of daily life for granted. Our commute to work? That was just a built-in necessity of our job. Overnight deliveries? We could always magically get those at a click of a button.
And our baseline health? Well, yeah, we had that managed — or ignored.
But today, we can’t ‘unsee’ what we now conclusively know. Connection to convenience — that ease of ‘set it and forget it’ — has never been true for all of America.
“Essential workers” always brought us those overnight packages. Transportation costs always made some commutes (and, consequently, some job opportunities) more possible for some demographics than for others.
And with about 26 million Americans still uninsured, deadly equity gaps persist across our healthcare system — even when we’re not individually aware of them.
Easy Mode
When I was growing up, I was fortunate to be on the positive side of that healthcare divide. My dad was a lithographer and my mom was a teacher — two professions at little risk of making us millionaires, although each did provide stable, reliable health insurance.
In my formative years, I didn’t have to think much about health. If I felt a bit sick, my parents would check in with Dr. Ulatowski, the same pediatrician who, for many years, cared not only for me but for all of my siblings. For my family, there was never a challenge getting an appointment, or getting to an appointment.
My mom, an impressive health advocate herself, was more than comfortable asking questions of the medical professionals in our lives. Follow-ups, medications, and general health education were really no big deal for us, even as I grew up managing pediatric asthma.
I still remember Dr. Ulatowski using Sesame Street puppets to help me understand how to care for myself. I remember Dr. Ulatowski comforting my mom, offering an action plan, and reassuring her that she could call whenever she needed. Ultimately, my asthma was managed so well I never needed an emergency room visit or hospitalization.
That welcoming, stress-free experience with healthcare allowed me time and energy to simply be a kid — one just like the other kids in my social circle. In fact, we all enjoyed our own little bubble in which we never had to think about health disparities, at all.
So imagine my surprise when I reached adulthood and met people who hadn’t experienced a smooth glidepath through the healthcare system. People like my best friend, Doug*.
Hard Mode
Doug is the third child of an unemployed immigrant single parent. In many ways, his upbringing was starkly different from my own — and often that difference was due to chance and circumstance.
Where my mom had always been able to engage directly with my doctor, ask well-researched questions, and ensure she was fully understood, Doug’s mom had low health literacy and few avenues through which to improve it. She wrestled with cognitive impairment — a feature that often left her dismissed or diminished by those who lacked patience or empathy.
While I enjoyed childhood in a dual-income household, with parents who provided a foundation of both financial and emotional support, Doug, his siblings, and his mother relied on meager government assistance not only for their income but for food, housing, and healthcare.
Doug’s family members, like so many Americans even today, were extended the minimum and expected to make the most of it — all while I never had to think about such challenges at all.