May 19, 2025
Prompt, "Read both documents thoroughly. PHL THIR theory discusses a constant. The National Academies conclude that racial and ethnic disparities have hardly changed. This does suggest a constant in this epoch. Write extensive and analytical essay elaborating on this. Assess the validity of a constant in light of the National Academies report."
By Grok under the supervision of Dr. Williams
The concept of a "constant" in the context of racial and ethnic health disparities provides a lens through which to examine the persistent and seemingly intractable nature of inequities in health care. Public Health Liberation’s (PHL) Theory of Health Inequity Reproduction (THIR) introduces this constant as a representation of deeply entrenched structural inequities that resist change absent significant societal transformation. Meanwhile, the National Academies of Sciences, Engineering, and Medicine’s 2024 report, Ending Unequal Treatment: Strategies to Achieve Equitable Health Care and Optimal Health for All, concludes that racial and ethnic disparities in health care have hardly changed over the past two decades, suggesting a stability that aligns with the idea of a constant within the current epoch. This essay elaborates on the notion of a constant, assesses its validity in light of the National Academies’ findings, and explores its implications for understanding and addressing health inequities.
Defining the "Constant" in PHL’s THIR Theory
In PHL’s THIR framework, the "constant" is a critical component of the equation for health inequity reproduction, expressed as:
Health Inequity Reproduction = Constant (Structural Inequity) × [(Desire for Change × Material Benefit) / Constraints]
Here, the constant symbolizes the persistent structural inequities—such as systemic racism, economic disparities, and historical oppression—that underpin health disparities. These inequities are described as "formidable and deeply entrenched," requiring seismic societal shifts, akin to those during the Civil Rights Movement or the Emancipation Proclamation, to alter significantly. The PHL document posits that while other variables (desire for change, material benefit, and constraints) can fluctuate, the constant reflects a baseline level of inequity that persists across time unless disrupted by transformative events. This formulation acknowledges that some structural factors are so ingrained that they maintain health disparities despite interventions, aligning with Derrick Bell’s racial realism, which suggests that racial equity may never be fully achieved without radical change.
Evidence of Persistence from the National Academies Report
The National Academies’ report provides empirical grounding for the idea of a constant by documenting the stagnation of racial and ethnic health disparities over the past 20 years. Key findings include:
Life Expectancy: Significant gaps persist, with Black Americans experiencing higher rates of premature death compared to White Americans, a disparity that has not narrowed substantially since the 2003 Unequal Treatment report.
Maternal and Infant Mortality: Black women face maternal mortality rates three to four times higher than White women, and infant mortality rates show similar persistent disparities.
Chronic Diseases: Conditions like diabetes, hypertension, and cardiovascular disease continue to disproportionately burden minoritized populations, with little progress in closing these gaps.
The report’s conclusion that disparities have "hardly changed" over two decades suggests a stability in health outcomes that mirrors the THIR constant. It attributes this persistence to structural factors, including a health care system that "by its very design, delivers different outcomes for different populations," alongside broader societal forces like structural racism and economic inequality. The economic burden of these inequities—estimated at over $421 billion for minoritized populations in 2018—further underscores their entrenched nature, as does the lack of sustained progress despite policy efforts like the Affordable Care Act (ACA).
Assessing the Validity of the Constant
The alignment between the National Academies’ findings and PHL’s THIR constant is striking, lending credence to the idea that a persistent structural inequity underlies racial and ethnic health disparities. Several points support this validity:
Empirical Consistency: The report’s data on stagnant disparities across multiple health indicators (e.g., life expectancy, maternal mortality) corroborates the THIR constant’s premise of a baseline inequity that resists change. This consistency suggests that the constant is not merely a theoretical construct but a reflection of observable reality.
Structural Roots: Both documents identify structural racism and systemic design flaws in the health care system as key drivers of inequity. The National Academies highlight how historical policies (e.g., residential segregation) and ongoing discrimination shape health outcomes, paralleling PHL’s view of the constant as encompassing historical trauma and structural violence.
Resistance to Incremental Change: The report notes that while interventions like the ACA have improved access for some, they have not significantly reduced overall disparities. This aligns with THIR’s assertion that the constant requires more than incremental reforms, supporting the idea that superficial efforts fail to disrupt deeply rooted inequities.
However, the validity of the constant is not without challenges:
Variability and Intersectionality: The National Academies report discusses intersectionality, noting that disparities vary by geography, gender, and socioeconomic status. This variability might suggest that the constant is not uniform across all contexts, potentially weakening its universality. Yet, PHL could argue that these variations occur within the bounds of the constant, as structural inequity adapts to different circumstances while maintaining overall disparity.
Modest Progress: Some areas, such as insurance coverage gains under the ACA, show improvement, particularly for minoritized populations. This could imply that the constant is not entirely fixed. PHL might counter that such gains are insufficient to shift the constant significantly, as they do not address the root structural causes.
Emerging Interventions: The report identifies promising strategies (e.g., community-centered care) that could reduce disparities over time. If successful, these might challenge the permanence of the constant. However, their current limited scale and unrealized impact reinforce PHL’s view that transformative change is needed to redefine the constant.
Overall, the National Academies’ findings strongly support the validity of the THIR constant within the current epoch. The persistent nature of disparities, despite decades of effort, suggests that a structural baseline—akin to the constant—continues to reproduce inequity.
Implications of the Constant
Recognizing a constant in health inequity reproduction has profound implications:
Limits of Incrementalism: Both documents suggest that small-scale interventions are inadequate against the constant’s entrenched nature. The National Academies’ call for systemic change echoes PHL’s emphasis on seismic shifts, implying that policies must target structural roots rather than symptoms.
Focus on Liberation: PHL’s emphasis on liberation—overcoming illiberation and fostering community agency—offers a pathway to challenge the constant. The National Academies’ advocacy for community engagement aligns with this, suggesting that empowering affected populations could disrupt the status quo.
Policy and Research Directions: Accepting the constant necessitates a shift in public health strategy toward structural interventions (e.g., addressing SDOH comprehensively) and accountability mechanisms, as both documents recommend. It also calls for research to quantify the constant and identify thresholds for transformative change.
The National Academies’ conclusion that racial and ethnic health disparities have hardly changed over two decades provides robust evidence for the validity of PHL’s THIR constant within this epoch. This constant, representing deeply entrenched structural inequities, explains the persistence of disparities despite efforts to mitigate them. While challenges like variability and modest progress exist, they do not undermine the core idea that a baseline inequity resists change absent radical transformation. Addressing this constant requires moving beyond incrementalism to systemic, liberation-focused strategies that tackle the structural foundations of health inequity, offering a path toward meaningful equity in health care.
