Dividing the Indivisible

By Dhruv Khullar, First Year Student at Yale School of Medicine

Every day in elementary schools across the country, thousands of students begin the day by reciting the Pledge of Allegiance. They declare their loyalty to the flag and describe America as “one nation under God, indivisible, with liberty and justice for all.” These are, no doubt, lofty and worthwhile ideals for any nation. But what happens when you divide the “indivisible?” What patterns emerge when you dissect and categorize “one nation” into smaller nations based on race and income and region? Do we really find “liberty and justice for all?” According to a recent study at the Harvard School of Public Health, the answer is a resounding no.

The study found that disparities in life expectancies between various subpopulations in the United States are “enormous by all international standards” and show no signs of improving [1]. On average, Asian-American females living in Bergen County, New Jersey live a remarkable 33 years longer than Native American males in south-central South Dakota. A Caucasian baby boy born in the rural Appalachia can expect to live almost 10 years longer than an African-American newborn in downtown Chicago. Black teenagers in high-risk urban areas are almost four times as likely to die before the age of 60 compared to Asian youth.

While health care disparities exist in every country, the magnitude and persistence of those found in the United States is striking and profoundly disturbing. The United States – the wealthiest country on the face of the planet – is also the only industrialized nation not to provide universal health care for its citizens. Despite spending more on health care than any other country, the United States ranks 26th in infant mortality rates, 24th in disability-adjusted life expectancy, and dead last in terms of fairness in the health care system among OECD countries [2].

Study after study has shown Americans that are uninsured or underinsured receive poorer quality of care and suffer worse health outcomes than those that are insured. Far too many minority and impoverished Americans receive too little preventative care, have no routine check-ups, and interact with the medical system only in emergency situations – often when it is too late to effectively treat illnesses that may have been amenable to simple medical intervention at an earlier stage. Even when minorities do receive care, there is no guarantee that they will receive fair or desirable treatment. For example, as compared to white diabetic patients, African Americans are far more likely to have a leg or foot amputated and far less likely to receive alternative, potentially limb-saving surgeries before amputation [3]. Although the United States is a leader in developing novel medical techniques and technologies, sadly these advances seldom translate into better care for large segments of the population most in need.

Since the days of the Pilgrims, American culture has boasted a unique brand of rugged individualism. Creativity, innovation, and hard work are inevitably rewarded with success, the well-off and well-educated reason. If you fail, it’s your fault. This is, after all, America: the land of opportunity. But the vast disparities in our health care system undermine that philosophy in a way that few other inequalities do. Lack of access to adequate medical services not only causes the physical and emotional suffering of millions of Americans, but also attacks the very ideals upon which this country was founded: self-determination, equality of opportunity, and the pursuit of a better life.

How can we legitimately expect a man to “pull himself up by his bootstraps” when the untreated pinched nerve in his back prevents him even from bending over to tie his shoes? How can a woman “grab the bull by the horns” when her congestive heart failure renders her too tired even to walk down the stairs? Any medical doctor can tell you that a staph infection eats away at the skin and internal organs, but we as a society must realize that it’s not too good for the entrepreneurial spirit either. For minorities in particular, too often the American dream consists of little more than recurrent nightmares about how to pay for this month’s prescriptions or last month’s hospital bill. It is difficult to be a productive and creative member of society when medical concerns overwhelm one’s ability to achieve his or her full potential.

The great Dr. Martin Luther King Jr. once said, “Of all the forms of inequality, injustice in health care is the most shocking and inhumane.” In the four decades since his death, America has made significant strides in a number of social arenas, from civil rights to gender-equality. But by failing to address the serious medical concerns of substantial portions of our population, we continue to inflict unfair harm to their health and well being, as well as to America’s worthy goal of “liberty and justice for all.”

Works Cited:

[1] Murray CJL, Kulkarni SC, Michaud C, Tomijima N, Bulzacchelli MT, et al. (2006) Eight Americas: Investigating Mortality Disparities across Races, Counties, and Race-Counties in the United States. PLoS Med 3(9): e260.

[2] http://dll.umaine.edu/ble/U.S.%20HCweb.pdf

[3] http://blogs.bet.com/news/newsyoushouldknow/health-news-blacks-bet-most-amputations-cola-may-be-bad-for-your-bones/