Thursday, October 29, 2009

Everyone's at Fault-Everybody's at Risk

In the healthcare insurance and healthcare reform debate (I consider the financial side a part of overall reform, but it is not the complete picture of reform) there are obviously sides that have been taken.

On one side is the "'we need universal healthcare', 'we need a so-called 'public option'; 'healthcare is a right not a privilege', 'those bad health insurance companies are bringing us all down,'" contingency. You are familiar with this side or you subscribe (at least in part) to it so you understand it experientially. On the other side is the "'this costs too much,' 'I like my healthcare just the way it is,' 'we are turning to socialism,' 'I really don't know what is going on with health insurance reform, but if it is anti-Obama I support it'" crew.

The fact is, both of them are creating something that we have seen often in the political process, They are creating an ever-narrowing bottleneck to progress.

In 2006, Harvard Professor Robert Putnam, author of the best seller Bowling Alone and an expert on human/social capital wrote a widely debated paper on social captial, increasing global diversity, its challenges and opportunities. His statements, when taken out of context indicated that he was anti-diversity, when in fact his intention was just the opposite. Writer William Goldsmith of the Harvard Crimson shares an interview with Putnam:

In more ethnically diverse communities, respondents were more likely to “hunker down.” Those results held true even when Putnam controlled his study for a host of other factors that might affect trust levels—including gender, education, and income.

“We act like turtles,” Putnam said. In diverse communities, people are not only less trusting of neighbors from different backgrounds, but also of those from their own ethnic and racial groups.

Los Angeles, one of the most diverse cities in the world, has the lowest level of trust in the United States, Putnam said. He attributed this to a “socio-psychological system overload,” a type of shock resulting from an influx of heterogeneous newcomers into a generally homogeneous society.

But Putnam said people’s turtle-like behavior when first confronted with diversity fades over time.


What is my point? Like this article by Putnam, interpretation is creating the outcomes vs. facts driving the dialog doing so. People saw all of this change in their surroundings and they began to trust no one, then they began to look to those who were as scared or as vocal as they were or desired to be to connect with.

By nature of the topic and historical political factions, the dynamic is inherently emotional. Of course, the emphasis on philosophical differences that has been primarily perpetuated by extreme so-called conservative groups is a much more viable tool in emotional manipulation.

However, in the situation the U.S. is in where healthcare (and our overall economy and society) is concerned, the result of creating emotionally-based bottlenecks is that everyone loses.

Indeed, there are many things to consider including the idea of increased taxes, how to pay for this whole thing, the dynamics of reform beyond cost: namely cultural competence and quality and all that they entail including health disparities, patient-centeredness, and other essentials to real reform. There is also the cost of perpetuating a self-destructive paradigm for our society that is based in too large a part on financial gain.

So, short-term thinking and political jockeying is creating the appearance of something that is dichotomous because the paths to getting where we know we need to be have slight philosophical differences. And of course who will take the credit (negatively or positively, visibly or invisibly) plays a major role, too.

The fact is, we are all at-risk of severe consequences as a result of this political cacophony (sounds redundant, huh). Health (insurance reform) is not just about health insurance reform (see Parrots and Protectionism). Our response as members of a society that desire to see our country evolve is very much a determinant of eventual outcomes. In fact, while we don't have 100% of the say in how this whole thing goes, our attitudes are being probed for and our ignorance is being preyed upon (and it is not party-centric)

I am not talking about whether or not there is a public option. I am not talking about who pays (the bottom line is that regardless of the outcome, we all pay and the cost is not going to be considerably lower. I hope that at the least we can keep it from increasing beyond the cost of inflation) or how much. My concern is that we keep this mindset that someone is taking something away from "me".

NEWS FLASH: It has ALREADY been taken away! If we understand this, mentally lying down along political lines will be less restful. If you "sleep" on either line you will be at fault.

Make it a great day!

Sunday, October 25, 2009

Go Beyond the Surface

It has been a minute since I had an entry. It has not been a break from the conversation, just one from my writing about the cultural competence and quality on our blogs.

This one will be short. It often occurs to me that we often think about health disparities purely from a deficit model. We approach the prevalence of adverse health outcomes with the notion that our opportunity lies solely in fixing what's wrong.

It is natural to try to repair the wrongs, especially when they are driving our intention. The issue with this is that it is a purely past-based approach that inherently leaves us with limits. We are limited in the sense that we begin to look for the root of problem and then spend countless hours and endless conversations about changing the root.

The problem is that the root is resistant to change just like we are. In fact, if I were to stretch a little, I would say that where health disparities (aka quality disparities) are concerned, trying to get at the root causes and change them won't work. Of course, I don't think change works all that well either.

When we enter into the conversation about health disparities, it is important to do a strengths inventory as well as understand the dynamics of disparate outcomes on the negative side. In example, is the "Chicana effect" with birth outcomes. This term has been used to indicate that interesting fact that low birth weight birth outcomes are similar to that of whites and in some instances have been found to be lower regardless of social-economic status. It has led researchers to conclude that there are things socially and culturally within Latino/Chicano culture that are protective in nature.

If research and/or anecdote via our experience gives us insight into a positive health outcome in a particular community, it is vital that we look at the dynamics involved within that outcome. They may be sociocultural, they be structural, they can be a number of things. And it is possible that they can be leveraged in our cultural competence and quality efforts.

Make it a great day!