The usefulness of health disparity: Stumbling blocks in the path to social equity

Health disparities in the United States have declined little over the past century despite far-reaching technological advances and, especially since the 1980s, heightened consciousness of the problem. Their persistence can be explained in large part by their usefulness to those who hold and seek to consolidate power. Among other things, health disparities help in bolstering master-subservient relationships; shoring up the ideology of rugged individualism; maintaining bureaucratic structures and jobs; providing plausible public enemies; monitoring upstream social ills; and sustaining a flow of research funding. Conditions likely necessary for ameliorating health disparities include open and mutual recognition of several often veiled realities concerning power relations: money equals power; power translates into access to resources; those who hold power are reluctant to part with it; those who lack power serve as convenient scapegoats; and institutions evolve so as to ensure their own survival. Health disparity will remain exceedingly difficult to eradicate so long as health inequities continue to perform useful functions in ways that seem cost effective for groups and individuals seeking to secure their power. A readiness to work around stumbling blocks in the path to equity-arrived at via frank and equitable discourse among community members and leaders in pursuit of vital community goals-will likely hinge upon heightened awareness not only of the cumulative economic burden imposed by health inequality but also of the extent to which even the most powerful are intrinsically dependent upon other members of the community.