Inequity In Dutch Healthcare: A Series

Beeld door Mirthe de Haas

There is no place that is as safe as under the care of a doctor. Well, at least that's what we expect. It's also what we are promised: newly graduated doctors swear that they want the best for their patients and that they do everything they can to give them the care they deserve. To them, it doesn't matter what you look like, what your language skills are, or what you have between your legs. It's a nice promise, but how much of it is noticeable in practice? When you go to the doctor as a white man, you feel that that promise is kept. The experiences of a Black, queer woman can be very different. The systems in the Netherlands are not as neutral as they seem. In fact, inequity in healthcare is one of the most harrowing and dangerous forms of institutional discrimination in our country. 

Not the same, but with equal importance
In order to fully understand why inequity in healthcare is so dangerous, I would like to explain the difference between inequality and inequity. Where inequality refers to the difference between people, inequity highlights the value attributed to those differences. Simply put, we're all different (thankfully!), that's not the problem. The problem lies in the value judgment we have about the things in which we differ from another person (or a group of people). It should be clear that such value judgments shouldn't exist, especially not among healthcare providers - where we should all be equally safe. And yet they are there, although some healthcare providers muay not even be fully aware of them. 

The white man as the norm
We have known for a long time that white men get payed more than women and people of color. The fact that artificial intelligence is currently the most beneficial for white men is also becoming increasingly apparent. An underexposed problem is that white men are also the norm in healthcare. What happens if your physical symptoms are not recognized by your doctor, because they are only used to recognize physical symptoms of white men? What should you do if the inequity in which you live (or survive) on a daily basis is the base for your physical complaints, but this is not recognized or acknowledged by anyone?

In 2020, racism in healthcare received attention within the Dutch media. At the end of 2021, articles were written about the role of sex and gende in health and disease. Another factor that plays a role, but which remains underexposed, is the effect of socioeconomic status on health. A 2019 study shows that people of low socioeconomic status live shorter and in poorer health. The less you resemble the standard of white, average-earning man, the less attention you get in healthcare. That's distressing.

A four part series
An intersectional approach to inequity in healthcare has not yet received sufficient attention, while it is a problem that literally costs lives. This needs to change. In the coming year, I will therefore investigate how inequity in Dutch healthcare manifests itself in various disciplines.

In March, I will focus on birth care. The only form of care in which, as standard, at least two people's lives are at stake at once.
In May, I will share more about preventive care. As obvious as taking a Pap smear or taking part in breast examinations may be for some people, the options are not the same for everyone.
In July I will write about general practitioner (GP) care. The GP in our country is the first place you should go if you have a health-related problem. How accessible is this form of care to everyone? And what effect does that have?
In September I will conclude with an article about mental health care. How safe is it to use mental health care? And why does that differ per person?

Hopes and wishes
My wish is that we are all able to visit our doctor with that same, self-confident feeling. That every physician understands our complaints, no matter where we come from, how we look and what our complaints might be. That everyone is taken seriously and that the battle for equity that is being waged right now, will someday be nothing more than a chapter in a history book. I hope that I can contribute to that. During my investigation I will use my experiences as a midwife, but also my experiences as a hijab-wearing Woman Who Sometimes Goes To The Doctor's As Well. By writing this series, I'm participating in a battle for equity. It is necessary that institutional inequity stops with us. I can see it happening already!