Your healthcare work is already political.
And as long as health inequities exist, it always will be.
It’s a balmy fall day, and I’m sitting in a lecture hall with 80 of my peers. Anticipation infuses the air as we cross into the professional phase of our clinical doctorate program following an intensive summer of anatomy exams and lab practicals.
The professor opens class with a simple prompt: “Why did you decide to become a physical therapist?”
People around me share stories about rehabilitating from injuries or witnessing their loved ones recover with the help of a therapy team. The responses were effused with values of service and care for others.
The question this professor posed was not, to my knowledge, intended to spark a political discussion. And it didn’t. In fact, over the course of my six years of study, the politics of “helping people” was scantly addressed. But helping people is - and has always been - political.
It’s why we’ve witnessed US-backed air raids targeting hospitals and healthcare workers in Gaza. It’s why bills restricting access to gender-affirming care are becoming law. It’s why our elected officials are banning and criminalizing abortion in disregard of their constituencies’ opinions.
Where politics exist that seek to erase, unalive, and repress groups of people, healthcare, with its aim of keeping people alive and strong physically, mentally, and spiritually, is inherently political.
Healthcare gets a say in the question, “Who gets the opportunity to stay alive, to stay strong?”
And in the United States, layers of hierarchy* dictate our answer to that question.
Race. In a country that has enshrined racism into its social order, healthcare practice has historically served to reinforce that order. Black Americans encounter discriminatory prescribing practices, lower-quality care, and higher rates of abuse and neglect at the hands of healthcare providers.
Insurance status. Healthcare systems mine the benefits of the well-insured and wealthy while holding the uninsured and underinsured at arm’s length.
Access. People living in well-resourced communities with well-staffed, well-funded healthcare infrastructure receive a higher quality of care than people in poorly-resourced communities.
Likeability/believability. People who are believed by their healthcare providers, who have a “real” diagnosis, are more likely to receive timely, coordinated care, while people with certain chronic conditions or mental health diagnoses are often stigmatized and shuffled around.
Disability and neurodivergence. Healthcare institutions and providers frequently deny disabled and neurodivergent people the same right to bodily autonomy and informed consent that they grant to abled, neurotypical people.
Body size. Fat patients are more likely to receive substandard care from providers whose clinical judgment is clouded by their anti-fat assumptions and biases.
Carceral/immigration status - People who are ensnared in the tendrils of our criminal and/or immigration system receive substandard, if any, healthcare services.
*This list is not comprehensive.
“Who gets the opportunity to stay alive, to stay strong?”
Every day, our practices contribute to the answer. If we approach our work without grounding into intentional politics of care, we may find ourselves unwittingly contributing to the dominant politics of care. Rather than challenging or dismantling these hierarchies, we may find ourselves defending and reinforcing them.
Engaging with the politics of our care is deep, slow, uncomfortable work. It requires us to peel apart our positionality and relationships within these hierarchies. It challenges us to practice accountability for the human, social impact of our practice. For who and what we prioritze. For the integrity, fairness, and justness of healthcare itself - even as our healthcare authorities act with impunity.
But opting out of that work - “helping without an agenda” - does not make us apolitical. The agenda has been set.