Social Inequality
Introduction
During the speaker session on Oct. 18, Health Inequities, Prof. Mendenhall from Sociology and African American Studies and Prof. Lleras from Human Development & Family Studies introduced how racial disparities had influenced people’s access to health resources. The first idea discussed is the notion of Racial Trauma and Intersecting Oppressions, or what it means when individuals are marginalized in societies. The New Nadir theory entails a theory for black racial formation, where historical patterns and current conditions together help to construct an undying and constantly changing racism that has the potential to persist in the future. Such discrimination, in turn, can have underlying meanings in society, like high levels of unemployment and underemployment. Prof. Mendenhall further introduced the concept of Colorblind ideology, in which people can be inclined to reject programs to improve opportunities and life chances. This situation is also worsened with the declining budgets and numbers of health infrastructures. She also discussed the iceberg-shaped social determinants of health resources. Basically, health resource is located at the bottom of the iceberg, and the way we build our society——including education, neighborhood & built environment, social & community context, discrimination, and economic insecurity—— all have impacts over the accessibility of health resources.
All the aforementioned points regarding racial disparity in accessing health resources is not exclusively applied to the pandemic period. So Prof. Lleras also discussed the impact of health inequities specifically in the time of Covid-19. It has already been introduced in the previous speaker session that from an anthropological standpoint all humanities, regardless of race, have the same risk for covid-19. So Prof. Lleras sought to use other factors to explain the pandemic’s disproportionate strong influence among racial minorities. She pointed to four primary points. 1) Social distancing is a privilege. Statistics show that racial minorities, as compared to white, are less likely to have the option to work from home. Their occupations are centered in the public-facing industries, including transportation, sales, which are usually regarded as essential jobs. Also, more minority households have at least one front line worker. And they are also more likely to live in a multigenerational household. All these factors contribute to a triple threat for social distancing. 2) Hardships in sustaining monthly income, in which minorities have higher chances for job losses. 3) Safe neighborhood. 4) Psychological costs, especially the potential traumas that can persist to children.
At the end of the session, a couple of potential remedies and solutions are also discussed. First, Prof. Mendenhall pointed to the idea of community health workers. She underlined the importance of working at the community level to promote the understanding of health messages. The second point concerns vaccine distribution. It is emphasized that people need to build trust among society to maximize the benefits of the vaccine. Again, such a trust is to be built from a community level, where scientific messages are properly educated. The final part concerns housing insecurities. For one part innovative technology can be used to provide affordable smart housings, and on the other hand a new safety net is needed: it needs to be built based on the fundamental belief that safety is not a zero-sum game, and that people don’t need to be in the margin.
The readings also discussed a similar topic on how the pandemic had influenced the social contact, the idea that individuals, in living in an organized society, give up some of their freedoms in exchange for the benefits of living among other people. The elements discussed include individuals’ emotional responses, the cooperation of different systems, the relationship between workers and communities, etc.
Reflection
One perception I got from the speaker session and readings is that the issue regarding social inequalities is constituted by a variety of elements. The factors leading to this issue are rather scattered, but at the same time intertwined in a surprisingly concrete manner to the point that together they have contributed to the persistence of the issue. I was unable to write a concentrated summary like the ones I did for my previous open-eds, and it is hard to merge the elements without sacrifice their underlying meanings. In this way, I’m particularly interested in the solutions to the problem.
In discussing the potential resolutions, Prof. Mendenhall pressed hard on the idea that we need to start from the ground level, reaching out to different communities so that we can implement proper methods designed to tailor specific needs. I fully agree with this idea. And given how complicated this issue is, I do believe that this is the best and most effective way. However, I also believe that people may need to carefully examine the viability and potential costs (both monetary and human efforts) of such a method. For the first part, there are various direct costs. Think back to the iceberg-shaped social determinants of health resources: there is a considerable amount of things that need to be changed, from neighborhood infrastructure to education and economic security. Additionally, we may also consider how to tailor these direct costs to each community to satisfy their needs, which may increase the cost once again. For the second part, and perhaps more importantly, I feel that this will not be a one-time cost. The follow-up costs in maintaining the continuity of the assistances can be fairly high (even exceed the original cost), especially if the recipient were unable to sustain themselves. Aside from sustaining the physical conditions, the reformation of people’s mentality is also an essential part, both the perception of the in-group members about themselves and also the perception from the out-group. I would expect both of these points to have a considerable amount of related costs. With all the aforementioned points, then, it is also important to consider the sources of the cost, as well as the reliability and sustainability of the sources. All together, even the viability (at least to implement this community-based reformation at a large scale) of this method might be put into question.
