More than the ACA: We Can’t Stop Fighting Now

Since the start of the new presidential administration, the onslaught of policies and executive orders have been met with outcries from communities, organizations and elected officials. In the medical community, there was an almost unprecedented bipartisan opposition to the White House’s proposed American Health Care Act. To some, the protection of the Affordable Care Act has given us a rare time to celebrate, rest and regroup.

Now is not that time.

Not one of us should have the delusion that an insurance card will be a game changer when it comes to addressing longstanding and dire health inequities. If we truly want to ensure America’s health, activists, physicians and medical organizations can’t just mobilize for preservation of the Affordable Care Act. We must respond with equal vigor to immigration reform, housing quality and segregation, civil rights and other policies that could shape the nation for generations. When 80 percent of health is determined by the context of our lives, confining advocacy to access to medical care is reckless and irresponsible.

In a brave new world, here’s how we move forward:

#1 Collect Data for Action

Medicine and health rely on facts. There can be no alternatives. The need to collect robust data and shape the narrative of health has never been more urgent. By quantifying the human toll of defunding Planned Parenthood, reducing SNAP benefits through the Farm Bill and block-granting Medicaid, we proactively treat more patients than a doctor could during a shift in the ER, or an entire career.

At the New York City Health Department, our data-driven health equity blueprint, Take Care New York 2020, guides our programs, policies and investments to improve overarching population health indicators—premature mortality, infant mortality and self-reported health status. We track these indicators because they plainly tell us how well our society is keeping people from dying before their time, protecting the sanctity of childhood and supporting residents in not only living, but thriving. As importantly, we track disparities within indicators over time to learn more about the hardwired social conditions that perpetuate inequities.

While scientific discoveries and evidence-based approaches form the foundation of medicine, they remain inadequate in wholly addressing the issues of the unquantifiable human experience. Letting data and test results speak for themselves without context robs us of the imperative to bear witness to the brutality inflicted on our communities by repressive and oppressive policies.

#2 Work with Movements and Across Issues

Government shapes health through legislation and regulation, but social justice movements influence the norms upon which legislation and regulation are based. Access to health insurance isn’t the only health issue. Environmental protections and climate change are health issues. Policing policies and mass incarceration are health issues. Immigration policies and the minimum wage are health issues. Women’s rights and LGBTQ rights are health issues. Isolating health from the movements that influence society results in a fractured system wherein communities and families pay the ultimate price. As social movements galvanize to create a fairer, more just society, white coats can’t symbolize surrender to antiquated ideas about what creates health. The power of the white coat, and those who wear it, lies in its ability to translate diagnoses and test results into everyday language that illustrates how seemingly abstract housing policies, educational policies and even land use policies have the power to heal or destroy.

There’s a long legacy of physicians advancing social justice and creating national reform. My personal hero, Dr. Helen Rodriguez-Trias, founded the Committee to End Sterilization Abuse and rallied families and physicians against reproductive violence that targeted women of color. Dr. Allen Keller has travelled around the world documenting torture’s aftermath for refugees and those seeking asylum. More recently, Dr. Mona Hanna-Attisha used her privilege as a pediatrician to help mobilize a response to Flint, Michigan’s cost-cutting and resultant poisonous drinking water.

#3 Focus on the Ground Game

We all have a role to play locally that will never be equaled at global or national levels. Health, like politics, is local. Health advocates and the medical community are reminded every day that community health isn’t strengthened solely through checks to national charitable organizations and Facebook likes. As doctors and public health practitioners, we have a role to play locally that will never be equaled at global or national levels. We are the ones who comfort parents after their children get sick while living in substandard housing rife with pests. We are the ones who help navigate an impossible medical maze when health insurance coverage is lost. We are the ones stemming the tide of lives lost to community violence’s contagion. We must not lose sight of that when we hold local and national elected and appointed officials accountable for their action, or more importantly, their inaction.

And we are the ones who can tell the stories of how our patients and our communities rely on and benefit from the services most at risk. We are the ones who put faces to the data, and make it clear what’s at stake in ways that cut across political and ideological lines.

Whether in red, blue or purple states, the voices and expertise of the medical profession and public health are needed to mount a sustained and comprehensive response to the approaching threats to public health. As we ponder next steps as a nation, it’s important to remember that individuals are never a means to an end and neither are communities. Political ideology should never come at the cost of our core values. The idea that advocacy has no place in the examination room, however well intentioned, doesn’t reflect the reality of American life. In exam rooms, patients are never alone. They always bring their histories, communities and contexts with them. For America to reach its full health potential, it’s about time we embrace that fact.

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