How Everything Intersects: Healthcare Outcomes and Policy Decisions

By Anjana Sreedhar

As a recent graduate from NYU’s Wagner School of Public Service, I have developed a newfound appreciation for how interconnected public service and quality of life are. If we as a society can improve healthcare access and coverage, public education access and quality, and urban transit, we can improve people’s quality of life by leaps and bounds. More importantly, understanding healthcare from a foundation of healing and systems thinking is what will bring us to a better future.

The best place to start this conversation is realizing that not all of healthcare is designed equally for everyone.

Healthcare in the United States is at the forefront of everyone’s minds due to the COVID-19 pandemic and the resurgence of the #BlackLivesMatter movement after George Floyd’s death. The pandemic has laid bare all of the challenges with America’s patchwork approach to healthcare: healthcare coverage contingent on political administration and ideology leaving millions of people behind.

But what it highlights is even more sinister.

It highlights how healthcare has not been designed for marginalized voices, specifically Black and Indigenous people, Asians and Latinx immigrants, and poor and rural Americans.

Black people not being given appropriate pain medication and being subject to discriminatory behavior in medical settings, for example, is deeply rooted in how Black bodies were exploited for medical experiments and were not seen as bodies that experienced pain. Legislation supporting the enslavement of Black people and enforcing segregation in hospitals and ambulances supported the thesis that Black people were not deserving of high quality, safe care. Similarly, indigenous health has been continuously sidelined due to forced relocation and lack of investment in the Indian Health Service. Policy decisions allowing for the Trail of Tears to occur are deeply connected to where reservations were built and how the Native American population is uniquely impacted by the COVID-19 pandemic. Latinx communities have been suffering with poor health outcomes due to draconian immigration policies and lack of access to economic opportunity as a result. Low income Asian immigrants suffer from poor health due to the model minority myth, dictating that as the most successful immigrant group, they do not need additional support with health coverage or care.

Poor Americans continue to be threatened by the lack of Medicaid expansion where they live, and surprise medical bills that threaten to end life savings in one fell swoop. Policies that support cost-prohibitive healthcare continue to lock out the poorest people from accessing healthcare. For those living in rural areas, lack of investment and increasing economic challenges make it difficult to access healthcare in meaningful ways. This has become especially critical due to the development of the opioid crisis.

In the above examples, it is clear to see the relationships between non-healthcare policies and health outcomes. For example, immigration policies dictate who is allowed to enter the United States and at what time in America’s history. “Manifest destiny” policies dictated when Native people had to leave their homes to make room for newer waves of European immigration.

And all of that has an effect on health.

This is why it is so critical for us to recognize these connections. It is the cornerstone of what will help us build better solutions that will improve healthcare, improve public transit, improve education, and improve all other aspects of public service that increase the quality of life of all Americans.

Read Anjana Sreedhar’s book Healthcare of A Thousand Slights
upon its release December 2020!

Anjana Sreedhar, MPA (she/her/hers) is the author of the upcoming book Healthcare of a Thousand Slights and a current administrative fellow at NYU Langone Health. She works in the hospital operations field and has a background in healthcare best practice research, healthcare strategic marketing, journalism, and campus activism. She is based in Manhattan, NY.

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