While I don’t have a good solution, but I do believe that a combination of ground level workers and other methods may help to mitigate some of the costs. For example, in educating the health messages, we can also take advantage of mass-media information to support community scientific meetings. It can help to provide reassurance to the validity of the information, and on the other hand the participants may use it to gain a better understanding when one channel is not clear. And on the other hand, we may also use social media or other media channels to advertise for the community worker’s progress. It may improve the community member’s own confidence and also help change other people’s perceptions of the community. These methods can operate at a relatively low cost, but yet still convey some of the benefits.
As a final thought, I want to point out that while cost efficiency is a consideration of mine, I don’t seek to avoid the costs altogether. I think a radical reformation needs to happen, and assistances are necessary. I certainly acknowledge the significance of implementing the reformation from a community level, but we may also have the need to find a way to make the most out of the limited resources.
Comments & Responses
Comment #1
By Cole Phillips
Hi Doris, I agree that radical change in the wake of the COVID-19 pandemic is a goal we should strive towards, and personally felt as if the ideas outlined by John Morrison in “Could 2020 be the year we finally rewrite the social contract?” really capture that notion. Through addressing the inequities you outlined by reimagining the social contract between laborers and their employers, the monetary compensations for human efforts can be more properly balanced. While I agree with Morrison that one way to do this is to further focus on ESG considerations in operating businesses, I was wondering what sort of change you think we can make in the aftermath of this pandemic to be able to implement some of the ideas that you outlined above?
Response #1
Hi Cole—
Thanks for your response!
When I was reading the article, I think the one thing that caught my eyes is the idea of “consent”. I obviously did not read the author’s book so I might need more context on this, but my perception of a social contract is that people enters it involuntarily, in a self-spontaneous way. For example, we have a social contract with the government because we modern people can’t live without a government (in the practical sense), and we have a social contract with businesses because we need to earn a living. I don’t think there is a way to opt-out from a social contract, and people don’t really “actively grant special permissions”. Building from here, I also think “trust” is automatically given when one enters into the contract.
I can be completely wrong on this, but I feel that inequalities are caused by the discrepancy between involuntary consent, trust, and legitimacy. For example, we all enter the contract with the government and trust it to fight for our best interest, but a government may fail to do so; the essential workers are all under the contract with various businesses, but the business may fail to provide them with proper benefits. There is no option for us to opt-out from the contract, but there is a possibility for the entities to mis-operate. I think the part that actually being called into question is legitimacy, and not really the consent & trust parts. I also agree with Morrison that the pandemic can help to put S in ESG, but I would say legitimacy is the one being plugged in here. I posted under your last open-ed asking if you think the pandemic is a cause of the problems or an amplification of them. I think good arguments can be made for both sides, and my personal opinion is more on the amplification side. I think what had been previously overlooked is now recognized, as the pandemic had provided a horrifying example for the inequalities. People are paying more attention to the legitimacy part.
Now going into your last question. I obviously don’t have a good answer on the best way to deliver the messages, but I guess my best bet would be on the combination of the two methods. For example, we can use mass media for the most part, and only implement the narrower focus method over the most problematic demographics or communities. If a balance point can be found, then maybe the benefits of efficiency and effectiveness can both be actualized. Another thing that I’ve been thinking about is the focus on motivation, and not education. For example, to target at the younger generation, maybe we can make it look like a “cool” thing to wear masks, as oppose to educate them that it is the “right” thing. I acknowledge that it is a one-time solution and is certainly not the most ideal way in the long term, but I think it might help to lighten some of the burden during this overloaded time.
Thanks!
Doris
Comment #2
By Roman Friedman
Thanks Doris!
As usual, a lot of food for thought here. You write: "One perception I got from the speaker session and readings is that the issue regarding social inequalities is constituted by a variety of elements. The factors leading to this issue are rather scattered, but at the same time intertwined in a surprisingly concrete manner to the point that together they have contributed to the persistence of the issue. I was unable to write a concentrated summary like the ones I did for my previous open-eds, and it is hard to merge the elements without sacrifice their underlying meanings. In this way, I’m particularly interested in the solutions to the problem."
