May 11, 2012

The truth about trauma

Health education programs are not a solution to the South Side’s structural disadvantages.

I’ve worked with STOP and FLY on the trauma center campaign for nearly a year now, and read with frustrated familiarity Maya Fraser’s critiques of the movement. She iterates quite perfectly the logic I’ve heard many other members of this institution use in order to justify complacency, a logic that, while perhaps valid, remains unsound, as its premises fail to grasp the fundamental point. While I found something objectionable in nearly every paragraph of the op-ed, I will attempt here to break it down into the most important points.

The first is one I’ve encountered the most, and is indeed the strongest point Fraser makes, which is that there are more pressing issues on the Southside than trauma care which require more immediate attention. More lives could be saved per dollar spent, to cite two of her examples, if we created programs to target the risky behaviors of smoking and lack of exercise. And indeed if it were a question of such simple calculus, I would put down my protest placards and bend before logic. But there are several reasons why it is not so simple.

Fraser tries to make the case that it is regrettable but necessary that in any healthcare system with limited resources a price must be put on lives to ensure that the most possible lives be saved; and, that within such a system some people will lose loved ones and they will feel that this loss is unjust. While this is reasonable, she then writes something I find very troubling: “This feeling of injustice is strengthened by the fact that there are so many people whose fates are not determined by how much the medical establishment is willing to pay.” Now we must ask, is this a “feeling” of injustice, when we admit that our system does not put any effective price on many lives while triaging others on the basis of their wealth (or lack of wealth)—or is it simply injustice in the clearest and most concrete sense of the term?

It is pretty much beyond dispute that the reason the U of C closed its center in the eighties is because they were seeing a high volume of uninsured or underinsured patients. But this is the same reason it is difficult for Southsiders to get any kind of care, not just trauma care. Enacting an anti-smoking program, however helpful it may be, does not increase access to care or highlight that the root of the problem is structural. High smoking rates and other risky behaviors do not occur in a vacuum; what must be changed is the structural disadvantage the Southside is placed at. What Ms. Fraser is proposing is more like enlightened despotism, born of either despair or complacency towards addressing the roots of our healthcare inequities.

She writes, “Unfortunately, we are stuck within the bounds of an often unjust and dysfunctional system. There are not enough resources, and those resources are not allocated equally.” And concludes that, “Repairing the disorganized state of the American medical system is far in the future, if it is to happen at all.” But this is precisely what must be done, and in the meantime I see no reason to stop demanding a system that provides equal access to care and values each life equally. That is the nature of this issue at its most fundamental.

Cynicism is not the mark of a sophisticated ethical stance; it is the mark of complacency and ethical laziness. Of course our healthcare system can change. We live in the world’s first revolutionary democratic state: What right have we to say that there is nothing to be done because we are “stuck” without putting forth the first effort at releasing ourselves?

Potentially because it is not “we” who are truly stuck—as Ms. Fraser points out, she herself has no difficulty receiving care. Now, if we fought for more money for anti-smoking and exercise programs as Ms. Fraser suggests (while not believing it is possible to achieve success anyway), we would not be increasing access to care.

We would also not be addressing the high anxiety that contributes to young people beginning smoking in the first place, anxiety perhaps caused—among the other stressors of poverty—by the fact that the number one killer of black men ages 15 to 34 is homicide. The violence evident everywhere on Chicago’s Southside might also contribute to low rates of exercise, simply because people don’t want to be outside. I’ve heard one woman speak about how she brings her children to play in Hyde Park rather than her own neighborhood playground for safety, but her son doesn’t want to go anyway since he saw a member of his family shot in a park; all parks now terrify him. There seems something deeply condescending in asking people to change their “behavior” before providing more resources to address the root of those behaviors in the first place.

Certainly a trauma center won’t fix all the issues surrounding violence on the Southside, but it could help, and this movement won’t stop there. The fundamental reason this is not about behavior is because behavior has nothing to do with political power. This movement is about demanding equal access to care through building political power, not enacting “public policy” that alone will never solve the myriad problems the Southside faces, and that does not come from the people. The medical establishment no doubt has good intentions, but it will never do all that it can until it is in its interest to do so. If things remain as they are, it never will be; things must change.

Michael McCown is a second-year in the College majoring in philosophy.