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The major and the minor

I was speaking with a marketing veteran last week about passions, gifts, and goals. The conversation helped me process through blocks I have been having for quite some time — what is my next right step to turn my gifts and passions into measurable goals. But before we get to that, we have to go back.

I met Melanie, the marketing maven, during a career counseling session a couple of weeks ago. During the session, she gave me homework – answer 12 questions.

One of which was: If you could do anything, what would you do?

My response: If I could do anything, I would launch a digital communications firm dedicated to helping healthcare providers create patient information/marketing materials geared towards minority groups. Specifically, creating health literate content (words, pictures, and videos) that provides culturally competent information about various determinants of health.

I didn’t think much about this response. I feel like I’ve said those exact words to anyone willing to listen, and I get the same response – “Oh, wow. I can’t believe that doesn’t already exist.”

But Melanie had an entirely different response.

She said, “I really enjoyed your answers to my questions. They were well thought out. But I have to say I was offended.”

“Offended?” I asked.

“I was offended by your use of the word ‘minority.’ Minority means less than — I am not less than; you are not less than.”

I’ve had some people say they don’t like the term minority, but no one has ever told me they were offended. I never mean any offense when I say “minority health,” it’s just a technical term in the healthcare industry. In the first proposal I wrote about inclusive health communications, I pointed out that separating health information about racial and ethnic minorities, women or seniors is biased.

“Separating this information gives the impression that racial or ethnic minorities, women, senior citizens, under-educated people, and those who are economically disadvantaged are not normal. And places middle-aged, wealthy, educated, white men as the standard of health.”

So I get it. Calling groups of people a “minority” is just as offensive as separating or ignoring groups because they don’t fit in with the white patriarchy.

But if we are not minorities, then what are we? If we aren’t seen as “less than” the white patriarchy then why aren’t we already included in health information?

I have theories about the second question, but I don’t want to divert from my purpose in this post. Suffice it to say we live in a hierarchical society. Someone will always be on top or bottom with varying degrees of value in between. Healthcare marketers and even doctors are well aware of this hierarchy and target clients accordingly.

The reality is there is no such thing as a minority or majority. There is no biological difference between the “races,” that’s a social construct. Those social constructs often based on stereotypes and generalities.

But medically there are differences between racial and ethnic groups, genders and age groups that affects health outcomes. We hear about these differences all the time — just wait for the next big health observance month.

  • American Heart Month (February)Heart disease is the no. 1 killer of women, causing 1 in 3 deaths each year.
  • Skin Cancer Awareness Month (May): Between 40 and 50 percent of Americans who are at least 65 years old will have either basal cell carcinoma or squamous cell carcinoma at least once.
  • Domestic Violence Awareness Month (October): One of the leading causes of death of African-American women ages 15 to 34 is homicide at the hands of a current or former intimate partner.

While these statistics make for great press releases, I have no idea what to do with that information other than going to a dermatologist or cardiologist regularly.

What if you don’t trust doctors?

It is understandable if you don’t. The road to modern medicine is paved with bodies — not just at Tuskegee. There are reports of our nation’s most prestigious institutions conducting unethical experiments: like doctors at the Rockefeller Institute for Medical Research injecting children with syphilisSloan Kettering doctors injecting women with live cancer cells, or the National Institute of Health and what would later be known as the World Health Organization’s Pan American Health Organization using prostitutes with STDs to infect prisoners and mental health patients in Guatemala. That’s just some examples of medical misconduct in the 20th century.

Even if you feel indifferent about the practice of medicine, what if you can’t afford to see a specialist?

The fact of the matter is, having health insurance doesn’t mean you can afford to access healthcare. For some reason, the two are often mixed up. Insurance is just that an assurance of compensation for specified loss, damage or illness. Health care is the maintenance of physical or mental health. According to a Commonwealth Fund report released last year, approximately 31 million people with some form of health insurance fail to fill essential prescriptions, undergo necessary diagnostic tests or procedures or see specialists due to cost.

The best-kept secret of the affordable care act (at least for those not purchasing plans on the exchange) is there is no regulation of the health insurance premiums and deductibles. With rather high premiums and deductibles, an average healthy person might pay for all healthcare costs out of pocket — if they can afford it. So if you purchase a plan on the exchange, it might feel like you’re paying twice for coverage. But I digress.

What does this have to do with my gifts, passions, and goals? More importantly, what does it mean to you, my patient reader?

It means we’re about to go on a journey into our bodies to understand factors that are often beyond our control. On this journey, I’ll try to answer the “why” — why do these disparities exist? And “how” — how can we work to eliminate these differences. Hang tight — it’s going to be a wild ride.