I think this is useful to think about in terms of the ongoing conversation we've been having about messaging for different groups, though in this case we can think of it differently. As you say, the impact of the virus is not merely determined by biology. Given the social complexity of the impact of COVID, and given that we have to consider the impact of institutions, psychology, inequality, and so forth, how might we be most effective in our messaging and in our actions generally? Do we need to have a narrower focus, and target specific demographics in order to be most impactful? Or are there ways in which everyone could be reached, despite the different effects COVID has had? If so, do these behaviors/solutions become diluted?
I bring all these questions up because in past posts you seem to have been more optimistic about the universality of messaging. Here, though, you write: "In discussing the potential resolutions, Prof. Mendenhall pressed hard on the idea that we need to start from the ground level, reaching out to different communities so that we can implement proper methods designed to tailor specific needs. I fully agree with this idea." Does this idea impact the way that you personally pursue your project?
Finally, I want to highlight Cole's question below. To quote him: "...I was wondering what sort of change you think we can make in the aftermath of this pandemic to be able to implement some of the ideas that you outlined above?" In your post above you emphasize costs/spending, but I'm curious if you had any thoughts on how to spend/on what? (Especially given my questions above on maximizing effectiveness)
-Roman
Response #2
Hi Roman—
I would first state that I completely agree with that the most impactful way is to have a narrower focus, targeting at specific communities and specific needs. I have never doubted the effectiveness of this method. However, I also have never considered it as a viable solution in the practical sense. So maybe my major problem is with the efficiency of such a method, and not the effectiveness. I outlined a couple of problems in the main section of my open-ed, and they are in fact in my mind for a long time (not merely a response to Prof. Mendenhall’s proposals).
I believe that to actualize the effectiveness of a narrowly-targeted method in a large scale (in a state or in a country), we need to implement a structural change. Maybe local NGOs or local social workers can be successful in implementing changes in a very small scale, but without a properly designed structure/organization to oversee the communication and resource allocation, the contribution of such a success would be minimized. Ground-level reformation should be implemented in a top-down manner (as oppose to bottom-up).
I have a personal example for this. My grandma currently lives in a small town by herself; it takes a five-hour train ride for my parents to visit her, and I’m somewhere 15 hours of flight away from her. With that being said, as an elderly person who don’t know technology, she depends heavily on the social workers, especially during the pandemic. I’ve personally talked to one of them during last summer, and what surprised me is that the services that my grandma had enjoyed is rather a result of the operation of an organization. There are various factors cooperating together, and just to name a couple in here: the source for fundings are consistent and reliable (partly from the local government tax income and partly come from a national funding program), there are detailed goals for the workers to complete (how many household visits to be conducted in a day, how many activities to be hosted in a month, etc), specific guidelines to be followed to maximize the benefit, and also reward procedures to help motivate better performance. All these factors combined, both sufficient fundings (small town but in a developed area) and reliable structures, contribute to a ground-level reformation. It is not the result of a bottom-level reaction to an existing issue, it is rather the result of a top-down structural effort. It takes both money and time, and it need to take place in an highly organized way.
With that being said, my optimism toward the universality of messaging is sort of my alternative way to think of this issue. From the very beginning I have never considered ground-level reformation as a viable solution, and perhaps mass messaging can make the delivery of message more practical by increasing the efficiency. However, I do think you really pointed to things that I have never considered before, namely the human psychology part. I admit that my original proposal might be too ideal in assuming that all people can operate under logic (under this ideal the main focus would be how to get the messages delivered). I really appreciate that you brought up the ideas on human psychology can intervene the procedure and how people can intentionally distort information (even if the messages are properly delivered to them). Nonetheless, I would still be optimistic on the point that the great majority of the people have logic, but maybe I will need to rethink about how to communicate to the other populations.
All in all, I think my major concern is not on the maximization of effectiveness (I agree that ground-level reformation is by far the most effective way). I’m more concerned on how we can get the messages out in real life. Now, pasting a paragraph of my response to Cole here:
I obviously don’t have a good answer on the best way to deliver the messages, but I guess my best bet would be on the combination of the two methods. For example, we can use mass media for the most part, and only implement the narrower focus method over the most problematic demographics or communities. If a balance point can be found, then maybe the benefits of efficiency and effectiveness can both be actualized. Another thing that I’ve been thinking about is the focus on motivation, and not education. For example, to target at the younger generation, maybe we can make it look like a “cool” thing to wear masks, as oppose to educate them that it is the “right” thing. I acknowledge that it is a one-time solution and is certainly not the most ideal way in the long term, but I think it might help to lighten some of the burden during this overloaded time.
