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The Professional Socialization of Medical Students and it’s Ramifications.

Doctors are regarded as the ultimate authority in the field of medicine. They enjoy unparalleled prestige, autonomy and dominance not seen by most other professions. This authority comes from two facts, the fact that medicine is over represented by White men and the fact that medicine is a highly technical and science-based discipline. In American society today, White males are still considered the embodiment of authority and intellect, and American culture values scientific knowledge. Medical students are trained within this context.

Medical school is long, expensive and difficult process. It is rigorous, hierarchical culture requiring students to master a lot of technical information about body systems. That can naturally lead a person to think of patients less as “people” and more as a collection of parts that needs to be fixed, sort of like a car. This is referred to as a mechanistic model of the body. This model combined with the American belief that one should be emotionally detached in order to make good decisions is supported and propagated in medical school. Also, the very essence of medicine is intervention. Doctors, and by extension medical students are trained in the belief that they must take proactive action to correct maligned body functions rather than letting the body heal itself.

The benefit of this type of training is you get highly competent doctors that do a lot of good for people.

One of the more devastating consequence of this is that a lot of “upstream” problems can be overlooked because of the absolute deference given to doctors. “Emotional detachment can lead doctors to treat patients insensitively and to overlook the emotional and social sources and consequences of illness.” (Weitz, 2010 :275). Furthermore, doctors are not immune to the biases and prejudices that afflict most of humanity. Because of that you end up with situations where minority people may not be given the same treatment and respect as majority people and that can have serious life or death consequences.

                                                                    References

The Sociology of Health, Illness, and Health Care: A Critical Approach. Rose Weitz. Seventh Edition, 2010

The Perils of the Working Poor. Poverty’s Vicious Cycle

The more popular cultural narrative that is pushed in America is the notion that in a capitalist democratic society like the U.S the only thing that separates the Haves and the Have nots is a willingness to work hard and apply oneself. Within that context poverty is often viewed as a moral failure, a consequence of a lack of initiative and industry, and it is considered an indicator of some integral deficiency in a person’s character. I contend that this view obfuscates the structural and historical context of American society and its role in maintaining exploitative class structure and by extension poverty. In this paper I intend to describe the difficulties that Poor and Working-Class people face and to juxtapose that against the advantages of Middle- and Upper-Class people in similar scenarios. This paper will also briefly discuss Class structure, poverty, and the minimum wage.

In trying to understand the difficulties of Poor and Working-class people, I feel it is necessary to conceptualize the idea of class itself and how it is viewed in American society. Historically and globally, classes can be thought of as groups of people divided hierarchically in a society with limited or no movement allowed between the groups. These divisions are usually based on power, status, or wealth. This definition of class is normally viewed as antithetical to the American idea up upward mobility and opportunity. However, a cursory observation of the U.S shows different lived experiences of people that effectively (if not legally), resembles a definition of class as it is viewed in the historical sense. In the U.S, a person’s class is largely a function of their occupation, income, and wealth. These factors also introduce a level of status that is directly proportional. The more prestigious a person’s occupation in combination with a high income means a higher status. This idea is summed up in an individual’s Social Economic Status (SES).

Using this reckoning we can broadly divide the U.S in to three major classes: Upper, Middle, and Lower class. The lived experiences for people in each of these groups are fundamentally different and many of the obstacles of the Lower Class are structural and self-perpetuating.

Three things to keep in mind regarding people of Lower SES are: Sources of income, The Federal Poverty Line, and the Minimum Wage. These three factors along with social inequalities work in tandem to create a self-perpetuating climate of poverty. It is worth briefly discussing the three.

Many Americans main source of wealth is in their primary residence (their house), and the primary source of income is their job. They are in effect exchanging time for money. Among the Upper Class, who generally enjoy wealth that was inherited, much of their income comes in the form of Capital Gains. Capital Gains is money that is earned through the sale of investment products like stocks and bonds.

