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.
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*.
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.
Navigating the Maze
Doug’s mom was as dedicated to Doug and his siblings as my parents were to me and mine. But love and dedication can’t close a persistent equity gap.
Throughout Doug’s adolescence, during various visits with medical providers, his mom faced numerous challenges grasping key information. Since her own cultural background defaulted to believing authority figures are always right, she rarely asked questions of doctors, and, consequently, she received few answers.
Even as Doug’s family met with a carousel of medical professionals throughout his life, there were rarely meaningful discussions about adjustments to diet or awareness of social determinants of health. For Doug and his family, the healthcare system simply remained a confusing labyrinth of doublespeak, false starts, and long waits.
Just like me, Doug had pediatric asthma that required regular management — but he faced clinic staff that changed so frequently, he never, during his entire adolescence, developed a lasting relationship with any healthcare provider. In fact, the first time Doug’s family began managing his asthma was while in the emergency room.
Although Doug’s mom had left that unsettling ER visit with lots of questions for doctors, she found it challenging to get answers. Doug’s follow-up appointment was delayed due to clinic scheduling. Proper inhaler use was left unexplained. No experts told Doug and his mom about the importance of reducing environmental triggers for his asthma.
It should come as little surprise, then, that Doug, in his youth, returned to the emergency room, many times, for care. In fact, it took months before Doug and his family understood how to manage his condition well.
Just as I had been, Doug and his siblings and friends were raised in a bubble of their own, collectively unaware life could be much different. In my bubble, healthcare was a non-concern. In theirs, it was a chore, a challenge — and, as far as any of them knew, it was likely to stay that way.
A Better Future
Today, even as a successful and financially comfortable adult, my friend Doug retains the anxiety one can expect from lifelong skepticism of the healthcare system. He has normalized poor self-care. He has poor circulation in both legs, and cramps that wake him from sleep. Nevertheless, he dismisses talk of going to the doctor by citing that his mom had similar issues — or by reminding me he doesn’t like to get “the run-around.”
I’ve dedicated my professional life to minimizing or eliminating that “run-around” — because I know people like Doug deserve, in childhood and in adulthood, a safe and informed health bubble like mine.
Ultimately, it’s Doug, and millions of others like him, who keeps me in the fight for an equitable healthcare system — one that will recognize the value of forming lasting relationships with patients as people.
One in which full access to health will no longer be a function of language or luck or circumstance but will simply be a baseline expectation shared by all human beings.
In this blog series for Belong Health, I’d like to explore exactly why such a system is not an unreasonable expectation.
I’d like to show you exactly why care management and health equity must be non-negotiable facets of the future of American life, if we ever expect it to reach its collective potential.
In short, I’d like to help burst the bubbles that have separated us from each other — and from our better selves — for far too long.