Thanks!
Doris
Comment #3
By Roman Friedman
Hi Doris,
Thank you for the response. As always it is thoughtful and thorough. I love your example here and I have a similar contrast. All of my grandparents are still alive, all live on their own, one pair lives in Jersey City, New Jersey, and the other pair lives in a suburban neighborhood in Israel. All live in subsidized housing for seniors and the response between the two places is interesting, because in both instances there have been COVID outbreaks in the building my grandparents live in. In Jersey City my grandparents are having some difficulty navigating their building and navigating groceries. Since there have been cases in their building, they are afraid to go do laundry, or to wander around for shopping. They have a healthcare worker come once a week, but what they can ask the worker to do is limited and this worker is paid only through insurance. In terms of government (local, state, or national) no action has been taken. Luckily my parents live about 1 hour away, so they can come by, bring groceries, pick up laundry, etc. (Like you, I'm a bit far, a 13 hour drive).
Meanwhile, in Israel the moment a case appeared in my grandparents building the government place the building on lockdown, no one allowed in or out (even family) except approved social workers and healthcare workers who would bring food and other necessities. There have since been multiple outbreaks and each time the building goes on lockdown.
This contrast is interesting given your topic, especially this line: "Ground-level reformation should be implemented in a top-down manner (as oppose to bottom-up)." Based on my family: In the U.S. people are (mostly) left to their own devices, and hopefully they have family to support them. In Israel the government takes control, and the family doesn't really have much say. (My uncle tried to get food into the building to give to his mother and they wouldn't let him, only the workers were allowed to bring groceries in). I'm curious if you think ideological differences would prevent the sorts of changes you're advocating for in the U.S.? Put another way, do people here have a different view of liberty, equality, freedom, etc. that instituting top-down reform might not be feasible? Do you have to change historically-embedded ideological beliefs and values first?
-Roman
Response #3
Hi Roman—
I’m so sorry to hear this, and I hope your family are all doing well!
I’m not sure the contradictions you brought up are caused by ideologies. I think the discussion on top-down reformation of social workers is more of welfare (as opposed to restriction or regulation), so I don’t think differences in views on liberty and freedom will have a conflict with this point. Also, while I don’t have further information to assist my judgement, but based on your descriptions, I think it is mostly structural differences. It seems to me that in the example you provided, the major differences resides on the payer for the healthcare workers, and on the presence of a top-down reformation.
In Israel the payer is the government (I saw that the entire building depends on social workers, so I would assume that the expense is paid by a more organized party that would cover everyone). My grandma’s case is more similar to the example in Israel, where the funding came from the government (both local and national). And essentially everyone who fits the requirements (over 65, have disabilities, etc.) can enjoy the benefit of social care. There are no discriminations, and there is a basic top-down structure in place. In the Jersey City example, on the other hand, the health workers are paid by the insurance. So people are divided into those who have insurance and those who don’t have. I also think of this as more of a bottom-up effort, where, when having no organized assistance in place, people need to seek helps for themselves. Such help can either come from a local community (like NGOs or maybe insurances) as suggested by Prof. Mendenhall, or from other sources (like families and friends) like you pointed out.
Additionally, I would say without a more organized party overseeing the activities, the benefits from a social worker can be limited, as people will need clarification on their responsibilities. In Israel, they know to bring necessities to the residents and to stop foreigners from entering the building. (I can understand why they are doing this, but it really shocks me how strict it is). In my grandma’s case the situation is more lenient: the area has zero confirmed case, so the restriction is to stop people from entering the town, and the daily life of the townspeople remains mostly unchanged. The social workers mainly function as educators to teach people about different precautions. My grandma is an elderly person who can’t use technology, who has no higher education, and who has not personally seen the devastating consequences of the pandemic (given the situation of the area). She, however, has not undermined the pandemic. I heard that the social workers were given special instructions on how to communicate the information to people like my grandma, and it turns out to be quite successful. And besides these guidelines, as I mentioned in my previous post, there are clear goals for the workers to complete (like how many household visits to be conducted in a day), and reward procedures to help motivate better performance. All these points coming from their organization really helped to improve the efficiencies of their job.
I think that’s my main point for a top-down reformation: the actions are taken at a localized level, but they need to be properly organized into a bigger entity so that the benefits can be actualized on a larger scale, and in a non-discriminating manner.
Doris