Maha Bali’s latest blog post on Unpacking terms around equity, power and privilege has got me thinking (actually, I was thinking about it just yesterday, but her post has prompted me to write more about it!). I’m slowly making my way through Freire’s Pedagogy of the Oppressed.
“But their perception of themselves as oppressed is impaired by their submission in the reality of oppression” (p. 45)
I’m trying to put this all in context to my research – looking at my lived experience as a breast cancer patient. I am struggling with some of the language. Is what patients experience oppression or is it simply a power imbalance – which doesn’t necessarily mean oppression? But then Freire has me asking myself if my perception is impairing my ability to see the reality?
Is it oppression when the end goal is caregiving rather than profit making? The purpose of the healthcare system is to care for patients, although there is certainly a level of profit making that is at play. In the US, there are a lot of times when your insurance affects your treatment options. Insurance companies seem to be the ones holding the power here, rather than medical professionals. In that essence, it is both the physicians / care providers and the patients who are in the subservient /oppressed role.
“the oppressed, who have adapted to the structures of domination in which they are immersed, and have become resigned to it, are inhibited from waging the struggle for freedom so long as they feel incapable of running the risks it requires” (p. 47).
As a patient, there is a risk of me rocking the boat too much. If you complain too loudly in the US system, you run the risk of being fired by your healthcare providers. That being said, if your healthcare providers suck too much, you often have the ability to change providers. If the ACA (Affordable Care Act otherwise known as Obamacare) gets revoked, then there is a huge risk of the patients who are the worse off already, being unable to get insurance. This adds a layer to the disempowerment of patients. In Canada, what I’ve seen in this situation, is that the patient just loses access to care completely. If you complain loudly enough, doctors stop seeing you – and you don’t always have options (especially if you are located in a rural setting).
Another place where I personally see struggle is around wait times. In the US, I am privileged to have good insurance. This means that I have easy access to healthcare. In many cases, the wait times are short. I’ve come to the expectation that I get responses from my care team within 48-hours of sending in an email requires. That type of response is unheard of in Canada (frankly, so is emailing care providers!). If I need to wait a couple months for a procedure or specialist appointment, I find myself complaining – but the reality it, my privilege in the US means that I have access that far exceeds what I’d get in Canada.
Canada has a much more equitable system, but it suffers from huge wait times. In Canada, the only privilege I carry is that I’m educated enough to ask questions. I’m able to figure out aspects of the system that others cannot, and yet I’m still placed in the queue just like everyone else. My privilege does not buy my way to the front of the line, but it does give me the information I need to ask the necessary questions to ensure that I’m waiting in the shortest line.
And so, I’m in the position of having adapted to the structures of domination, and I know a fair bit about how to play the games I need to play to get things done. With that, I’m hesitant to want to rock the boat, for fear that it would impact my personal healthcare.
“Any situation in which ‘A’ objectively exploits ‘B’ or hinders his or her pursuit of self-affirmation as a responsible person is one of oppression” (p. 55)
So this goes right back to my original question. When I’m looking at the patient experience within the healthcare systems, is that one of oppression? The system is intended do provide care, not exploitation. There are definitely power imbalances within the system, but does a power imbalance mean oppression? What do you think?