Resuscitating Equality

Bringing the Heartbeat Back to Healthcare

Authors

  • Sandy Rao University of Calgary

DOI:

https://doi.org/10.18060/27660

Keywords:

Health Equity, Equality, structural determinants, social justice, utilitarianism

Abstract

Within the evolving healthcare sector, the focus on health equity has led to interventions that, despite good intentions, often fall short. Recognized by a broad spectrum of healthcare professionals, including numerous social workers, as marginally better than inaction—colloquially referred to as “better than nothing,” these efforts risk overshadowing deeper structural and systemic issues. Consequently, they divert attention from the need for comprehensive solutions that genuinely address the roots of healthcare inequities. This manuscript delves into the nuanced interplay between health equity and equality through the methodology of critical analysis, drawing on the insights of critical social work and relevant theories of justice and power. While contemporary discussions increasingly restrict equality to uniform resource distribution, the core of social justice emphasizes equality’s deeper significance: recognizing the inherent worth of every individual, regardless of their background. The primary objective of this article is to advocate for the “resuscitation” of equality in healthcare, aligning it alongside health equity to ensure a comprehensive approach for individuals and families. A reductionist view of equality may cloud essential structural health determinants and compromise truly equitable care. The ramifications for social work are clear: a fervent advocacy for both equality and equity is indispensable. By embracing equity and equality in their most nuanced dimensions, we ensure that individuals, irrespective of their unique circumstances, receive care that is both just and tailored, elevating the benchmark in healthcare delivery.

References

Adams, R., Dominelli, L., & Payne, M. (Eds.). (2002). Critical practice in social work. Palgrave.

Alderson, P. (2021). Health, illness and neoliberalism: An example of critical realism as a research resource. Journal of Critical Realism, 20(5), 542-556. https://doi.org/10.1080/14767430.2021.1995689

Allan, J., Briskman, L., & Pease, B. (2009). Critical social work: Theories and practices for a socially just world (2nd ed.). Allen & Unwin.

Amis, J. M., Mair, J., & Munir, K. A. (2020). The organizational reproduction of inequality. Academy of Management Annals, 14(1), 195-230. https://doi.org/10.5465/annals.2017.0033

Amundson, R. (2005). Disability, ideology, and quality of life: A bias in biomedical ethics. In D. Wasserman, J. Bickenbach, & R. Wachbroit (Eds.), Quality of life and human difference (pp. 101-124). Cambridge University Press. https://doi.org/10.1017/CBO9780511614590.005

Andrews, E. E., Ayers, K. B., Brown, K. S., Dunn, D. S., & Pilarski, C. R. (2021). No body is expendable: Medical rationing and disability justice during the COVID-19 pandemic. American Psychologist, 76(3), 451-461. https://doi.org/10.1037/amp0000709

Atkinson, A. B. (2018). Inequality: What can be done? (Paperback ed.). Harvard University Press.

Ballan, M. S. (2008). Disability and sexuality within social work education in the USA and Canada: The social model of disability as a lens for practice. Social Work Education, 27(2), 194-202. https://doi.org/10.1080/02615470701709675

Bates, T. R. (1975). Gramsci and the theory of hegemony. Journal of the History of Ideas, 36(2), 351-366. https://doi.org/10.2307/2708933

Ben-Harush, A., Shiovitz-Ezra, S., Doron, I., Alon, S., Leibovitz, A., Golander, H., Haron, Y., & Ayalon, L. (2016). Ageism among physicians, nurses, and social workers: Findings from a qualitative study. European Journal of Ageing, 14(1), 39-48. https://doi.org/10.1007/s10433-016-0389-9

Beresford, P. (2016). From psycho-politics to mad studies: Learning from the legacy of Peter Sedgwick. Critical and Radical Social Work, 4(3), 343-355. https://doi.org/10.1332/204986016X14651166264237

Bettache, K., & Chiu, C.-Y. (2019). The invisible hand is an ideology: Toward a social psychology of neoliberalism. Journal of Social Issues, 75(1), 8-19. https://doi.org/10.1111/josi.12308

