The word “equity” is trending right now, being used by many good people who want a kinder, gentler society. The AMA, AACN, and ANA all have equity statements. Here is an example from the National Academy of Medicine’s publication: The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity:
“Health inequities, including diminished life expectancy and poor health outcomes, vary based on race, ethnicity, culture, sexual orientation, gender identity, age, and socioeconomic status.”
Equity advocates proclaim that, because of systemic racism in America, some people hold all the power and are treated well--the rest are not. How many people fall into the privileged category if we factor in each of the above attributes? Do the math (well, I’ve done it for you, as follows): According to Census.gov, 61% of the U.S. population are neither children nor elderly. 50.8% of these are female, so around 30% are non-elderly adult males. 76% of the population are “white only,” so that brings the percent of non-elderly, adult, white-only males down to 23% of the population. Then if we subtract another category which gets virtue points, disabled people under age 65, which is 8.6% of the population, that brings us to 20.93% of the population being non-disabled, non-elderly, adult, white-only males--so they’re the privileged ones?
But equity advocates (for example, see Alspach, 2016) also specify that other attributes cause healthcare inequity. Those who are nonheterosexual (5.6% of the population), obese (36.5%, plus another 32.5% of American adults who are overweight), have mental illness (20.6%), have AIDS (0.03%), have a felony conviction (8%), live below poverty-level (10.5%) and/or have a substance use disorder (16.65%) are purported to suffer from concerns regarding sub-standard healthcare. These attribute categories overlap with each other, so the math is foggier when adding them in, but it’s readily apparent that, of the 20.93% of non-disabled, non-elderly, adult, white-only males, probably at least half of them would have at least one of the above attributes which are deemed to convey victimhood.
Where does this leave us? We’re now down to about 10% of the population who are the supposed oppressors of the other 90%; who, it’s said, hold all the power and get all the privileges. This is a fantasy, and a dangerous one. Vilifying any group of people based on their identity leads to nothing good (Rufo, 2021), but refuting it is easy. Physicians are to society as a sentinel species is to an ecosystem, and current data shows that though 76% of the U.S. is white, only 56% of physicians are white (AAMC, 2018). Should we increase the quota of white admissions to medical schools--excluding minorities? The AMA Equity Panel spotlighted in this Chamberlain University retweet wants to do just the opposite, slap racial quotas on medical school admissions, further decreasing the percentage of white doctors (or just white males? What if you’re biracial? What if you’re African American but your adopted parents are white, like my three kids? Can my kids get into medical school? It all falls apart under scrutiny).
But there's a deeper issue. The policy statements relating to healthcare inequity are problematic, and I believe can cause harm to society in several ways. Just at a time when we need more nurses--there are 100,000 vacant jobs (ANA, 2021), the social justice advocates are demanding that nurses take on a mission to tinker with the “social determinants of health and health equity”: “the conditions in which people are born, grow, learn, live, work, play, worship, and age – coupled with the distribution of money, power and resources” (World Health Organization, 2016; Healthy People 2020, 2016).” In other words, everything that makes up our lives should be scrutinized and controlled.
The report goes on to say that, “By 2023, state and federal government agencies, health care and public health organizations, payers, and foundations should initiate substantive actions to enable the nursing workforce to address social determinants of health and health equity more comprehensively, regardless of practice setting (NAM, 2021).
How could "equity" come about and what would be the pros and cons of proceeding with such a large project? Who is qualified to wield such absolute power (to enable the nursing workforce to address every aspect of life)? Those writing such grandiose statements want us to believe that nurses can be these superheroes, but it is hubris. For at least two hundred years now, social planners have gathered scientists, economists, medical professionals, business and finance professionals, etc. and come up with plan after plan to create utopias in various countries around the world. All have failed and the cost in human life and suffering has been vast.
Besides the plain fact that it's unethical for one person to take something from someone and give it to someone else, there are insurmountable practical problems. Economist F. A. Hayek states that “The knowledge of the circumstances of which we must make use never exists in concentrated or integrated form, but solely as the dispersed bits of incomplete and frequently contradictory knowledge which all the separate individuals possess.”
