Healthcare and the four freedoms

four freedoms

The 511

For information in the 20th century, we called 411. The 511 includes: 

  • a handful of paragraphs about health tech or some other science-y thing
  • 1 sentence for reflection (and maybe a laugh), and 
  • 1 track I’ve currently got in heavy rotation.

Talking with the SCOTUS about freedoms

And then there were nine. Justice Amy Coney Barrett gets some new threads for her wardrobe — just in time to determine the fate of the Affordable Care Act, it seems. Barrett, of course, made headlines when asked to list the five freedoms of the First Amendment: “Speech, religion, press, assembly … I don’t know — what am I missing?” Senator Ben Sasse tossed her the bone of “redress” of grievances. Here’s the full text:

First Amendment Rights - The Association for Women in Communications
The Constitution, from back in the day.

Great stuff, but let’s go bigger — namely, back to FDR’s State of the Union, 1941. The “Four Freedoms Speech” highlighted the freedoms of speech and worship (codified above), along with the freedoms from want and from fear. In this speech (full text here), FDR acknowledged that democracies in Europe were under assault and the US had an obligation to defend its allies. The freedom from want and the freedom from fear, respectively, appealed to the universal need — the human right — for economic security and freedom from aggression between nations.

Now it took awhile, but shortly after the close of the cold war, global poverty declined year over year for 25 years — until this year. War, of course, remains an all-too-steady feature of contemporary life.

I want to focus here on want as a key feature of American health disparities across racialized lines. For example: Black Americans aged 35 to 44 experience Covid-19 mortality rates that are nine times higher than their white counterparts. In pre-pandemic times, disparities in life expectancy were comparably frightful. “For COVID-19 to raise mortality as much as racial inequality does,” notes Elizabeth Wrigley-Field, “it would need to erase two to three decades of mortality progress for whites.”

Back to want and fear (in a more general sense): the two go hand-in-hand. The eight million Americans who have fallen below the poverty line since May (and, presumably, lost their employment-tied healthcare) have a right to be terrified. No pandemic-related relief is expected from Congress for another three weeks. (Recent studies indicate that over 114 million Americans lack health insurance or are underinsured.)

So … I’m just mapping out some parameters here, a series of threads to weave together in a future piece. These include:

  • the growing acceptance of Zoom-based education
  • the absurd level of debt incurred by students in medical school
  • the challenges faced by (and provisional solutions offered to) underrepresented groups in STEM disciplines in post-secondary education (here, to begin)
  • the decline in the number of Black male doctors in the US (here), and
  • community-driven solutions to health disparities (here)

And, since the AMA is the 7th biggest lobbyist in the country, I have an idea of how to pay for it. Thanks for checking this out.

5(1)1 — On the need for a renaissance of hope

The infinite promise of American youth — a promise elaborately articulated by movies and advertisements and university prospectuses — has been an empty lie for so long that I notice my students joking about it with a black humor more appropriate to old men, to the veterans of wars.”

Zadie smith, from intimations (2020)
51(1) — In rotation: Van Morrison’s “Astral Weeks”

When the colors of fall roll in and the wind turns brisk, I think more of Morrison’s Moondance than Astral Weeks. But this track (and nearly every track on the album) help lift the weight of this strange historical moment. Hail to the music that helps us to straighten our backbones and do what needs to be done. Here ya go.

Astral Weeks - Rolling Stone
Astral Weeks, 1968.

If you like this stuff, and you know someone interested in health, leadership, and music, all mixed up with a dash of humor, please spread the word.

I’m also on this thing called Twitter (@randaldoane). While it may be a passing fad, drop me a note, if you like what you see.

If you want to talk about a project with words, drop me a line over here.



Reducing achievement gaps in undergraduate general chemistry could lift underrepresented students into a “hyperpersistent zone” BY R. B. HARRIS, M. R. MACK, J. BRYANT, E. J. THEOBALD, S. FREEMAN, SCIENCE ADVANCES, 10 JUN 2020 : EAAZ5687 /

Elizabeth Wrigley-Field. US racial inequality may be as deadly as COVID-19. Proceedings of the National Academy of Sciences Sep 2020, 117 (36) 21854-21856;

Jamila Taylor. “Racism, Inequality, and Health Care for African Americans,” The Century Foundation, December 19, 2019.

National Academies of Sciences, Engineering, and Medicine; Health and Medicine Division; Board on Population Health and Public Health Practice; Committee on Community-Based Solutions to Promote Health Equity in the United States; Baciu A, Negussie Y, Geller A, et al., editors. Communities in Action: Pathways to Health Equity. Washington (DC): National Academies Press (US); 2017 Jan 11. Available from: doi: 10.17226/24624

Laurencin, Cato T, and Marsha Murray. “An American Crisis: the Lack of Black Men in Medicine.” Journal of racial and ethnic health disparities vol. 4,3 (2017): 317-321. doi:10.1007/s40615-017-0380-y

Published by Randal Doane

Living the good life in NE Ohio. I dig science and the written word. Let's build something amazing together.

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