Blackorby, C., Bossert, W., & Donaldson, D. (2002). Utilitarianism and the theory of justice. In K. J. Arrow, A. Sen, & K. Suzumura (Eds.), Handbook of social choice and welfare (Vol. 1, pp. 543-596). Elsevier. https://doi.org/10.1016/S1574-0110(02)80015-7

Blackstock, C. (2020). Wanted: Moral courage in Canadian child welfare. First Peoples Child & Family Review, 6(2), 35-46. https://doi.org/10.7202/1068875ar

Boozary, A., & Laupacis, A. (2020). The mirage of universality: Canada’s failure to act on social policy and health care. Canadian Medical Association Journal, 192(5), E105-E106. https://doi.org/10.1503/cmaj.200085

Brodie, J. M. (2007). Reforming social justice in neoliberal times. Studies in Social Justice, 1(2), 93-107. https://doi.org/10.26522/ssj.v1i2.972

Campbell, C., & Baikie, G. (2012). Beginning at the beginning: An exploration of critical social work. Critical Social Work, 13(1), 67-81. https://doi.org/10.22329/csw.v13i1.5849

Canadian Association of Social Workers [CASW]. (2022). CASW social policy principles. Author. https://www.casw-acts.ca/en/governance/casw-social-policy-principles

CASW. (2024). Code of ethics, values and guiding principles. Author. https://www.casw-acts.ca/files/attachements/CASW_Code_of_Ethics_Values_Guiding_Principles_2024_0.pdf

Charles, J. L. K., Holley, L. C., & Kondrat, D. C. (2017). Addressing our own biases: Social work educators’ experiences with students with mental illnesses. Social Work Education, 36(4), 414-429. https://doi.org/10.1080/02615479.2017.1297393

Cho, S., Crenshaw, K. W., & McCall, L. (2013). Toward a field of intersectionality studies: Theory, applications, and praxis. Signs: Journal of Women in Culture and Society, 38(4), 785-810. https://doi.org/10.1086/669608

Collins, P., & Bilge, S. (2016). Intersectionality. Polity Press.

Conner, K. O., Koeske, G., & Brown, C. (2009). Racial differences in attitudes toward professional mental health treatment: The mediating effect of stigma. Journal of Gerontological Social Work, 52(7), 695-712. https://doi.org/10.1080/01634370902914372

Crash Course. (2016, November 21). Utilitarianism: Crash Course philosophy #36 [Video]. YouTube. https://www.youtube.com/watch?v=-a739VjqdSI

Crenshaw, K. (1990). Mapping the margins: Intersectionality, identity politics, and violence against women of color. Stanford Law Review, 43(6), 1241-1300. https://doi.org/10.2307/1229039

Cresswell, M., & Spandler, H. (2016). Solidarities and tensions in mental health politics: Mad studies and psychopolitics. Critical and Radical Social Work, 4(3), 357-373. https://doi.org/10.1332/204986016X14739257401605

Danermark, B. (2019). Applied interdisciplinary research: A critical realist perspective. Journal of Critical Realism, 18(4), 368-382. https://doi.org/10.1080/14767430.2019.1644983

Dietz, C. A. (2000). Reshaping clinical practice for the new millennium. Journal of Social Work Education, 36(3), 503-520. https://www.jstor.org/stable/23043527

Dominelli, L. (2017). Anti oppressive social work theory and practice. Bloomsbury.

Dore, I. (2019). Doing knowing ethically-Where social work values meet critical realism. Ethics & Social Welfare, 13(4), 377-391. https://doi.org/10.1080/17496535.2019.1598458

Dougherty, C. J. (1993). Bad faith and victim-blaming: The limits of health promotion. Health Care Analysis: HCA: Journal of Health Philosophy and Policy, 1(2), 111-119. https://doi.org/10.1007/BF02197104

Downey, M. M., & Thompson-Lastad, A. (2023). From apathy to structural competency and the right to health. Health and Human Rights, 25(1), 23-38. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9973510/

Dupré, M. (2012). Disability culture and cultural competency in social work. Social Work Education, 31(2), 168-183. https://doi.org/10.1080/02615479.2012.644945

Edwards, N., & Cohen, E. R. M. (2012). Joining up action to address social determinants of health and health inequities in Canada. Healthcare Management Forum, 25(3), 151-154. https://doi.org/10.1016/j.hcmf.2012.07.002