Even the best interdisciplinary collaboration cannot begin to untangle all of the factors needed to plan for the health and well-being of everyone. A community organizer may intervene/plan/organize/spend to fix a problem that is actually not a big concern for many of the residents in a community. The “local knowledge problem” of economics states that in a system of any magnitude there is an infinite complexity aspect which defies the ability of the best of planners. For example, as a community health nurse perhaps I become concerned about the lack of sidewalks in a community as a health risk, and convince the local planning board to spend money on installing them. That is good for some people. But before my intervention and activism, the money had been earmarked to build a new handicap-accessible pool, so that disabled people can take advantage of the health benefits of swimming. Now they’ll have to wait until the next fiscal year for a pool they can use, so it’s bad for them. And without either of these spending plans in place, the money could have been left in the hands of those who earned it to spend as they please, whether on new running shoes or a new wheelchair.
The Relation of Positive Rights to Bureaucracy
Living near Washington D.C. I have been aware of various groups collaborating to fix problems as complex as fiscal policy and climate change (my husband is a Ph.D. economist and worked on and off Capitol Hill for decades). The policy initiatives trending now related to equity are just as multifactorial, and just as likely to entail large power grabs on behalf of government agencies, with money and privileges funneled down to preferred groups.
The textbook Community/Public Health Nursing notes that “Human rights violations occur when governments fail to provide their people with the infrastructure, services, and information necessary to promote health, reduce risk, and control disease” (Nies & McEwen, 2019, p.174). Healthcare is being framed as a human right provided by governments. If we say that everyone has a "right" to something (positive rights) then we must create a vast bureaucracy to ensure that right.
But this is not the America that I know and love. The U.S. Constitution guarantees our right to non-interference from the government in the vital areas of freedom of conscience, of association, of speech, etc.--these are known as "negative rights." The Constitution does not guarantee that we will have enough food, housing, or healthcare, and that is simply because government does not produce anything. It can only give to one person what it has taken from another.
We all have a responsibility to care for our family members first, then to reach out to those in need around us in our communities, then finally, if we have the resources, to assist those in need in other communities. The U.S. is well-known as the most charitable country in the world (World Population Review, 2021). But if government gives agencies (including well-meaning ones like nurses associations) enough power to manipulate the “social determinants of health” (live, work, play, money, power, etc.) that is saying that nurses have the moral/intellectual authority to supersede the choices that individuals make with their own lives and their own money.
To summarize, here’s a quote from The Law, by Frédéric Bastiat, an economist who battled the rise of socialism in France in the 1840s.
God has given to men all that is necessary for them to accomplish their destinies. He has provided a social form as well as a human form. And these social organs of humans are so constituted that they will develop themselves harmoniously in the clean air of liberty. Away, then, with the quacks and organizers! Away with their rings, chains, hooks and pincers! Away with their artificial systems! Away with the whims of governmental administrators, their socialized projects, their centralization, their tariffs, their government schools, their state religions, their free credit, their bank monopolies, their regulations, their restrictions, their equalization by taxation, and their pious moralizations!
And, now that the legislators and do-gooders have so futilely inflicted so many systems upon society, may they finally end where they should have begun: May they reject all systems, and try liberty; for liberty is an acknowledgment of faith in God and His works.
The Wrap Up: Equity activists want us to believe that systemic racism is crippling America in every arena, from healthcare to education. Their solution is to cede ever more power to groups who want to substitute their judgement and choices for yours. #pushback #freedomisntfree https://stoplcpscrt.com/
References
https://www.nap.edu/resource/25982/Recommendations_Future%20of%20Nursing_final.pdf
https://www.census.gov/quickfacts/fact/table/US/PST045219
Alspach, J. (2018). Implicit bias in patient care: An endemic blight on quality care. Critical Care Nurse, 38(4), 12-16. doi: 10.4037/ccn2018698
https://imprimis.hillsdale.edu/critical-race-theory-fight/
https://www.nursingworld.org/practice-policy/workforce/
https://fee.org/articles/hayek-the-knowledge-problem/
https://worldpopulationreview.com/country-rankings/most-charitable-countries
Nies, M. A., & McEwen, M. (2019). Community/Public Health Nursing: Promoting the health of populations (7th ed. p. 174). Saunders/Elsevier.
https://fee.org/media/14951/thelaw.pdf p.79