This is an opportunity to visualize how structurally one group is advantaged versus another and how it can be self-propagating. The United States has a progressive tax system that aims to tax Low- and Middle-Class people at a proportionately lower rate than the Upper -Class. In theory the amount that one pays in taxes is indexed to rise with income. People that must work for income often pay their taxes through payroll deductions. “ The U.S. payroll tax is often considered a flat tax because it taxes all wage earners at the same percentage. However, as of 2016, this tax is not applied on earnings over $118,500, and as a result, it is only a flat tax for people earning less than that amount. Taxpayers earning more than that amount pay a lower percentage of their total income in the payroll tax, making the tax regressive.” (https://www.investopedia.com/terms/p/progressivetax.asp). Lower- and Working-class people spend a greater portion of their income on necessities like food, clothing, and shelter. Even though lower SES people pay a lower percentage of their income on taxes the burden is functionally harder. For example, let’s consider two hypothetical people. If person A makes $30,000 dollars a year and is taxed at 20%, their annual take home pay will be $24,000. If Person B makes $500,000 a year and is taxed at a higher rate of 30% their after-tax income would be $350,000. Given the costs associated with housing, healthcare, and food we can see how person B is in a much better position than person A even though person A is taxed a lower rate. The absolute, raw dollar amount of $350,000 can better meet a person’s needs annually than $24,000. This is further reinforced by the fact that Capital gains income is taxed differently and at a lower rate that regular wages. This strengthens the Upper SES’s ability to save and invest more than someone in the Middle to Lower SES.

When trying to understand the challenges of affordable living it’s important to delve into the minimum wage and the Federal Poverty line. “The Federal Poverty Level (FPL), or the “poverty line” is an economic measure that is used to decide whether the income level of an individual or family qualifies them for certain federal benefits and programs. The FPL is the set minimum amount of income that a family needs for food, clothing, transportation, shelter, and other necessities.” (https://www.investopedia.com/terms/f/fpl.asp). The Minimum wage is the lowest amount that an employer can legally pay a person for their labor. Certain types of workers are exempt such as waiters and bartenders and obviously doesn’t count the work done by undocumented immigrants. In states where the State Minimum wage is absent or lower than the Federal minimum wage, the worker is entitled to the higher federal salary. Conversely if the state minimum wage exceeds to federal level then the worker is entitled to the higher state salary.

How the two work together informs us how well a person can meet their financial needs. The Federal Poverty line is a measure of income and the number of people that composes a household. The U.S Department of Health & Human Services for 2019 sets the poverty level at $12,490 a year for a single member household. (https://aspe.hhs.gov/2019-poverty-guidelines). A person making the federal minimum wage of $7.25 an hour has a gross annual income of $13,920. This hypothetical person is above the poverty by $1,430 but has very little disposable income for emergencies, savings or educational investments. This precarious situation can be helped or hurt by increasing the number of people in the household that either can or can not work. So, if we add another member to the household that is also making minimum wage you have a combined income of $27,840. The Federal poverty line for a two-person household is $16,910. That is a difference $10,930 which is a significant increase from the $1,430 from the earlier example. If we however add non employed person instead, we have a household that is $2,990 below the Federal Poverty line.

So far, we looked at some metrics that indicates how a person’s SES correlates to their lifestyle and financial security without regard to societal influences like race, and gender. In her book Nickel and Dimed: On (Not) Getting by In America, author Barbara Ehrenreich explores the intersectionality of all these factors and some of the paradoxical effects of poverty incurring greater expenses. She accomplishes this my leaving her Upper-Class lifestyle to embark on a journey of low wage jobs in order to gain firsthand insights on the plight of the working poor. The book was first published in 2001, but the challenges outlined in the book is still applicable almost 20 years later in 2019. It is worth taking a similar look at a hypothetical single mother of two earning minimum wage, living in contemporary metropolitan Atlanta.

