An Approach to Tap the Enthusiasm of Progressive Democrats

To drive change it is necessary to tap into into the energy of progressives and bring back convictions that governments have a role to solve social problems and challenge the oligarchies. The progressive movement focuses on many issues including environmental and social justice. These movements tend to be silos. Progressives need to control ideas in order to challenge the political philosophy of the power elite that drive the political debate in Washington. How you label things is more important than how you debate them. Whoever controls the language controls the debate. They must embrace the language of the social determinants of health. The social determinants of health are the conditions in which people are born, grow, live, work and age, that is, their whole life cycle, encompassing not only the social, but also economic, political, environmental, cultural and individual determinants. The social determinants of health concept can help make the links between government policy, the market, and the health and well-being of citizens to surmount the barriers to change.

Individual and community health are determined by a vast array of external conditions and factors that involve housing, education, transportation, social networks and income, to name a few. We now know that these social determinants of health explain why life expectancy and good health improve in some communities and fail to advance in others.  Their impact can even be greater than that of the health care system itself. The consequences of poverty on health are well established and include lower life expectancy, higher disease burden, and poorer overall health. Inequality and inequity are not interchangeable. Inequity is unfair, unavoidable, differences arising from poor governance, corruption, or cultural exclusion. It is the result of human failure giving rise to avoidable deaths and disease. The social determinants of health are mostly responsible for health inequities – the unfair and avoidable differences in health status seen within and between countries.

People who suffer from adverse social and material living conditions also experience high levels of physiological and psychological stress. Stressful experiences arise from coping with conditions of low income, poor quality housing, food insecurity, inadequate working conditions, insecure employment, and various forms of discrimination based on disability, gender, or race. Institutional discrimination occurs when resources such as housing, quality, schooling, jobs, criminal justice and other social determinants of health are differently allocated among groups, even when following the explicitly stated “rules of the game.” When this type of discrimination is perceived by the target, it is seen as a major stressful life experience. Whether or not it is perceived by the target, institutional discrimination may trigger additional stressful life experiences, such as unemployment, exposure to poor-quality housing, and environment or stagnated social mobility. The lack of supportive relationships, social isolation, and mistrust of others further increases stress.

What are the policy implications of stress? The focus must be on the source of problems rather than dealing with symptoms. Numerous studies demonstrate that low socio-economic status (SES) individuals have increased stress levels. In addition, it is well known that poverty increases one’s risk for chronic health problems, such as severe depression and other mental illnesses, which hinder success in academics or work. These disorders make it much more difficult for low SES individuals to improve their situation through any form of economic advancement. While it is possible to fulfill the “American dream” and make a better life for oneself, that is not the case for most low SES individuals, especially after they leave school and start supporting a family. Therefore, an effective way to reduce stress and improve health is by improving the living conditions people experience.

The economic elite demand a dressed-up sophisticated economic theory be applied to society regardless of the outcome which has nothing to do with economics but everything to do with power. We now live in a world where those who can afford to spend the most money to have their version of it advertised widely control the debate. There are expectations that Joe Biden, who belongs to the mainstream of the Democratic Party, deliver change. Biden plans to create a public option for health insurance, a New Deal type program to counter the effects of COVID pandemic, as well as raise the minimum wage and invest in green energy. In addition, he supports expansion of tuition-free colleges, and universal preschool access. These would be paid for using money gained back from withdrawing the Trump-era tax cuts. These plans cover a wide swath of issues.

There are soul searching questions why the Democrats lost seats in the House and struggled in the Senate races in the 2020 election. Moderates are blaming the progressives. The real problem, said Alexandria Ocasio-Cortez, was that the party lacked “core competencies” to run campaigns, rather than, the ability of the republicans to create fear in the electorate over taking funds away from police departments and the “socialist” influence on policies by the progressives. Ocasio-Cortez has criticized the Democratic party for incompetence in a no-holds-barred, post-election interview with the New York Times, warning that if the Biden administration does not put progressives in top positions, the party would lose big in the 2022 midterm elections. She sees the need for ideas that keep young voters and minorities engaged in process towards change. The fact of the matter is Democrats need a process to control the level of fear that Republicans can create at election time.

Biden declares to the Black community, “You’ve always had my back, and I’ll have yours.” The impact of structural inequities follows individuals from womb to tomb.” For example, African American women are more likely to give birth to low-birth weight infants, and their newborns face higher infant death rates that are not associated with any biological differences, even for accounting for socio-economic factors. Although the science is still evolving, it is hypothesized that the chronic stress associated with being treated differently by society is responsible for these persistent differential birth outcomes. In elementary school there are persistent differences across racial and ethnic divisions in rates of discipline and levels of reading attainment, rates that are not associated with any difference in intelligence metrics. For many people, the challenges which structural inequities pose limit the scope of opportunities they have for reaching their full potential. It is important to consider how health of communities is dependent on the social determinants of health.

If groups want high-quality decisions with strong support for follow through, and they are willing to invest time to create a proposal or plan, they will benefit from consensus decision-making. Involving all group members in the discussion of issues and making decisions together is a powerful process. Biden needs a process to counter the power struggle between Democratic moderates and progressives. The best tool for him to develop cohesion is to apply the filter of the social determinants of health to structure the dialogue for input on proposals. Social determinants will include discussions on systemic racism, education opportunities, unemployment, and a comprehensive health care plan. Effective consensus building results in decisions that have been thoughtfully deliberated, incorporate diverse experience and views, and may produce the best possible decision given the configuration of interests that have come together for a given purpose.

By the end of the 20th century, individualism, happiness, and capitalism were part of the core values of Western culture. Individualism is the belief that one’s place in the societal hierarchy – their occupational class, income and wealth, and power and prestige as well as the placement such as health and disease status – comes through one’s own efforts, and the right to make free choices which feeds consumer capitalism. The philosophy of individualism promoted by the power elite provides the support within the general population that keeps this system of privilege in place. We need to ban making public policy decisions through the lens of individualism (which oversimplifies complex and multifaceted problems) and switch to filter social and economic policies through the lens of the social determinants of health before they are implemented to ensure they support actions that reduce inequities in the system.

Eating well and exercising are important, but the things that contribute most to our health are how much money we have and our status within our community. By adopting the social determinants of health inequities as the focus of change the Democrats will achieve three important benefits. The first is to take control the dialogue in Washington that is necessary to bring forward new ideas and legislation. The second is to have both the progressives and moderates sing from the same page of the hymn book with a standardized message format on the programs they want to introduce during the next session. This includes developing short term and long-term policies for key domestic issues such as addressing systemic discrimination, accessible health care for all, equitable employment and new green jobs. The third benefit is ongoing development of dialogue around proposals that describe long-term polices that will inform voters in the 2022 mid-term elections.

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