Eiler, E. C., & D’Angelo, K. (2020). Tensions and connections between social work and anti-capitalist disability activism: Disability rights, disability justice, and implications for practice. Journal of Community Practice, 28(4), 356-372. https://doi.org/10.1080/10705422.2020.1842278

Elliott, D. E., Bjelajac, P., Fallot, R. D., Markoff, L. S., & Reed, B. G. (2005). Trauma-informed or trauma-denied: Principles and implementation of trauma-informed services for women. Journal of Community Psychology, 33(4), 461-477. https://doi.org/10.1002/jcop.20063

Fante-Coleman, T., & Jackson-Best, F. (2020). Barriers and facilitators to accessing mental healthcare in Canada for Black youth: A scoping review. Adolescent Research Review, 5(2), 115-136. https://doi.org/10.1007/s40894-020-00133-2

Fennig, M., & Denov, M. (2019). Regime of truth: Rethinking the dominance of the bio-medical model in mental health social work with refugee youth. The British Journal of Social Work, 49(2), 300-317. https://doi.org/10.1093/bjsw/bcy036

Gitterman, A. (2014). Social work: A Profession in search of its identity. Journal of Social Work Education, 50(4), 599-607. https://doi.org/10.1080/10437797.2014.947898

Glouberman, S., & Millar, J. (2003). Evolution of the determinants of health, health policy, and health information systems in Canada. American Journal of Public Health, 93(3), 388-392. https://doi.org/10.2105/AJPH.93.3.388

Haegele, J. A., & Hodge, S. (2016). Disability discourse: Overview and critiques of the medical and social models. Quest, 68(2), 193-206. https://doi.org/10.1080/00336297.2016.1143849

Hankivsky, O., Doyal, L., Einstein, G., Kelly, U., Shim, J., Weber, L., & Repta, R. (2017). The odd couple: Using biomedical and intersectional approaches to address health inequities. Global Health Action, 10(sup2), 73-86. https://doi.org/10.1080/16549716.2017.1326686

Harvey, D. (2007). A Brief History of Neoliberalism. Oxford University Press.

Harvey, G., & Kitson, A. (2016). PARIHS revisited: From heuristic to integrated framework for the successful implementation of knowledge into practice. Implementation Science, 11(1), 1-13. https://doi.org/10.1186/s13012-016-0398-2

Hattersley, R. (2006). Is equality outdated? The Political Quarterly, 77(1), 3-11. https://doi.org/10.1111/j.1467-923X.2006.00724.x

Health Quality Ontario. (2016). Health Quality Ontario’s Health Equity Plan. Author. http://www.hqontario.ca/portals/0/documents/health-quality/health_equity_plan_report_en.pdf

Houston, S. (2012). Response: Reviewing the coming crisis in social work: A response to Longhofer and Floersch. Research on Social Work Practice, 22(5), 520-522. https://doi.org/10.1177/1049731512441264

Hugman, R. (2009). But is it social work? Some reflections on mistaken identities. British Journal of Social Work, 39(6), 1138-1153. https://doi.org/10.1093/bjsw/bcm158

Hugman, R., Pittaway, E., & Bartolomei, L. (2011). When “do no harm” Is not enough: the ethics of research with refugees and other vulnerable groups. British Journal of Social Work, 41(7), 1271-1287. https://doi.org/10.1093/bjsw/bcr013

Illich, I. (1982). Medical nemesis: The expropriation of health. Pantheon Books.

International Federation of Social Workers. (2018, July 2). Global social work statement of ethical principles. Author. https://www.ifsw.org/global-social-work-statement-of-ethical-principles/

Islam, F., Multani, A., Hynie, M., Shakya, Y., & McKenzie, K. (2017). Mental health of South Asian youth in Peel Region, Toronto, Canada: A qualitative study of determinants, coping strategies and service access. BMJ Open, 7(11), 1-11. https://doi.org/10.1136/bmjopen-2017-018265

Iyer, S. N., Boksa, P., Lal, S., Shah, J., Marandola, G., Jordan, G., Doyle, M., Joober, R., & Malla, A. K. (2015). Transforming youth mental health: A Canadian perspective. Irish Journal of Psychological Medicine, 32(1), 51-60. https://doi.org/10.1017/ipm.2014.89

