Discussant: Reflections on health reform and progressive change – an ecosocial perspective

As discussant, I will reflect on each speaker's views – including areas of agreement, disagreement, and uncertainty – about the US health reform law and what it means for progressive goals of rectifying inequities in both health and health care. Informing my remarks will be four considerations. First, we need to be explicit that inequities in health and health care are: (a) eminently political in nature, (b) intertwined, (c) “arise from inequities involving, singly and in combination, adverse working and living conditions and inadequate health care, as linked to experiences and policies involving socioeconomic position (e.g., occupation, income, wealth, poverty, debt, and education) and discrimination” (Krieger 2005), and (d) require asking, in each in every case, who benefits and who is harmed. Second, our analyses and remedies must be inclusive and hence address the embodied reality in which we all live. By this I mean we are not one day, say, a man or a woman, another professional or working class, still another white or a person of color, or US-born or foreign born, or non-Indigenous or Indigenous, or on yet another day straight or lesbian/ gay/ bisexual/transgender – we are all of these at once. Hence, just as our bodies daily integrate these aspects of our lives that together shape our health, so too must our thinking and actions. Third, we need to be imbued with a deep sense of history, recognizing both the possibilities of and obstacles to social change – and, as part of this, that we have much to learn not only from those who have come before but also those newly entering the fight, with the hope and enthusiasm of a new generation. Hence, fourth, we will do well to keep in mind the spirit of Emma Goldman and her many kindred spirits, because this is about not only critique but also making the alternative world we envision possible.