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Privilege and Policy, or Why We’re Always Angry with Congress


Congress can be frustrating. Beyond political affiliations and tactical alliances, navigating the actual policies created by Congress can be challenging. This causes many people, medical students included, to write off policy as “boring” or “irrelevant” to their careers. For medical students, nothing could be further from the truth. Everything from services covered by Medicare and Medicaid insurance policies to the types of research funded at the NIH are influenced in one way or another by policy. Inevitably, policy does not always reflect the realities of practice. One of the factors contributing to this disparity may be privilege.

What is privilege? Defined in Merriam-Webster as “a right or benefit that is given to some people and not to others,” privilege can manifest in many forms. In recent months, topics of racial privilege, economic privilege and sex and gender privilege have come to the forefront. As medical students, we must ask: how does this impact health policy, and how can we deconstruct a policy decision with this lens?

1. Racial-, gender-, sex-, sexual orientation-related privilege: 94 of 100 senators in the 113th Congress have identified their race as “white.” This racial homogeneity has a profound impact on policy formation. Certain experiences of isolation and oppression are intrinsic to the minority experience, and there is a growing body of research that suggests a link between internalized racism and negative health outcomes. Much like this, there is evidence that discrimination based on sex, gender and sexual orientation are related with negative health outcomes. Similar to the way medical students develop empathy via experiences on the floors, a Congress lacking in demographic diversity may struggle to adequately address the concerns of different minority groups — not because of a lack of interest in these issues, but from a lack of awareness.

2. Economic privilege: It takes money to enter politics. A study by Maplight found that it costs on average $2,315 per day to run a winning Congressional campaign for the House of Representatives in 2012, and $14,351 for a seat in the Senate. Now, consider the story of Ms. A in Philadelphia: her primary care provider felt she could benefit from psychotherapy; however, she struggled to find affordable care within a thirty mile radius. This left her with two choices for how to receive care: to miss several hours of work to drive fifty miles each way to a therapist covered under her insurance plan, or to pay significant fees out of pocket for a therapist closer to her place of work. When one is of significant means, it can be difficult to relate to this feeling.

It is easy to feel discouraged about the policy scene in light of these revelations. Don’t. There are many unintentional biases facing policy makers, chief of these in health policy is that the vast majority of Congress has never been to medical school. Or nursing school. Or worked as a physician assistant, physical therapist, psychologist, medical assistant or laboratory technician. They are — for the most part — only in tune with what they witness when they see a physician, or what they might hear from a briefing from someone with a background in health policy, but not necessarily health care.

While it may seem that only politicians can have a say in policy, this is not the case. In fact, there are many ways medical students can get involved in health policy and advocacy.

1. Pick up the phone: Call your congressperson’s office and set up an appointment either in their district office or in their DC office. Face-to-face meetings or phone calls are the perfect opportunities to share your anecdotal evidence from the field.

2. Join a lobby: It doesn’t have to be a formal lobbying organization, but parent organizations such as the American Public Health Association (APHA) have student sections which work to prepare policy agendas. Take two minutes to send in your opinion on a topic!

3. Respond to calls for comments: When a policy is proposed, often times congresspeople will open periods for comments. This is a chance for the public to send honest, informed feedback. Don’t miss it! The best way to find open periods for comments is to join a lobby or affinity group — often they will post links to various proposed policies and ask for feedback.

4. Find your voice: Take fifteen minutes a week to read about new policy on the table. Write a blog! Follow an interesting hashtag. Like some advocacy organizations on Facebook.

5. Join an event: Many medical schools host advocacy days or related events, consider attending or assisting in the planning of the event! If your school doesn’t have an advocacy themed event, propose the idea to your Student Government!

6. Sign petitions: The answer to the “I’m-too-busy-for-any-of-the-above”: add your name to a growing petition.

No one doubts that medical school is hard, nor that free time is a precious commodity. However, when the ultimate goal is to provide incredible care for each and every patient, clinicians have a responsibility to make sure they are able to do just that. By learning what the policy climate is, and by doing their part to raise their voices, medical students can be a part of coalition of future physicians hoping to make a better world for doctors, for their coworkers and for the communities they serve.

Aishwarya Rajagopalan Aishwarya Rajagopalan (16 Posts)

Writer-in-Training, Columnist and in-Training Staff Member

Philadelphia College of Osteopathic Medicine

Aishwarya is a second year medical student at the Philadelphia College of Osteopathic Medicine. She relishes any opportunity to talk policy, social determinants of health, mental health parity and inclusion topics. Outside of school, Aishwarya enjoys yoga, green tea with lemon and copious amounts of dark chocolate.

Doctor of Policy

Doctor of Policy is a column dedicated to exploring and challenging contemporary health policy issues, especially in the fields of behavioral health, health care access, and inclusion, all from the eyes of a public health girl in a basic sciences world