HJNO Sep/Oct 2021

HEALTHCARE JOURNAL OF NEW ORLEANS  I  SEP / OCT 2021 45 Stewart T. Gordon, MD, FAAP Chief Medical Officer, Medical Affairs Louisiana Healthcare Connections ultimately, punished by our current sys- tems? Do you hear blatant and unfair in- equities? Do you, perhaps, hear your own biases being challenged? Stress from poverty, hunger, neglect, addiction, crime and other mental health burdens is toxic to the health of an adult and to a developing child whose body and brain are especially vulnerable. More- over, sustained stress has been linked to long-lasting biological changes in our ge- netic makeup, which cause serious phys- ical medical problems throughout life. It’s a vicious pattern for those born into economically challenged environments and, until we address systemic barriers to health, will continue to be replicated over and over. Ultimately, health inequity harms every- one, regardless of background or identity. Most importantly, though, health inequi- ty is avoidable. Recognizing and under- standing that not everyone has an equal opportunity to achieve optimal health and well-being is a significant first step. With the collective will, desire and ability to end health inequity, we can achieve health eq- uity. n REFERENCES National Academies of Sciences, Engineering, and Medicine. Health and Medicine Division. Communities in Action: Pathways to Health Eq- uity, Ch. 3 The Root Causes of Health Inequity. Washington, DC: The National Academies Press, 2017. https://www.ncbi.nlm.nih.gov/books/ NBK425845 Leonard, J. “What is Health Inequity?” May 16, 2021. https://www.medicalnewstoday.com/ articles/health-inequity Tirado, L. Hand to Mouth: Living in Bootstrap America. G.P. Putnam’s Sons, 2014. sider this simple explanation by a young woman working two jobs while trying to raise two children: “Poverty is bleak and cuts off your long- term brain. I smoke. It’s expensive. But short-term, it’s also the best option. You see, I am always, always exhausted. It’s a stimulant. When I am too tired to walk one more step, I can smoke and go for another hour. Long-term, it is not a good decision, but it is the only one that I have access to. It is the only thing I have found that keeps me from collapsing or exploding.” And consider how the system does not support her or her situation: “Nobody gives enough thought to de- pression. You have to understand that we know that we will never not feel tired. We will never feel hopeful. We don’t apply for jobs because we know we can’t afford to look nice enough to hold them. I would make a super legal secretary, but I’ve been turned down more than once because I ‘don’t fit the image of the firm.’ I am good enough to cook the food, hidden away in the kitchen, but my boss won’t make me a server because I don’t ‘fit the corporate image.’ I am not beautiful. I have missing teeth and skin that looks like I live on B12 and coffee and nicotine and no sleep. But beauty is a thing you get when you can af- ford it, and that’s how you get the job that you need in order to be beautiful.” Do you hear an emotional but cogent explanation of circumstances responsible for how someone is treated, judged and, children and grandchildren, both psycho- logically and physically. Because economics and health are in- extricably linked, families and individuals with low incomes are typically at the mer- cy of and suffer from the “domino effect.” With barriers to affordable healthcare, healthy food and other basic necessities, poor health develops. With poor health comes instability. With instability, con- sistent employment and regular income are impacted. With loss of income, there is economic stress. And with economic stress, there are emotional and mental challenges. The net result is overwhelming and debilitating. The Voices of Health Inequity It would be difficult to find a recent study on healthcare that does not men- tion health equity, healthy inequity, health disparities or the social determinants of health or that does not include ways to achieve the former by addressing them in rigorous, academic terms. But, what is dif- ficult to find are the voices of those whose day-to-day reality represents the very es- sence of health inequity. They are conspic- uously absent from the discourse, and yet the discourse is meant to help them. And so, can one truly understand their circum- stances and empathize with them if they don’t hear them? If you have ever judged someone living in poverty for making “bad choices,” for buying something that is not economically prudent or good for their health, then con-