In Georgia the Minimum wage is $7.25 per hour (290.00 a week). One of the ways the minimum wage is calculated is by using the Consumer Price Index(CPI).”The Consumer Price Index (CPI) is a measure that examines the weighted average of prices of a basket of consumer goods and services, such as transportation, food, and medical care.”( https://www.investopedia.com/terms/c/consumerpriceindex.asp). One the most essential expenses of a person is the cost of housing and that is not included in the CPI. For a minimum wage earner this presents the first and most challenging objective. As of 2019, in Atlanta the average price for a one-bedroom apartment is $ 1,460 per month (average square footage around 978 feet). (https://www.rentcafe.com/average-rent-market-trends/us/ga/atlanta/)

Here is how this one aspect (housing cost) can potentiate other problems. The first is by restricting where a person can live. The Buckhead Community of Atlanta is a coveted area that has access to plenty of amenities to include parks, good schools, hospitals, and stores that sell healthy foods. A low SES person making minimum wage can not afford to live there unless they either take on roommates, work an extreme amount of overtime, or sacrifice in other areas of essential spending like healthcare. The more likely and feasible solution is to simply move into a lower priced part of town. A manageable rent for this person is around $348 per month (that’s 30% of the monthly income). https://www.apartmenttherapy.com/how-much-rent-you-can-really-afford-renters-solutions-186462) Discounting the challenges of availability, a reasonable expectation is somewhere in the area of around $600-700 a month. An apartment at this price point is likely to be in a low-income neighborhood. Low-income neighborhoods are by nature unequal and there is a link between poor neglected areas and the likelihood of being a victim of and committing crime. In her paper Inequality And Crime, Morgan Kelly concludes” … the impact of inequality is large, even after controlling for the effects of poverty, race, and family composition.” Furthermore, low-income areas are usually in areas that are considered “food deserts”. The USDA defines Food deserts” …as parts of the country vapid of fresh fruit, vegetables, and other healthful whole foods, usually found in impoverished areas. This is largely due to a lack of grocery stores, farmers’ markets, and healthy food providers.” (http://americannutritionassociation.org/newsletter/usda-defines-food-deserts). Being in a designated food desert coupled with a lack of parks and open green spaces increases the risks of preventable diseases thereby raising the cost of healthcare on an already vulnerable population. This is a position that is less likely to happen to people of greater means.

To further add to the burden of affordable housing as it relates to healthcare costs, we must also consider other cascading factors. One way of coping with the stresses of low SES is by smoking. Smoking likewise raises the risks of preventable disease. Low SES people are less likely to having health insurance which means that a lot of times the primary healthcare provider is the emergency room. ER costs can run into the hundreds and thousands of dollars, placing further economic burdens on a person. Low income areas are also more likely to suffer from environmental toxin exposures than an upper income area would. Exposure to these environmental toxins also increases the risks of health problems and their associated costs. Finally, low SES individuals are less likely to participate in the political process which decreases their tendency to combat business and governments from placing polluting structures in their areas. Where a person lives determines a lot of ancillary effects that can have profound impact on a person’s health and wellbeing. All of this can be mitigated by more money and resources.

In the proceeding scenario we have not included the cost of public transportation, childcare, and utilities. These other costs only make the challenging goal of financial security more onerous. The biggest long-term affect is that outsized financial burdens inhibits a person’s ability to provide educational investments in their children thereby decreasing the likelihood of exceeding the parent’s SES. Additionally, White Cultural hegemony in the U.S propagates negative racial and gender stereotypes that can very often get internalized, creating a self-fulfilling prophecy of criminal behavior and educational underachievement. This is an example of structural problems creating individual behavioral problems. These individual behavioral problems can lead to low graduation rates, criminality, subsequent incarceration leading to an inability to earn wages, marry, and do the other things helpful in achieving financial security.

In conclusion I believe that the most concrete and practical solution is an increase in the federal minimum wage to $15.00 an hour. Income and financial security are directly proportional. Less money equals less security, so it follows that more money equals more security. Next I believe that we need a national return of the prominence of Unions and their abilities in collective bargaining. Collective bargaining would shift the power imbalance of employees and employers more towards the workers. This would further help eliminate the problem of income inequality. Finally, there has to be a continued effort at eliminating the system of advantage based on race that currently operates in the United States.

 

 

 

 

 

 

 

 

 

 

 

 

References

6.) https://www.apartmenttherapy.com/how-much-rent-you-can-really-afford-renters-solutions-186462)

7.) (http://americannutritionassociation.org/newsletter/usda-defines-food-deserts

 

How It Was Versus How It Could Have Been. A Summary Of Two Lives.

