Martin Luther King, Jr., wrote me a letter before I was born, postmarked from Birmingham. What I felt, decades later when I first read it, was urgency—an urgency keenly aware of the value and necessity of allies, yet critically aware of the tools and instrumentalities of distraction and obfuscation. For King, this distraction was in the form of “white moderates” bent on setting the pace of change with paternalistic, subversive calls to “go slow” and to wait for “a more convenient season.” Of course, King was under no illusion that everybody was truly down to ride for the cause, and his vision of and for racial, economic, and social justice did not require such. Nonetheless, it was important to discern the real from the fake and to call the latter to task. And here, I can’t help but notice parallels within discourse about health equity.
I find myself increasingly troubled by how we are growing accustomed to the idea that health equity is something to be “achieved”—that we can somehow arrive at this mountaintop of health, take a bow, pop bottles, and clock out. Specifically, I question our continued deployment of White supremacist language of “achievement” and our continued subservience to settler-colonial, positivist paradigms of science, knowledge, and evidence as prerequisites for action. I’m convinced that King has something to teach us here.
The Beloved Community, Health Equity, And Dreams Versus Myths
King spoke of a “beloved community” characterized not by a perfectly peaceful and equitable society in some distant future, but by love, compassion, and the pursuit of justice now. There’s an enduring recognition of our connected humanity and our inextricably linked liberation from all forms of oppression and exclusion in this beloved community. Yet, it’s not an idealized world without conflict; it’s an inescapably imperfect society wherein the roots of conflict are recognized and responded to (not necessarily “resolved”) with love and reconciliation, on the path toward justice.
Much like health equity, the beloved community requires attention to political and economic power—not as ends but, as articulated by King, as a means to do the work of justice. And it’s the collective pursuit of justice that gets us to the proverbial mountaintop, but this mountaintop is not the top of the mountain. Rather, it’s the love and mutuality expressed on the slopes of our many ascents. A love that comes with the acknowledgement that some of us are carrying 80-liter Osprey packs filled with other peoples’ toilet paper, while some carry only selfie sticks. A mutuality that understands that our packs will never be balanced, and that we will always contest the burdens of ours and others’ existence—yet still be aware, willing, and open enough to do some inventory and, yes, some reallocation. And this will invariably involve conflict.
In this light, health equity is not something that is “achieved,” as this implies—and indeed requires—the absence of conflict. Properly understood, health equity in a beloved community—as the embodiment of our resistance and resilience—does not aspire to reach mountaintops and take selfies, but to move mountains and take names. It’s not a data point or objective to “achieve;” it’s a call to be (permanently and thoroughly) about that business. To orient our frame around language of “achievement” is to subvert the power of our dream and mythologize our struggle.
The Beloved Community And Health Equity: White Logic And White Moderates
Here, it’s important to appreciate that public health is deeply rooted in what Tukufu Zuberi and Eduardo Bonilla-Silva refer to as “White logic”: “a context in which White supremacy has defined the techniques and processes of reasoning about social facts.” This logic manifests in our overwhelmingly positivist and settler-colonial orientations to research (that is, “White methods”). In the context of US population health inequities, this commonly entails forays into Black and Brown communities/bodies for White capital accumulation (see, for instance, predominately White, non-property-tax-paying R1 institutions located in historically redlined communities). It should come as no surprise then that the language of “achieving health equity” is rooted in an epistemic position that presumes the human condition, and the world of power relations therein, exists in and as discretely measurable states of “truth” and “fact” that can be “captured” via endless arrays of experiments, variables, and effect estimates. And if we just refine our measures…. If we can just use big data…. If we can just specify this last parameter a little more specifically…. Voilà: achieved!
No. Odd ratios are not going to carry us off to some utopian state of achieved health equity. Health is fundamentally political, and we are inescapably human. Every one of us lives a contested existence, some of us more than others. And this contestation, this conflict, is not bound to our epistemic myopia nor will it be resolved based upon who produces the best regression models. Tighter margins of error cannot recalibrate margins of care, and, to paraphrase King, we cannot confidently rely upon intervals of change calculated by someone else. To proceed under the belief that more evidence or better science or bigger data is what’s needed to protect our futures is to fundamentally misunderstand what equity is and requires, and ultimately, to cede power to the systems that preclude it. White supremacist, settler-colonial, positivist logics dominate our field, yet here we are trying to free ourselves from the burdens of said logics by quite literally using the master’s tools. Mostly, we look ridiculous with our “more research is needed” taglines—especially when there is no documented correlation, for example, between the volume of studies published and reductions in racial health inequities. This is distraction and obfuscation at its finest, the public health equivalent of “a more convenient season.”
Perhaps now more than ever, it should be clear that science and (what counts as) evidence are not what fundamentally drive policy decisions or the social and political activism that often animate them. Cis, straight, able-bodied White men have not held the social and economic powers and privileges they have—and health opportunities therefrom—because a nationally representative study “proved” something to voters or policy makers. Yet, here we are in 2021, weeks after an attempted coup by a subset of said (mostly) White men, waiting for science to “prove” 400-year realities to justify appropriate structural policy changes. It’s no longer a matter of insufficient evidence but a matter of being insufficiently political. And here, it only needs to be said once: Public health academia is a whole White moderate. Any honest pursuit of a beloved community within our field must begin by changing that.
As a start, we must be deliberate in the narratives we create about health equity, starting with our language (such as “achieve,” “disparities,” and “at-risk”). And as scholars, researchers, practitioners, community organizers, and everyday health champions, we must be unmistakably explicit about our goals and judicious in our choice of research questions, methods, dissemination venues, organizing tactics, and communication strategies—all of which, I suggest, must be rooted in antiracist, critical race, and decolonizing frameworks. And this, invariably, means we must stop pretending our work is apolitical or neutral—it is not, nor should it be. In the beloved community, you’re either about that business, or you’re not. And as a great poet once said, “ain’t no half-steppin’.”