The pitchforks and efforts to aid the uninsured, disabled, and decrease health disparities.

Nick Hanauer is a self-described .01%er and capitalist. Just one of his über-successful business ventures includes the sale of aQuantive, an Internet advertising company that he founded, to Microsoft for $6.4 billion in cash. ¹ I heard him speak on NPR during a TED radio hour episode entitled, “Seven Deadly Sins”. ² He was specifically addressing greed. I was struck by many things he said and later found an article he wrote echoing the same sentiments to his fellow Zillionaires. The title began, The Pitchforks are Coming…

But the problem isn’t that we have inequality. Some inequality is intrinsic to any high-functioning capitalist economy. The problem is that inequality is at historically high levels and getting worse every day… Unless our policies change dramatically, the middle class will disappear, and we will be back to late 18th-century France. Before the revolution… If we don’t do something to fix the glaring inequities in this economy, the pitchforks are going to come for us. No society can sustain this kind of rising inequality. In fact, there is no example in human history where wealth accumulated like this and the pitchforks didn’t eventually come out. You show me a highly unequal society, and I will show you a police state. Or an uprising. There are no counterexamples. None. It’s not if, it’s when. (Hanauer, 2014. p.1) ¹

I began to wonder if he was right. Because inequality in this country is not limited to economics, it is equally apparent in health. In fact, strong and complex relationships exist between health and economics, where those in the highest income group can anticipated to outlive their lower income peers by six and a half years, on average. ³ Likewise, the four most common, non-communicable diseases – cardiovascular diseases, cancers, diabetes and chronic lung diseases disproportionally affect lower income persons and countries. ⁴ Health disparities are not limited to incomes – they include race, education and access-related factors. Addressing health disparities requires us to look beyond just inequality (as increasing numbers of American obtain health insurance) to health equity – the pursuit of which is key to addressing these disparities. Health equity relates to variations in population health, tied to unequal socio-economic conditions that can only be addressed by altering or attempting to alter these underlying conditions (disparities). ⁵ Healthcare policy is the only route to achieve a healthcare system that is equitable, sustainable and just (and thus avoid the pitchforks)!

The U.S. Government has a history of attempting to address poverty and public health problems such uninsured, underinsured, disabled, and health disparities through the public sector. This includes programs like Social Security, welfare, Medicare, and Medicaid. ⁶ Depending on who one might ask they have been marginally successful. For more than two decades, 2000 -2020, a primary goal of ‘Healthy People’ has been to reduce and then eliminate healthcare disparities. Yet they persist.

Disparities, in particular racial disparities, are pronounced in maternal and infant health. African-American women die in pregnancy or childbirth three to four times more often than white women, and their babies die 2.4 times the rate of their white counterparts. ⁷ African-American babies have lower birth weights – the leading cause of infant mortality. ⁷ Not attending high school impacts prenatal care; women who receive no prenatal care are three to four times more likely to die after giving birth than those who have even one prenatal appointment. ⁷ Rural women experience poorer health outcomes and have less access to health care than urban women.

Midwives are in an ideal position to help address these health disparities by providing safe, accessible, cost-effective, and quality care. ⁸

References

1. Hanauer, N. (2014). The Pitchfork are coming…for us plutocrats. Polotico Magazine. Retrieved from http://www.politico.com/magazine/story/2014/06/the-pitchforks-are coming-for-us-plutocrats-108014.html#.VOZq5_nF_UX

2. Raz, G. (Narrator). (2015, February 6). Seven Deadly Sins [Radio broadcast episode]. In G. Raz (Producer), TED Radio Hour. Washington, DC: National Public Radio.

3. Unnatural causes: Is inequality making us sick? Smith, L., Adelman, L., California Newsreel (Firm) and Vital Pictures (Firm) (Directors). (2008). [Video/DVD] San Francisco, Calif.: California Newsreel.

4. World Health Organization (WHO). (2015). Global Health Observatory (GHO) data. NCD mortality and morbidity. Retrieved from http://www.who.int/entity/gho/ncd/mortality_morbidity/en/

5. Braveman, P., & Gruskin, S. (2003). Poverty, equity, human rights and health. Bulletin of the World Health Organization, 81(7), 539-545. Retrieved from http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S004296862003000700013&lng=en&tlng=pt. 10.1590/S0042        96862003000700013.

6. Kraft, M. E., & Furlong, S. R. (2015). Public Policy: Politics, Analysis, and Alternatives (5^th ed.). Thousand Oaks, CA: CQ Press.

7. Association of State and Territorial Health Officials (ASTHO). (2015). Disparities and inequalities in maternal and infant health outcomes (Issue brief) http://www.astho.org/Programs/Health-Equity/Maternal-and-Infant        Disparities-Issue-Brief/

8. I am a Midwife 2.0 [iamamidwife]. (2012, May 18). ‪Midwives address health disparities. [Video file]. Retrieved from https://www.youtube.com/watch?v=euagoBCsZBM&feature=youtu.be