How it was…

I suspect that my story in its broader outlines mirrors many others. I was born on October 6th,1970 in New Orleans, Louisiana to two Black parents. I was the youngest of five boys and there is a fifteen- year difference between me and my youngest brother. My mother had me at forty years old and my father was fifty-five years old when I was born.

The neighborhood I grew up in could be described as a Black Working\Middle class neighborhood. On my block there was one White family. There were seven houses on the block and five of them were owned while the remainders were rentals (We rented). Crime was relatively rare, but it was not a fabled “you could leave the doors unlocked” type of neighborhood or time. One night when I was about ten years old my mother was robbed at gunpoint on our front porch.

I went to an elementary school that was, I believe, to be average performing. In my household and in my school the importance of education was stressed to me. Being born into a middle -class lifestyle meant that I didn’t want for food, or shelter. I had no such concerns and my family had enough money so that I never qualified for free or reduced lunch. My mother was an avid reader and so the house was always filled with books. I remember she would always buy whatever book, magazine or comic book I wanted, and I remember when she once ordered me a set of encyclopedias called Childcraft.  I am a voracious reader today because of that. I struggled with math so that was and remains a challenge for me. My family could not afford private tutors and I don’t remember if my school offered after\before school tutoring. My mother had enough education to understand and help me with the math I was having trouble with. I can envision many parents not being able to do so.

Moving on to middle school some issues began to surface in my home life. The first being that my dad was diagnosed with diabetes, atherosclerosis and Alzheimer’s disease. At the same time by next older brother moved in with us and he was addicted to cocaine. Later, my oldest brother moved in with us too and he was likewise addicted to drugs. My mother worked from 5 pm to 11 pm and so it fell to me to take care of my dad and to keep a watch out for my brothers. Middle school through high school was difficult because my dad started losing more and more cognitive function and he became progressively more difficult to care for. My brothers got worse with their addictions and their behavior became more dangerous. All the while I was expected to stay and do well in school and to stay out of trouble. I believe that(paradoxically), the fact that I had those abnormal responsibilities kept me out of trouble because I essentially had no social life. The impact though is that today I still find social situations awkward and often prefer my own company.

I was an average student in high school. Although I continued to struggle in math I managed to graduate and get accepted into the University of New Orleans. No one in my immediate family graduated from college. Two out of my four brothers dropped out of high school. I had no role models to emulate (college types). I had no support system at home to help me. I did not have good academic habits or discipline and so I ended up on academic probation a lot. People generally think I’m a very intelligent person, but I never realize my full potential. I think that is a correct assessment. Eventually I dropped out of college and join the army with getting a degree.

In the army I served 8 years. I re-enlisted and got accepted into the U.S Army’s Academy of Health Sciences program for Cardiovascular Technology. Those same bad habits I had plagued me in that program, and I end up being recycled and sent through the program again. I graduated, left the army and have enjoyed a career that has been professionally and financially rewarding as a Registered Cardiovascular Invasive Specialist. I have since returned to school (Saint Leo) to pursue a degree in Sociology. My life to this point can be summarized as” fortune from unfortunate circumstances.” Although my life could have turn tragic, I was lucky to have good people looking out for me and to have grown up in a household where I didn’t worry about food or shelter. Overall, to this point I have been very lucky, and I feel grateful.

How it could have been…

I was born in New Orleans on October 6th,1970 to two wonderful parents. My father was a cardiac thoracic surgeon at LSU Medical Center and my mother was an attorney that came from a long line of politicians with a deep history in New Orleans. I grew up in an exclusive neighborhood off St Charles avenue with my only sibling, a sister. There are no Black people that live in my neighborhood. From everything I see on TV I don’t think they would fit in here very well anyway. This is a nice area and I wouldn’t want any trouble.

As a child I did well in school, but I had a bit a trouble with math. Luckily Dad got me a private tutor, to work with me and I finally get it and excel. Life was pretty good growing up. We often traveled out of the country once a year and I got to visit mom and watch her work in the court room from time to time. I’m fascinated with the law and think that I might want to become a lawyer someday.

Later, when I was about ten years old my dad was diagnosed with Alzheimer’s disease and so he had to stop working.  We had to hire someone to care for him, it was difficult watching him like that but at least he received outstanding care until his passing. High school was great. I was the captain of the debate team and we went (but didn’t win the nationals). I graduated as valedictorian thankfully to the outstanding tutors and mentors I have had.

