Monday, August 9, 2010

Embracing the Uncomfortable

Posted by Katherine Lao, CCRMC Graduate Student Intern / MPH Candidate / UC Berkeley School of Public Health

Prior to working for CCRMC, I spent some working in programs referred to as “health-pipeline” programs that worked towards addressing health disparities by developing healthcare professionals from underserved and underrepresented backgrounds. I was a 20-year old intern at that time, and I immensely grateful for these programs to opening the world of healthcare, diversity, and social justice to me. In many ways, the students that I have met and their passions, motivations and inspirations for going into the field of healthcare have also become mine.

While I personally did not live in disparity, I spent a good amount of life growing up around it. I was born and raised in a middle class/upper middle class family in Manila, Philippines, and I remember daily pictures of families living underneath bridges, street children selling cigarettes or knocking on car windows to make a living, and next door neighbors without the resources to take care of their sick children. Poverty surrounded me every single day and while I constantly wondered why it was that way, I had also learned to accept it as the norm and had somehow became numb to the suffering around me.

I went back to the Philippines for the first time three years later (back in 2003), and I clearly remember the culture shock and the pervasive feeling of discomfort I felt in the three months that I was there. Poverty seemed hidden and invisible in the Silicon Valley suburb I had grown accustomed to, and here I was once again confronted by daily reminders of suffering and poverty. Amidst all this, I was among the company of affluent friends and family who entertained me at beautiful resorts, posh restaurants, and daily luxuries. Manila has been consistently described as a “city of contrasts” with the economic gap between the rich and poor blatantly obvious to many of its citizens. Latest reports show that even amidst economic growth between 2000 and 2006, poverty incidence in the country in fact grew worse.

Nationally, the US does not fare any better:
  • The top 1% of the U.S. population holds more wealth than the bottom 90% combined. During the past 25 years, while the rich became richer, the net worth of the least affluent 40% of American families fell by half.

  • People in the highest income group can expect to live, on average, at least 6.5 years longer than those in the lowest. Even those in the middle (families of four making $41,300 to $82,600 a year in 2007) will die, on average, two years sooner than those at the top.

  • More African American, Native American, Latino and Pacific Islanders are in poor or fair health than whites at practically every income level (although recent Latino immigrants report better health).

  • In 2002, Former U.S. Surgeon General Dr. David Satcher and colleagues calculated that if Black and white mortality rates were equal, 83,570 African Americans would not have died. That’s 229 “excess deaths” per day: the equivalent of an airplane loaded with Black passengers being shot out of the sky and killing everyone on board every single day of the year.

    Source: Unnatural Causes Amazing Facts

Here in Contra Costa,

  • While Whites make up more than half (52.9%) of the population, and represent the greatest number of deaths; African Americans are at the greatest risk for poor health outcomes and suffer significantly higher death rates from all causes combined than county residents overall and than Whites, Latino, and Asians.

  • Contra Costa communities with the highest percentage of low-income and non-white residents – San Pablo, Richmond and Pittsburg - experience higher death and disease rates than the county overall for many chronic and communicable disease, injury and maternal and child health issues.
Source: 2007 Community Health Indicators for Contra Costa Report

We, too in fact, are a nation of contrast.

After several years of liberal Berkeley education, I remain, if not more even more, uncomfortable with these disparities. Even after several trips back home in the recent years, the pervasive feeling of discomfort remains in the back of mind and I still struggle with simultaneously juggling the two worlds of poverty and privilege all within the same place.

I shared these feelings of frustration with a mentor a couple of years back after my trip to rural South America. I shared with him my frustrations, and the guilt I felt in being in a position of privilege with an education and the ability to venture off and volunteer abroad for two months. His advice has stuck with me since then, “channel all that frustration and anger into something productive – something useful that could contribute something to the world,” he said. “Instead of complaining and wondering why things are the way they are, ACT and work towards making it better.”

In light of remembering his advice, I have also come to recognize that perhaps I need to EMBRACE my discomfort with the concept of disparities. Perhaps because it is this discomfort with inequality that continues to push me to change things and make them better. That discomfort has been the one true source of motivation in my career. In some ways, I do not ever want to be comfortable knowing that gaps in quality care, income, health, education and social justice exist…because being comfortable means being complacent and being complacent means doing nothing…and doing nothing means status quo…and that in turn, means that people continue to suffer.


  1. Dear Katherine,

    Thank you for this powerful, personal reflection and glimpse into your passion to fight health disparities and social inequities. I have been one to experience much discomfort with these issues, as well, most especially in regards to the seriously and persistently mentally ill. Challenging the status quo is my mantra in regards to all harm, pain, and suffering.

    I have enjoyed observing your social conscience influence the improvement efforts of the Behavioral Health System of Contra Costa County. We are so fortunate to have your bright, compassionate perspective to remind us to embrace our discomfort with all disparities. You will be a force in the fight to "...making it better."

    My Best...Teresa

  2. Juliette Kelley11 August, 2010 15:32

    This is beautiful, Katherine. Thank you.

  3. Thank you Katherine for your introspection. In a world of over-stimulation and competing priorities, you have done well to remind us that ignoring the 'noise' and resting on our laurels leads to nothing but complacency, acceptance of the unacceptable, and ultimately, inertia.

    We are social beings, and we value and push each other to be better - to have greater impact, and lead better lives. We forget that everyone deserves to be healthy enough to have the opportunity to make this difference in the lives of others. Thank you for sharing - your public self-reflection serves as spiritual grounding and is a strong motivating reminder of what we are here to accomplish.