Posted on | August 23, 2013 | 2 Comments
NIH Director Francis Collins remembers Rev. King in 2011
“Of all the forms of inequality, injustice in health care is the most shocking and inhuman.” — Dr. Martin Luther King, Jr.(1)
This week we celebrate the 50th anniversary of Rev. Martin Luther King’s “I Have A Dream” speech. The promise of that dream – lives lived to their fullest, with purpose, goodness, fairness and justice – can not be realized without leadership in health. What President Obama understood, and what increasing numbers of Americans are beginning to understand is that health and human potential are one and the same.
When it comes to health politics, there are no “lazy days of summer”. Controversy is in full swing as the federal government begins to execute on the promise of Obamacare and a vocal minority of the Republican party continues to believe their political future is tied to unrealistic visions of defunding or otherwise eliminating the program.
At the same time, states – even those led by Republican governors – are one by one signing up for the Medicaid expansion in response to their state’s hospital and health professional organizations active appeals.(2)
At the core of this clear if messy transformation is the calculated decision by those in the majority that the value of creating an integrated and preventive health delivery system has finally outstripped the value of keeping the system disintegrated and reactive. More fundamental is the growing acceptance that health and the realization of human potential and full productivity is at its core a political exercise.
Health is Political. Health is a collection of resources unequally distributed in society. Health’s “social determinants” such as housing, income, and employment, are critical to the accomplishment of individual, family, and community well being and are themselves politically determined. Health is recognized by many throughout the world as a fundamental right; yet it is irreparably intertwined with our economic, social, and political systems. And growth in health, health care, and health systems requires political debate and political consensus.(3,4)
The value of integration extends to individuals, families and communities for certain. But as a JAMA editorial emphasized last week, it also impacts population health and society overall.(4)
In the paper, the authors state that, ” The current epidemic of chronic disease has emerged in an environment in which unhealthy behaviors and exposures are often the default.” and that “…physicians and other health professionals…have a special duty to weigh in on how society mitigates the social and environmental conditions that lead toward unhealthy choices.”(5)
On August 28, 1963, fifty years ago, Reverend King, the 16th of 18 speakers that day, invoked the three core documents that have defined our nation – the Declaration of Independence, the Emancipation Proclamation, and the United States Constitution. He repeated the aspirational phrase “I have a dream…” eight times. But he also repeated the pragmatic call to action, “Now is the time…” four times.(6)
For most Americans, faced with the challenge and promise of understanding and executing Obamacare, the time for dreaming has past. Now we must act.
For Health Commentary, I’m Mike Magee
1. Moore A. Tracking down Martin Luther King’s Words On Health Care. Huffington Post. 1/18/2013. http://www.huffingtonpost.com/amanda-moore/martin-luther-king-health-care_b_2506393.html
2. Michigan votes to expand Medicaid: Move is a victory for Republican Governor Rick Snyder and the Obama Administration. August 27, 2013. Wall Street Journal. http://online.wsj.com/article/SB10001424127887324591204579039731555402394.html
3. Magee M. Health Politics: Power, Populism and Health. Spencer Books. NY,NY. 2007. http://spencerbooks.com/books/HealthPolitics.html
4. Bambra C, Fox D, Scott-Samuel A. Towards a politics of health. Health Promotion International. 2005;20:187-193. http://heapro.oxfordjournals.org/content/20/2/187.full.pdf
5. Chokshi DA, Stine NW. Reconsidering The Politics of Public Health. JAMA. August 22, 2013. http://bit.ly/152HxSD