Regardless of topic, all epidemiologists will spend time understanding equality. Trump’s (and others’) election have demonstrated that the biggest battle to realizing a more equal world is not about resources, outreach or policy effort. It’s about what humans (do not) want to do.
Our studies further the notion of equal social status because they give inherent value to the fight. Whether just deciding to adjust for race/sex/ethnicity because we know group X is inherently worse off than others, whether its studying disease outcomes in ‘vulnerable’ groups, or whether it’s about the effect of health insurance, the examples are infinite. But time and time again, we show the relative health disadvantage of marginalized groups. The implicit message: more resources, more outreach and more policy effort targeting those who need it the most. While admitting it means crossing the much-dreaded line into advocacy , it is clear we are secretly imagining a world where disadvantage due to characteristics inherited at birth is gone. If everyone did well, half of epidemiology would disappear.
Unfortunately, such a world will be stalled by those who stand something to lose. Trump’s win, Viktor Orbán, Brexit, Pegida, Marine Le Pen….have demonstrated that the desire for social power trumps (no pun) any broad desire to give everyone a chance. Yes, poverty, disaffection, and loss of political voice (the problems of type of voter that effectively led to Trump’s and Brexit’s victory) are sad. No doubt, large groups of people have seriously lost out on our ‘new economy’. But these factors alone are not what caused the recent voting and ideological trends. The missing piece? It’s poverty, disaffection, and loss of political voice among those who were once all but guaranteed it.
Maybe we over-estimate humanity. The election of Trump and others are as much referendums on whether historically excluded groups deserve a better chance, as they are driven by a belief in the urgency of restoring a social identity that was once the pride of certain demographics. People like Mr. Trump here or Mr Farage in the UK did not create this belief: they merely gave it permission to fly. We hope that it is a small minority, but it is not. Which leaves us with a dilemma. How can we fight for the best programs, policy and interventions to improve equality when humanity’s desire for inequality is so strong?