Jewson, N. D. (2009). The disappearance of the sick-man from medical cosmology, 1770-1870. International Journal of Epidemiology, 38(3), 622-633. https://doi.org/10.1093/ije/dyp180

Khan, M., & Absolon, K. (2021). Meeting on a bridge: Opposing Whiteness in social work education and practice. Canadian Social Work Review / Revue Canadienne de Service Social, 38(2), 159-178. https://www.jstor.org/stable/27117851

Kitson, A. L. (2009). The need for systems change: Reflections on knowledge translation and organizational change. Journal of Advanced Nursing, 65(1), 217-228. https://doi.org/10.1111/j.1365-2648.2008.04864.x

Kitson, A., Powell, K., Hoon, E., Newbury, J., Wilson, A., & Beilby, J. (2013). Knowledge translation within a population health study: How do you do it? Implementation Science, 8(1), 1-9. https://doi.org/10.1186/1748-5908-8-54

Kubiak, S. P., Ahmedani, B. K., Rios-Bedoya, C. F., & Anthony, J. C. (2011). Stigmatizing clients with mental health conditions: An assessment of social work student attitudes. Social Work in Mental Health, 9(4), 253-271. https://doi.org/10.1080/15332985.2010.540516

Lalonde, M. (1974). A new perspective on the health of Canadians: A working document [ Nouvelle perspective de la santé des canadiens]. Minister of Supply and Services Canada. http://www.phac-aspc.gc.ca/ph-sp/pdf/perspect-eng.pdf

Longhofer, J., & Floersch, J. (2012). The coming crisis in social work: Some thoughts on social work and science. Research on Social Work Practice, 22(5), 499-519. https://doi.org/10.1177/1049731512445509

Low, J., & Theriault, L. (2008). Health promotion policy in Canada: Lessons forgotten, lessons still to learn. Health Promotion International, 23(2), 200-206. https://doi.org/10.1093/heapro/dan002

Luxford, K. (2016). ‘First, do no harm’: Shifting the paradigm towards a culture of health. Patient Experience Journal, 3(2), 5-8. https://doi.org/10.35680/2372-0247.1189

Mahabir, D. F., O’Campo, P., Lofters, A., Shankardass, K., Salmon, C., & Muntaner, C. (2021). Experiences of everyday racism in Toronto’s health care system: A concept mapping study. International Journal for Equity in Health, 20(1), 1-15. https://doi.org/10.1186/s12939-021-01410-9

May, G. E., & Raske, M. B. (2005). Ending disability discrimination: Strategies for social workers. Pearson Allyn and Bacon. http://books.google.com/books?id=bmtHAAAAMAAJ

McFarling, U. L. (2021, September 23). ‘Health equity tourists’: How white scholars are colonizing research on health disparities. STAT. https://www.statnews.com/2021/09/23/health-equity-tourists-white-scholars-colonizing-health-disparities-research/

McGorry, P. D., Purcell, R., Hickie, I. B., & Jorm, A. F. (2007). Investing in youth mental health is a best buy. Medical Journal of Australia, 187(S7), 5-7. https://doi.org/10.5694/j.1326-5377.2007.tb01326.x

Ministry of Health and Long-Term Care. (2009). Health Equity Impact Assessment (HEIA)—Ministry programs—Health care professionals—MOHLTC. Author.

Mooney, G. (2009). Is it not time for health economists to rethink equity and access? Health Economics, Policy and Law, 4(2), 209-221. https://doi.org/10.1017/S1744133109004848

Mullaly, R. P. (2002). Challenging oppression: A critical social work approach. Oxford University Press.

Mullaly, R. P. (2007). The new structural social work (3rd ed). Oxford University Press.

Mullaly, R. P. (2010). Challenging oppression and confronting privilege: A critical social work approach (2nd ed). Oxford University Press.

Oliver, M. (2009). Understanding disability: From theory to practice (2nd ed.). Palgrave Macmillan.

