Can you believe it’s February already? I just wanted to pop in with a few links to some of my recent interviews and public outreach in the areas of medical geography, health services research, and social theory.
First, here is a podcast episode from Death Panel with hosts Beatrice Adler-Bolton, Philip Rocco, and Artie Vierkant, released today (11 Feb 2021). The transcript can be found here. We discussed the importance of addressing the inequitable spatial allocation of healthcare resources, & redressing the resultant (racial, ethnic, class…) inequities in healthcare access as we address the financing of healthcare in the U.S. In the course of that discussion, we got into some important points about the conceptual and operational distinctions between acute care models and chronic care models:
“But the thing is, with these episodic models of healthcare access, you also get these conceptualizations of affordability that are very narrow, and that are very specifically focused on medical bills. But they’re not necessarily attentive to all these additional costs, such as the travel time… the cost of parking, the forgone income when we use HC, so in the absence of paid sick leave, or in the absence of generous leave…, people are having to forego income and pay OOP for health care services. So it’s a net loss [for patients with chronic conditions].”
And in May 2020, I had the pleasure of being a guest, as part of the Contra* podcast‘s Solidarity Chat with Aimi Hamraie (link with audio and transcript). In this conversation, we traversed the terrain of ableism and eugenics, addressing the differential (de)valuation of disabled people, and how that is reflected in the allocation (rationing) of healthcare resources. I asked the key question: “how was life distributed already, before the pandemic?”
“…before the pandemic, we saw what should be pretty damning inequities in health status and healthcare quality and access. At the axes of… you know, assigned race, ethnicity, citizenship status, disability status, even on the basis of where you live. I know there’s a—there’s a popular refrain in public health circles where, you know, disparity has become this sort of hot buzzword, you know? Where they say, “Oh, your zip code determines your life expectancy.” And that’s not true. It reflects a sort of ahistorical and sort of mechanistic understanding of the relationship between places and health, and health outcomes. Because when we’re talking about zip codes too, we’re also talking about postal routes, which don’t necessarily reflect neighborhoods, they reflect how one particular arm of the government demarcates space. It’s not the same thing as a neighborhood, it’s not the same thing as a place. But, the idea that your zip code determines your life expectancy completely elides all of these underlying structural factors that shape health, you know, health inequities, or that produce health inequities. Like… majority Black zip codes; those are there by design, for the most part. You know, you have this history of red-lining, restrictive covenants and other forms of discrimination housing, that socially sorted people by race, ethnicity, class, in space. So it’s like this social sorting in space by design, to maintain a social structure. A racist—white supremacist, capitalist social structure—white supremacist, capitalist—I guess racist, if you want to make it clear—racist social structure. So, and then along with that, you also have healthcare systems that plan their distribution of the facilities around who lives where. Because healthcare systems, they locate their facilities where there’s higher household incomes, generally healthier populations. The term they’ll often used is “payer mix”. So they want a mix of commercially or privately insured patients, mostly patients who have insurance through their employer, so they’re generally working-age people. So there’s also a bias against areas that have older populations. Because Medicare, which covers people over sixty-five in the U.S., has lower reimbursement rates, compared with commercial insurance funds. So, people who are working-age are much more desirable patients—much more desirable patient base for healthcare systems. That’s like—that’s two examples: housing and healthcare.”
I also interviewed with Antonio Osuna at Scaling up Safe Surgery for District and Rural Populations in Africa (Surg Africa). The video can be found here. It was a lovely conversation about medical geography and its role in global health (particularly global surgery). I opted for a more casual vibe, so you can see my bearded dragon hanging out in the tank behind me (lol!).
In July 2020, I was a guest on Adrian Banning’s podcast, Airwaves + Educators (link to episode, entitled, “Episode 9: Human Geography, Doctorates, Accommodations, and Tea with Arrianna Planey! Oh My!” with transcripts).
AB: Ok. Great point. What’s the clinician’s role in access and policy?
AP: Well, if you’re a clinician who can give referrals for specialist care- you’re a key nexus in the process of help-seeking for health conditions. Clinicians can also be powerful advocates for better and more accessible care. I do think that there is great potential for powerful and effective advocacy when practitioners join forces with patient advocates. For example, violence in health care settings is a danger to both practitioners (nurses, PAs, doctors) and patients. Or in the debate over opioid prescribing, clinician advocacy paired with chronic pain patient perspectives can counter the push for prescribing limits that ignore the specificity of each case.
I’ll stop there. I hope you enjoy these links!