By Virginia Brennan, Ph.D., MA
As society used to be, or as I used to understand it, equity shone brightly, a star that society reached for. The great machines of universal progress as seen during and after the Enlightenment—medicine, law, education—were to build ships capable of sailing us across the heavens towards universal well-being, justice, and knowledge.The recent U.S. federal elections, and the complex societal and economic tensions that underlay them, call into question whether equity remains an ideal in the United States today. They call into question whether the ship of state is guided by self-interest—sometimes rhetorically identified with another American ideal (liberty, or freedom, in the narrowest sense)—rather than the polestar of equity and its bright companion, freedom in a deep and broad sense. This self-interest is interest in one’s own wealth, power, and well-being and those of relatives and friends.
An individual with this extremely narrow idea of freedom, of liberty, may well reject taxes that support programs enhancing the health, education, and legal protections of all. Similarly, this narrowed ideal of liberty might easily move individuals to insist on the freedom to own and use dangerous, military-grade weapons—regardless of the consequences for the common good. An individual’s response to the actions of the police in a community will hinge on how those actions affect him or her directly—and others in the same community—rather than on an over-riding, multi-layered, responsive, system of jurisprudence. And so society fractures again and again as self-interest divides individuals and groups from one another on a never-ending set of questions about how the collective is going to decide fundamental questions. The collective! With so much of society fractured by self-interest, one must ask whether there remains any collective worth the name—one capable of running a government, for example.
For many people in the United States, the ascendant narrow ideal of liberty frees one from concerns about identity-based injustice as well (injustices springing from racism, sexism, ageism; intolerance for various sexual orientations; unwillingness to recognize and redress limitations faced by people with disabilities; and more). In a society steered by self-interest and the narrow notion of liberty, people often deny that such injustices even exist.
Short-sightedness must be called out here, too: The physical and built environments resulting from population growth and unregulated industry threaten us now—ask the residents of Flint, Michigan about their water—and into the great future abyss that climate change is opening up all around us. A narrow ideal of liberty never the less promotes the freedom of corporate and other entities to build and profit*, disregarding any notion of collective well-being that hinges on a healthy environment.
When equity (rather than this narrow notion of liberty) inspired action, the (dis)advantages conferred by birth and circumstances came into full focus. Such inequity mattered morally, as well as from the point of view of the general well-being, the commonweal. The star of equity was the star by which one could confidently steer towards a more perfect society.
Judging by political and artistic discourses of long periods during the 19th and 20th centuries, sharp inequities in material and social circumstances imposed the responsibility of redressing them on societies and institutions. African slavery in the United States and the infection of racism it spawned remain the paradigmatic case of inequity here. That cauldron of cruelty and injustice evoked resistance intuitively, philosophically, and politically. The resistance came about in two ways.First, human empathy and the perception of inalienable human rights both cried out against social and economic systems in which some people died helpless and unhelped, systematically deprived of the tools of education, legal protection, and stability that might allow them to improve upon what birth had provided. Of special concern for our readers, health inequities arose (and continue to arise) in large measure from social determinants of well-being, which became the very targets of equity-based programs for change.
Secondly, for a long time in the 20th century the notion of the common good was current, resulting in laws, schools, and health care for the many—the goal was to build a society of healthy, educated people, protected by law. This was understood to be good for all of society: We would all better off if the children in our communities were healthy and educated, even if some of us had no children of our own. It was in everyone’s interests to help ensure this—and so taxes paid to that end were understood to be for the common good, nothing like charitable contributions.
Last month, during Black History Month, of all times, we at JHCPU raised our sights to the ideal of equity and commit ourselves to reaching for that star. We stand against narrow self-interest in favor of a society in which everyone has equal rights, equal pay for equal work, equal and sound health care, first-class education, and justice under the law, as well as the freedom to build the life one wants for oneself and for society as a whole. If this means that in the current era we must tirelessly engage in organized resistance, so be it. We are reaching for the stars.
This essay was previously published as the introduction to Volume 28, Issue 1 of the Journal of Health Care for the Poor and Underserved. Journal editor Virginia Brennan is an Associate Professor at Meharry Medical College.