Arrianna Marie Planey, PhD Profile picture
Medical Geographer \ Incoming Asst Prof @unchpm \ health services research, social theory, health justice \ @Cal @UChicago @Illinois_Alma alum \ Tweets mine
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12 Jul 20
The idea that paying people to stay home during a pandemic isn’t “cost-effective” is possible under a status quo where health is seen as an individual characteristic & responsibility, & thus, HC costs must be borne by individuals, regardless of the structural drivers of illness
If anything, a pandemic shows us the limits of methodological individualism in biomedicine & public health.

But that doesn’t mean that limit is heeded as the least protected & most marginalized individuals are expected to bear the weight of state failure.
Read 3 tweets
29 Jun 20
Why I resist the framing of "racism is a SDoH!":

"The #SDoH framework similarly allows certain “acceptable” structural problems to become visible and treatable, while downplaying problems that might more substantively challenge the structures that the framework operates within."
1) Racism is a fundamental cause
2) The SDoHs are structured by racism & other forms of oppression within society
3) The framework addresses downstream effects of racism, not racism itself. It does not grasp the root.

Read 9 tweets
12 Jun 20
We’re not going to medicalize our way out of the social inequities that are killing Black, indigenous... folks.
Just as we’re not going to medicalize our way out of the social inequities that are killing LGBTQI2... folks. Gender & sexual orientation have long been medicalized (frequently as a ‘deviation’ from a heterosexist & cis-sexist norm) & it has not brought us well-being or justice.
I’ll spell it out:

Medicalization is a sure fire way of making people & communities who bear the brunt of social inequities into *the social problems*.

And frequently, medicalization demands individual-level solutions based in the same stigma that produces health inequities.
Read 5 tweets
6 Jun 20
Ok, despite my reservations about anti-racist reading lists, I’ll tweet a short list based on my surrender bookshelf. This list is mostly aimed at people in the biomedical/health sciences.
This list is not limited to being ‘anti-racist.’ It covers topics at the intersection of racism, professional hierarchies in healthcare, biomedical research, & social policy more broadly.
The following books are necessary reading for healthcare workers- on racism, professional hierarchy, & health justice:

- Clark Hine (1989) Black Women in White: Racial Conflict in the Nursing Profession, 1890-1950
- Ward (2003) Black Physicians in the Jim Crow South
Read 19 tweets
29 Mar 20
One of the most segregated metros in the Midwest, with the highest rate of incarceration for Black residents.

The quotidian practices & conditions of racial segregation, environmental racism, & mass incarceration all predispose Black communities to illness & premature death.
In other words, this was a crisis before the pandemic, & these inequities are pronounced amid a pandemic.
Read 4 tweets
16 Mar 20
Framing responses to a pandemic in terms of ‘war’ rightfully suggests that the emphasis is not on care or attention to the needs of those most endangered.

War is a pretext for rendering people & communities as collateral. Death is a foregone conclusion in war.
If responses to a pandemic are framed as ‘war’, who is the ‘enemy’?

Is it people who are potentially infected, whose mobility is seen as a threat against which militarized borders must be mobilized?

Is it immigrants & racial Others who are already treated as vectors of disease?
Read 12 tweets
29 Feb 20
Viruses infect people.

Saying that un(der)insured people who forego care are ‘infecting’ others is to frame them as embodied social problems, when the problem is that healthcare is inaccessible & inequitable, rationed by employment status & income amid structural unemployment.
The language we use is so important- especially in an emergent situation where danger is unevenly distributed (older & immunocompromised people). It communicates who does or does not matter

E.g. most of the messaging WRT mask use excludes people who are immunocompromised.
See also: calls for quarantine & isolation (not equivalent in public health parlance) that ignore the reality that most workers in the US- esp. low-paid workers- do not get paid sick leave. If folks are already un(der)insured & foregoing care, they can’t afford to miss work.
Read 7 tweets
20 Feb 20
The argument that universal healthcare will not address the fundamental drivers of health inequities is not an argument against universal healthcare.

The people bearing the brunt of inequitable social arrangements & allocations of resources also have the highest need for care.
We can make healthcare equitable in terms of access & quality AND we can address the fundamental causes of inequitable healthcare outcomes.
And there’s the inconvenient fact that addressing the drivers of inequitable health outcomes will not eliminate the need for healthcare.

It may not even reduce healthcare utilization, because we have an aging population with a growing prevalence of chronic illness.
Read 5 tweets
21 Jan 20
“A new NIH-funded study of more than 175,000 U.S. women diagnosed with breast cancer from 2010-2016 has found that nearly half of the troubling [racial] disparity in breast cancer detection can be traced to lack of adequate health insurance.”…
Underlying causes:
- Employer-sponsored insurance as the primary means of coverage among working-age people
- Amid structural unemployment, which disproportionately affects Black & indigenous folks
- & these same communities have poorer spatial access to care (PCPs & specialist)
“Black, American Indian, Alaskan Native, and Hispanic women [ages 40-64] also had higher odds of receiving a late-stage diagnosis”…
Read 4 tweets
10 Jan 20
This conversation about addressing social needs or SDoH in healthcare provision highlights the need to revisit the fundamentals:
- social inequity patterns health outcomes
- healthcare intervenes @ the level of the individual *after* the cumulative disadvantages take a toll
- you can address patient-level "social needs" in the short term and not see an effect in long-term health status changes because the fundamental causes have not changed, & the cumulative disadvantage compounds as they age
- social needs are NOT SDoH
And this folds into itself:

- in conjunction with the ways that social inequity pattern poor health outcomes, social inequity patterns inequities in access to the care necessary to remedy the outcomes of social inequity

Read 10 tweets
7 Jan 20
A key difference between health equity & healthcare equity is highlighted in this framing:

"More Birth Complications Push Up Hospital Costs"…
Important Questions:
- What is driving maternal morbidity? Answer that without blaming the individual patients.
- What is being done to address those underlying social/environmental/economic factors?
And why are traumatic births being framed as "preventable costs" to hospitals, when the OOP cost of C-section & vaginal births has gone up 54% & 48%, respectively, between 2008-2015?
Read 8 tweets
7 Jan 20

Training NPs & PAs is *not* undercutting the supply of physicians.

