Time and space as operations of racism in healthcare


Hospital building with one side side: Sorry, We're Closed

In  this piece, Arianna M. Planey explains how spatial access to healthcare arises from processes of structural racism, and thereby contributing to the impacts of time as a social determinant of health that produces racial inequities in healthcare access and outcomes.

“We discuss the potential for health/medical geography to contribute to a policy-relevant geographical research agenda that remains attentive to social theory debates. We illustrate the importance of time as a social determinant of health, through the case study of racial/ethnic inequities in spatial access to acute hospitals in the U.S. South region amid rural hospital closures, conversions, and mergers, which have decreased the supply of hospitals since 1990. In sum, racial disparities in spatial access were most pronounced for travel distances/times to the nearest alternative hospital, underscoring the importance of both temporal and spatial equity.”

Planey, A. M., Wong, S., Planey, D. A., & Ko, M. J. (2022). (Applied) geography, policy, & time: whither health and medical geography?. Space and Polity, 1-13.



Doing the Work—or Not: The Promise and Limitations of Diversity, Equity, and Inclusion


Stuffed animals on a couch: baby yoda,stingray, hello kitty, owl

We talk about diversity all the time- are equity and inclusion just extra words?

Caitlin Jade Esparza MS4 explains the fundamental problems in DEI work at US medical schools:

“The catch-all term, “diversity, equity and inclusion” can thus allow institutions to hide behind language and skirt the difficult work of examining and uprooting the foundations upon which medicine has accumulated and concentrated power…”


Read the full commentary here:

Doing the Work—or Not: The Promise and Limitations of Diversity, Equity, and Inclusion in US Medical Schools and Academic Medical Centers


Healthcare Policy by Executive Order


In the absence of legislation around immigration reform, Barack Obama used executive actions to create policy, i.e. now we have DACA. Taking a similar page out of the presidential playbook, Donald Trump is using executive orders to bring about a retrenchment from the Affordable Care Act.

Today there was not one, but two, EOs that will increase uncertainty in the health insurance marketplaces, such as Covered California.

  1. Association Health Plans and Short-term Insurance: AHPs are plans for small businesses (and maybe self-employed individuals) who band together. Both AHPs and short-term plans can lead to a broader range of cheaper insurance options- in part because neither one has to meet ACA or state requirements, e.g. these plans do not have to cover essential health benefits such as prescription drugs (required for the marketplace plans). Healthy people who don’t need comprehensive coverage will be drawn to the cheaper AHPs and short-term plans, leaving behind sicker people in the marketplaces. The more sick people are packed into the marketplace, the higher premiums will go.
  2. Cost-sharing subsidies: These are payments that the federal government makes to help cover the costs of co-payments, deductibles, etc., for low-income people buying insurance in the marketplaces (over half of buyers).  Without the subsidies, health insurance plans will (and have already, due to uncertainty) increased premiums.

Both EOs could also make the cost of doing business in the marketplaces too high, and insurance plans may simply drop out.

*Now both EOs are likely to trigger lawsuits from states (1) and insurance companies (2) so it’s likely not much will happen yet. (2) can also be resolved by an act of Congress.

However, Congress has not yet renewed funding for the Children’s Health Insurance Program, employers are not required to offer plans with contraceptive coverage, and Puerto Rico–still struggling for clean drinking water and electricity– is on a Medicaid block grant.

I try to conclude these posts with a summary for implications for disparities- but they all seem to come to the same conclusion: if these EOs come to pass in the absence of other reforms, disparities by income, race and ethnicity, and gender, are all likely to widen. For all the new choices available, those with chronic and pre-existing conditions will likely see their premiums go up.