When it was time to go college, the choice was clear. I would attend Tulane university. I was lucky enough to get in because of legacy admissions and the enormous amount of “donations” my family made to the university. I eventually graduate Magnum Cum Laude with a degree in political science. I get accepted and graduate law school in ’96. Since passing the Bar in ’98 I’ve been a practicing attorney for close to thirty years now. I am now entertaining the idea of running for a newly vacated senate seat. We shall see. If I were to summarize my life, I would say it would have to be one of “fortunate circumstances”. I was born a White male, in America to a wealthy family. My life could have so many more obstacles, but I have been lucky, and I recognize that.

The lesson of two different and same people…

In comparing my real life to the fictionalized account, I tried to give the alternate version the same innate challenges. The differences in resources, money, and social standing has led to diametrically different outcomes. Although I consider myself accomplished, how much more could I have achieved if I wasn’t burdened with the responsibilities of a sick brother and drug addicted siblings. If I had a legacy of professional people in my family maybe I would have done better in college and never went into the military in the first place. It’s impossible to tell but I think it is reasonable to assume that the effects of race, privilege and social status has an out sized impact on a person’s life with respect to the effort the expended. I believe that, underprivileged people have a harder time with everything when compared to more privileged people even in the cases where the both work just as hard.

Social Inequality

Social inequality is a noticeable fact of life in the United States and around the world. The first time I remember noticing it was when I was a little boy around 6- or 7-years old living in New Orleans. I would notice, especially in my neighborhood, that the cars driven by White people were always nicer looking and without damage as opposed to the cars I saw being driven by Black people. I asked my mom about that fact and she said it was because Black people don’t often have the money to afford repairs or expensive cars. It was one of the first moments in my life when I started to associate Whiteness with money/status/resources.

I think the ultimate origin of all social inequality comes down to tribalism. I think that in most cases that tribalism is realized in the form of racism and ethnicism. There is a slight bit of nuance though to my feelings of social inequality. I believe that a good paradigm for understanding society combines a bit of the functionalist theory and a lot of the conflict theory of social thought. I believe that social inequality is inevitable and desired. Like Durkheim I feel that society has certain essential roles that must be fulfilled. These roles are more difficult and should be rewarded accordingly. However, applying the Conflict Theory I believe that different groups(races) unfairly monopolized resources (wealth, jobs, income) and drive the disproportionate inequalities seen in minorities.

So, when considering the United States and its history of inequality, we should first acknowledge the fact that the nation was founded predominately by White men. White men “othered” American Indians and acquired their lands for the purposes of expansion. Being the dominant culture in America also means that cultural narratives and “truths” are controlled by that culture. White men enslaved Black people to physically lay the foundations of this nation. Paying enslaved people and granting them freedom and a level playing field would have threatened the elevated status, wealth and class of White people. As in the case of the American Indians, Black people where “othered” in order to justify the inhumane and brutal treatment of those people.

The elevated status of White people in the country allowed them to pass on their status to  successive generations. At the same time the increased access to money and power led to almost universal political power and that power led to an ability and willingness to pass laws advantaging them and disadvantaging others. The power over messaging (Control of media outlets) allows the White culture to perpetuate negative and dangerous stereotypes. The stereotypes while false becomes cultural truths and are often internalized by oppressed groups. These groups will often act in accordance to these images and create a self-fulling prophecy of inequality. Practices like Jim Crow, lynching, denying the GI bill to Black veterans, Redlining, and other discriminatory practices also further depressed attempts for equality in this nation.

Over time these differences along with the White Affirmative action of government agencies, and the over representation of Whites in the Judicial, financial and housing industries, leaves a legacy of inequality and injustice that persists despite the progress made by Black people and other minorities.

I believe that in a Utopian world free from racism and discrimination that there would still be inequalities, but those inequalities would be spread out evenly among the different groups in proportion to their numbers in society. I feel that would be a more just and fair society. I think that the goal shouldn’t be equality of outcome but rather equality of opportunity. If we had equality of opportunity then the individual talents, traits and work ethics of individuals would be the differentiating factors. I believe that individual barriers are much easier to overcome than structural/societal barriers.

