Many economists and researchers have written about the growing inequality in the US. Tyler Cowen's latest book: Average Is Over like many others supports the theme of widening gap between rich and poor. How does inequality manifest in medicine or health care? Most physicians cite lack of access! Health services researchers tend to focus on behaviors (e.g. adherence) and health systems factors such as quality indicators and cultural competency. More and more, our society (“regular folks,” politicians, even public health advocates and health care providers recognize the importance of providing equal opportunities for all Americans, support growth of the middle class and on issues such has housing, jobs, education (social determinants of health) BUT increasingly accept that we
as a country thrive on a compassionate survival of the fittest mentality.
Let me give you an example, abeit a more extreme one. I just came off a 2-week inpatient service and my team worked with a patient who has a substance use as well as a chronic pain problem. He has to remain in the hospital for 6 weeks of IV antibiotics because home health would not accept him due to past behavioral issues. All hospital staff and consultants have advised against giving him opioids because of repeated positive urine drug screen for cocaine and as a high risk candidate. In my opinion, he
has pain due to current vertebral osteomyelitis and multiple back
surgeries. He does not see himself as an addict (self-denial possible) but use crack/cocaine to alleviate the pain. I have treated, crossed
paths with several patients struggling with addiction and certainly some have benefited from second chances—government initiatives, private and faith-based programs BUT more and more, our society has made it tougher for people to have additional second chances. When someone does not make it in life, it is attributed to their moral and behavioral failings and not social and environmental factors modifiable through policy and
structural changes. Sometimes, it does not even require such momentous efforts, just a few individuals getting together agreeing on doing the right thing.
"I wish to do something Great and Wonderful, but I must start by doing the little things like they were Great and Wonderful"