It’s maddening to see the differences in health outcomes between the rich and the poor. Even more unsettling is reflecting upon the psychological pain accumulated when living in a fad-obsessed materialistic comparison-creating society, the postponed dreams, and the day to day compromise that those with less have to endure – thoughts that may be far removed from the ruminations of the those who have abundance. I don’t mean to stereotype, and this is not intended to be a polemic, but the country is divided, and many are living in two different worlds. The resultant health consequences should be contemplated upon, especially in the midst of a pandemic where the differences have the opportunity to be most blatantly highlighted. Health equity research is certainly a burgeoning field of research, and the views of stalworth public figures who prioritize tackling vast wealth inequality have thankfully increasingly made their way into the public conversation, but more needs to be done to not only understand inequality driven health differences but to neutralize them. I don’t go so far as to assert half-baked uninformed positions about the soundness and ‘just-ness’ of a system allowing for the accumulation for vast sums of wealth – that is beyond my grasp – but what I can sufficiently say with enough personal evidence is that large income inequality rears its ugly head not only in the public sphere but also in the privacy of the deified doctor-patient relationship, in the embarrassed faces of kind, hardworking, struggling people when they need a doctor’s note to restart their electricity with the explanation to their energy provider that having their lights turned on would allow them to read their prescriptions, and in important talks about blood pressure management lifestyle strategies that have to be truncated swiftly by equally important emotional talks of familial financial related strife related to unemployment, feelings of inadequacy, domestic violence, and fear. These needs are all equally important to the clinician as we try to practice holistic care, but it is obvious that in times of crisis such as the one we are in now, differences between patients that should not matter, unfortunately, begin to matter more and more. Testing for COVID-19, which first began in the U.S. at a glacial pace at best, was somehow initially more available to the likes of movie stars, famous athletes, and the elite. Articles talking about “white-collar quarantine” appropriately highlight the class-divide we face, and articles describing the lavish furnishings of “billionaire doomsday bunkers” appropriately nauseate us. Suffice it to say that the public hears enough about trickle-down economics; we don’t want trickle-down health care. I’m confident that with preparation, appropriate intelligent government action, and with enough focus, this virus can be tackled – hopefully not at the cost of an exponential number of more lives. But when in the distant future, we eventually venture out of the trenches, we will be given another opportunity to extricate ourselves from the corrosive nature of income-related health inequality. We will remember and memorialize the countless precious lives lost around the globe, but I hope we also meditate on the times when our health care systems failed to help the elderly, the poor, and the disadvantaged manage their ‘pre-existing’ conditions that made them more vulnerable to this scourge in the first place. Life has enough optimization problems where scarce resources must be begrudgingly allocated to myriad uses; health care should not be as difficult of an optimization problem. Devoted health care workers such as doctors, pharmacists, nurses, and others want to make things better for the patients that we serve, but holistic, effective care cannot be provided appropriately without lifting the boats of patients who are most vulnerable. This can only be done by making health equity a critical priority in the coming years post the coronavirus and prior to the next potentially, even more pestilent, pandemic. Harsh Bhavsar is an internal medicine resident. Source