Tendrils Of Power

Not too long ago I finished a book by Naomi Alderman titled The Power. It’s a story about a world where women posses the power of electricity and how that changes gender roles and politics around the world. The opening chapters describes the fractal appearance, of lightning discharges, tree root systems and the like. That book got me to thinking about the nature of power and influence and its bearing on American life.

In America, just as its always been in the world those with power are the ones that controls what happens. People with power are loathe to give up the privilege and influence that comes with power. In this country nothing symbolizes power more than money. Those with money influences politicians, messaging (through the media), and the criminal justice system. Businesses with enough cash can donate to the coffers of those running for office thereby insuring their mutual beneficial interests. The owners of media conglomerates can perpetuate stereotypes of any kind and those depictions often become the truth in the minds of many viewers. If you’re rich and commit a crime you are far less likely to be jailed than if you are poor and commit a crime.

With so few people controlling so much of the wealth in this nation it can be disheartening to the average person that wants to make change. Decisions like Citizens United seem to nullify the voices of individuals while amplifying the voices of corporations. Elected officials doing their job badly get elected over and over while clearly criminal presidents go un impeached. While it may seem hopeless it’s important to know that it is not hopeless and we are absolutely not without power. We arguably have the most powerful role in American society and that is the role of citizen.

The power of the citizen is embedded in our US Constitution. Those elected to lead us derive their power from the citizen so ultimately it is the citizen that is the ultimate authority. The power we have though sometimes doesn’t seem as obvious as compared to those with money and influence. It’s a power that is often subtle, and slow moving but ultimately it is the strongest there is I liken it to a blades of grass or a plant root system. Sure a lawn mover is used to cut grass but left unchecked grass can destroy the foundations of houses and cities. In much the same way our power can cause drastic changes in a society but I believe it takes four principles to exercise that power: Belief, Knowledge, Action, and Engagement.

Belief. In politics as in life belief in your success can be summed up in this poem:

The Man Who Thinks He can

by Walter D. Wintle

If you think you are beaten, you are;

If you think you dare not, you don’t.

If you’d like to win, but think you can’t

It’s almost a cinch that you won’t

If you think you’ll lose, you’re lost,

For out in the world we find

Success begins with a fellow’s will;

It’s all in the state of mind.

If you think you’re outclassed, you are.

You’ve got to think high to rise.

You’ve got to be sure of yourself before

You can ever win a prize.

Life’s battles don’t always go

To the stronger or faster man;

But sooner or later the man who wins

Is the one who thinks he can.

Essential to affecting change is the belief that it is actually possible. If you are already convinced that an endeavor is impossible then you are more than likely going to be right. We have to be willing to take the leap of faith first and then wait for the evidence.

Knowledge : No one is uplifted or made better by being ignorant. There is a reason why the slaves were prohibited from reading. We must educate ourselves on issues and policies and how they influence our lives. We most certainly have to understand how to distinguish between credible and non credible sources of information. In this internet connected world we live in being ignorant( or just stupid) is a choice. We can’t be lazy in this. We have to do the hard work of learning about anything we don’t understand so that we may make better decisions about who we elect to lead us.

Action: All the knowledge and the belief in the world does no good if we don’t put it into action. To that end we must register to vote. We must get others to vote and then actually vote on Election Day. We must volunteer time and money to causes and candidates that reflect our values and concerns. If we’ve found someone we believe in then why not canvass for them or work for their campaign. What ever it is you do, standing on the sidelines and hoping for better is not going to cut it. Every major change we’ve had in this nation is because ordinary people stood up and demanded it. We must do the same.

Engagement. Everyone’s view of how things should be is shaped by their experiences. We are a nation of many points of view but among reasonable people there is room for compromise. The only way to do this is to engage with people that may not share our views. Engagement gives you perspective and a broader understanding. Understanding, patience and tolerance is sorely needed in our national discourse.

Most of us are not rich, famous or elected officials. Most of us are citizens and as such we ultimately are responsible for the direction this nation goes. We can no longer afford to be apathetic bystanders. Now more than ever is the time to work together and make this nation and world a better place for all of us.