Helpful to consider the history of physician professionalization. Professional associations stressed limiting the supply of physicians (& excluding entire groups) to keep wages up.
And in medically underserved communities, depending on scope of practice laws & state licensure regulations, NPs & PAs can & do provide primary care where physicians are scarce.
I'm commenting on this because interdependence or complementarity (sp) between healthcare workers is of interest to me/my research on healthcare equity + access.
Read 4 tweets
25 Dec 19
Periodic reminder that “we are all immigrants” is false.

The US is a settler colony built on the forcible exploitation of trafficked & enslaved Africans, genocidal displacement & dispossession of indigenous people, & the concurrent transfer of stolen ‘wealth’ to white settlers.
Further, the history of immigration & asylum regimes in this settler colony highlights the quotidian violence that upholds the border. Quotas, excluding sick & disabled people, redefining indigenous people as ‘foreign’ when the border crossed them.
Further, a study of immigration law & asylum processes in this settler colony is a study of racism itself.
Read 6 tweets
28 Nov 19
I don’t think I have ever explicitly talked about my approach to talking about race/ism (phrasing coined by Shay Akil McLean).

Some thoughts below 👇🏾
I take a more materialist approach that does not linger on discourses of racist ‘inferiority’ or ‘superiority’. Instead, I focus on the material consequences of the political & socio-spatial ordering of society under racism & related systems of oppression
I am not preoccupied with defending people who are negatively racialized as Other (Black, indigenous, AfroLatinx... along the skin color & class gradients) against white supremacist narratives of ‘inferiority’ or ‘insufficiency.’ Too often, that’s a trap.
Read 14 tweets
13 Oct 19
No, racism is not a Social Determinant of Health (SDoH).

Racism is a root cause of the social arrangements that allocate life to some (white, wealthy, non-disabled), and premature death to others (racialized Others, impoverished, underpaid, sick & disabled).
.@MatthewLeeMPH (who I suggest following!) rightly suggests reading Link & Phelan's work on fundamental causes 👇🏾
Read 8 tweets
15 Sep 19
I can’t get with arguments to the tune of ‘social justice is the core of medicine’ or ‘social justice is core to public health’ because both fields are so heavily rooted in eugenics. There is no eugenics (positive or negative) without medical & public health practitioners.
I mean, think of the convergence in the ‘harvesting’ of Henrietta Lacks’ cells without consent. The broader context of paternalistic health care provision- whereby impoverished & Black patients implicitly traded all privacy/right to consent for care in ‘charity’ hospitals.
Consider that in the context of the Flexner Report a few decades before- the closure of medical schools that trained Black doctors/nurses, the continued segregation of/closure of Black community-serving hospitals- which reinforced the sorting of Black PTs into charity hospitals.
Read 14 tweets
12 Aug 19
I was alluding to blanket claims like this earlier
Inequities in birth outcomes & infant mortality are the outcomes of *racism.*

Racism in our everyday lives. Causing psychosocial stress, ⬆️ our risk of CVD. Racism in health care that makes what should be routine prenatal care harmful & counterproductive.
Read 11 tweets
9 Aug 19
I finally put my finger on why the ‘Moving to Opportunity’ study- conceptually & epistemologically- raises 🚩🚩🚩 for me:
- imputes mechanistic nature to social relations
- treats poverty as an exposure or state (not an outcome of policy w/ intergenerational effects)

- places onus on impoverished people to move to ‘opportunity’, despite a wealth of social scientific work on placing opportunities where people are
- side-steps the problem of social networks & capital- how moving often disrupts those
- treats places as simply filled in spaces
But, all of these objections arise from my orientation as a social scientist & a geographer. I begin w/ the assumptions:

- poverty & income inequity are policy choices
- mechanisms: social sorting in social space via residential segregation & rationing by price in rental market
Read 11 tweets
16 Jun 19
‘Perceived’ is doing a lot of work here
Ok, upon closer inspection, this use of ‘perceived’ is pernicious & ahistorical

Patients’ right to refuse as a barrier to medical/scientific progress.

As though medical distrust & a desire to protect one’s privacy/health data in an era where discrimination on the basis of ‘pre-existing conditions’ may become the norm again... ok. No.
Read 3 tweets
14 Jun 19
My least favorite form of critique is calling systems "broken" when they are working as designed.
"omg financializing crisis isn't actually incentivizing responses to crises! it's as if the arbitrary mortality thresholds were defined by people unaffected by said crises!"
Things that are not "broken":

- a financial system that favors the "haves" by dispossessing/producing "have nots"
- the carceral state & its extension, surveillance capitalism
- highly marketized health care systems that ration care, disadvantaging improverished, racialized PTs
Read 6 tweets
12 May 19
I think sleep = when I work out problems.

Currently trying to untangle some of the epistemological probs of addressing health issues as a geographer who communicates with clinicians.

Clinicians often focus on one body- the one in front of them- where I see bodies as permeable.
Here's a snippet from my dissertation proposal (defended Sept 2018) that summarizes the 'problem' (with an added note to my former self)
Read 2 tweets