Oliver, M. (2016). Rewriting history: The case of the Disability Discrimination Act 1995. Disability & Society, 31(7), 966-968. https://doi.org/10.1080/09687599.2016.1213054

Oliver, M., Sapey, B., & Thomas, P. (2012). Social work with disabled people (4th ed.). Palgrave Macmillan.

Organisation for Economic Cooperation and Development [OECD]. (2023). Infant mortality rates [dataset]. Author. https://doi.org/10.1787/83dea506-en

Peters, S. M. (2019). Medical neoliberalism in rape crisis center counseling: An interpretative phenomenological analysis of clinicians’ understandings of survivor distress. Journal of Social Issues, 75(1), 238-266. https://doi.org/10.1111/josi.12316

Potts, M. (2020). The Hippocratic Oath, medical power, and physician virtue. Philosophia, 49, 912-922. https://doi.org/10.1007/s11406-020-00276-5

Relman, A. S. (1980). The new medical-industrial complex. New England Journal of Medicine, 303(17), 963-970. https://doi.org/10.1056/NEJM198010233031703

Roulstone, A. (2013). Vic Finkelstein, disability rights and lessons for contemporary social work. Critical and Radical Social Work, 1(2), 247-252. https://doi.org/10.1332/204986013X673308

Sanders, J. E. (2021). Teaching note—Trauma-informed teaching in social work education. Journal of Social Work Education, 57(1), 197-204. https://doi.org/10.1080/10437797.2019.1661923

Shapiro, J. (2018). “Violence” in medicine: Necessary and unnecessary, intentional and unintentional. Philosophy, Ethics, and Humanities in Medicine, 13(1), 1-8. https://doi.org/10.1186/s13010-018-0059-y

Shmerling, R. H. (2020, June 22). First, do no harm. Harvard Health Blog. https://www.health.harvard.edu/blog/first-do-no-harm-201510138421

Sobočan, A. M., Bertotti, T., & Strom-Gottfried, K. (2019). Ethical considerations in social work research. European Journal of Social Work, 22(5), 805-818. https://doi.org/10.1080/13691457.2018.1544117

Solas, J. (2008). What kind of social justice does social work seek? International Social Work, 51(6), 813-822. https://doi.org/10.1177/0020872808095252

Solas, J. (2018a). Deserving to deserve: Challenging discrimination between the deserving and undeserving in social work. Journal of Social Work Values and Ethics, 15(2), 62-70. https://www.jswve.org/wp-content/uploads/2018/12/10-015-209-JSWVE-2018.pdf

Solas, J. (2018b). Is it just enough? Journal of Sociology & Social Welfare, 45(2), 1-17. https://doi.org/10.15453/0191-5096.4120

Sotto-Santiago, S. (2019). Time to reconsider the word minority in academic medicine. Journal of Best Practices in Health Professions Diversity, 12(1), 72-78. https://www.jstor.org/stable/26894228

Tawney, R. H. (1964). Equality. Allen & Unwin.

Teo, Y. (2018). This is what inequality looks like: Essays. Ethos Books.

Tonelli, M., Tang, K.-C., & Forest, P.-G. (2020). Canada needs a “Health in All Policies” action plan now. Canadian Medical Association Journal, 192(3), E61-E67. https://doi.org/10.1503/cmaj.190517

Weinberg, M. (2019). Structural social work: A moral compass for ethics in social work. Critical Social Work, 9(1), 1-6. https://doi.org/10.22329/csw.v9i1.5761

Whitley, R. (2018). Men’s mental health: Beyond victim-blaming. The Canadian Journal of Psychiatry, 63(9), 577-580. https://doi.org/10.1177/0706743718758041

Yao, Q., Li, X., Luo, F., Yang, L., Liu, C., & Sun, J. (2019). The historical roots and seminal research on health equity: A referenced publication year spectroscopy (RPYS) analysis. International Journal for Equity in Health, 18, 1-15. https://doi.org/10.1186/s12939-019-1058-3

Yu, T. (2006). Challenging the politics of the “model minority” stereotype: A case for educational equality. Equity & Excellence in Education, 39(4), 325-333. https://doi.org/10.1080/10665680600932333

Zaner, R. M. (1988). Ethics and the clinical encounter. Prentice Hall.

Downloads

Published

2024-10-29