On Foundational Privilege.

To begin today’s Note, a thought experiment that comes to us by way of the political philosopher John Rawls. Imagine we are designing a completely new society. Will it be democratic or monarchical? Will it be egalitarian, or will rights and privileges be exclusive to a select few? We get to decide. There is, however, a catch: In designing this society, we are not permitted to know in advance what our status in it will be—we have an equal chance of being at the top or the bottom of the hierarchy. Rawls called this lack of foreknowledge the “veil of ignorance.” He meant it as a means of determining the justice of a given system. Would, for example, the Americans who justified slavery using moral arguments still have considered the practice benign from behind the veil of ignorance? Or would the possibility of becoming slaves themselves have made them reconsider? In our own time, we frequently deny or overlook the degree to which privilege is disproportionally allocated in our society. Many of us are born with advantages. This head start can affect everything from our income to our education, housing, experience with the legal system, chances of finding employment, and overall quality of life. Given this influence, it seems to me that without recognizing unearned, foundational privilege, we risk falling short in our understanding of the inequalities that shape our world. An examination, then, of privilege, and its relevance to the work of public health seems warranted.

Among the many factors that determine privilege—specifically privilege in the context of the US—I would like to focus on three: race, gender, and class. Starting, then, with race. Blacks living in the US are more likely than whites to be poor, more likely, in some parts of the country, to be stopped by the police, and more likely to be struck with a host of health conditions, to name only a few black–white disparities. Beyond these data, race and privilege intersect in subtle, yet powerful ways. These can include the assumption that whites are more likely than blacks to see their own lived experience reflected back to them in the media and popular culture; whites also do not have to contend with pernicious, often violent stereotypes about their race, or worry that any success they achieve will be ascribed to affirmative action. Those who are white and male have even more privilege. In the US, women make less money than men, are under greater physical scrutiny, and are periodically at risk of losing their reproductive freedoms. Finally, the economically privileged are positioned to enjoy greater political influence, a higher likelihood of obtaining an elite education, and a number of other advantages.

Some additional words on the power of money to confer privilege. In the US, we are fortunate enough to enjoy wealth on a large scale. In terms of nominal GDP, the US currently has the largest economy on earth. Our collective wealth translates into privilege in several ways. It gives us tremendous economic leverage over other nations, allowing us to impose economic sanctions on countries whose behavior we seek to change. It also empowers us to invest in a strong military, with the capacity to safeguard American interests all over the world. Finally, our economy gives us a greater say in world affairs. Not only are lower-resource countries denied these privileges, they are particularly vulnerable in times of global financial crisis. International trade policies favoring wealthier nations have done much to maintain this imbalance of advantage.

How conscious are we of our privileged position in the world? Not particularly, it would seem. Despite our improving economy and greater diversity and tolerance, a recent poll reported that 69 percent of Americans are dissatisfied with “the way things are going in the United States.” Our attitudes toward the privilege conferred by race are similarly skewed. White Americans, for example, have historically enjoyed tremendous privilege in this country, and still do. However, economic hardship, poor health, and an increasingly diverse society have led a large and vocal segment of the white population to believe that their privilege is being taken away. And while efforts to acknowledge white privilege are increasingly common in the media and on our college campuses, such efforts can be met with ambivalence, or even backlash.

Despite these difficulties, an acknowledgement of privilege is key to the work of public health. If we wish to work with communities, and create sustainable programs that make a difference, we must be sensitive to the fact that we often come to these populations at an economic advantage. We are students, faculty, and staff at an elite university, which means that many of us, although certainly not all of us, come from a middle-class or wealthy background. In a sense, our privilege is reflected in our academic offerings themselves. Our knowledge base is the product of generations of public health scholarship and practice. This accumulated wisdom comes to us as an inheritance; it is a gift. We did not necessarily do anything to deserve it, but it is ours nonetheless.

The awareness of privilege has real ramifications, and is perhaps particularly clear, in our global work. Acknowledgement of privilege forces us to not only take a thoughtful look at who we are, but also to examine what we represent—what our race, gender, and nationality mean within the context of history and the lived experience of other people. As Ria Pal and Olivia Low have written, “We have to practice a critical awareness of the implications of our presence.” When we work in countries that have less resources than the US, or that have borne the degrading effects of physical or economic colonialism, we must be aware of the “implications of our presence,” and remember that, at the end of the day, we are guests in these places. Our intention should therefore be to build partnerships, listen more than we talk, and, when in doubt, always let empathy be our guide as we engage with a wide range of populations. We can cultivate this empathy through our reading, and our study of the various cultural, political, and economic systems that shape daily life in other countries.

In public health, we are unstintingly concerned with context—with the underlying structural drivers that shape health. I would argue that this habit of mind positions us to bring to the examination of privilege a unique level of awareness. Where others might shy away from looking at the broader context that enables or discourages privilege in our society, our training compels us to take just such a wide-angle view. The fact that we are a school makes this line of inquiry all the more appropriate. Committed as we are to creating “a respectful, collaborative, diverse, and inclusive community,” a discussion of privilege is entirely consistent with our values as an institution. It is perhaps for this reason that we have already embraced an honest, good-faith attempt to engage with this issue—from our Beyond Ferguson symposium, to our discussions of global poverty, to the champions for gender equity we have invited to our campus. We are also fortunate to live and work in the city of Boston—a diverse community that provides ample opportunities to open ourselves to the experiences of others. This exploration can begin right here at SPH; as a school, it is our privilege to be able to access the perspectives and insights of others on a daily basis, in a respectful, inclusive setting. We can, of course, do better. Privilege has a tendency to be invisible to those who do not feel the lack of it; we must work to move this issue to the forefront of the public debate—taking great care to reinforce the reality of privilege with hard data about its effects on health.

As we reflect, then, on how many of our advantages come to us unearned, we are able to perceive how the disadvantages of others can likewise be unearned—an important realization in a society that often stigmatizes misfortune, or ascribes it to moral failing. When we are able to see our privilege fully, we are then in a position to look past it, to view our society from behind the veil of ignorance—where our advantage is no longer a given—and see just how harmful the consequences of imbalance in privilege actually are.

I hope everyone has a terrific week. Until next week.

Warm regards,

Sandro

Sandro Galea, MD, DrPH
Dean and Robert A. Knox Professor
Boston University School of Public Health
Twitter: @sandrogalea

Acknowledgement: I am grateful to Professor Sophie Godley, Paola Peynetti Velazquez, and Eric DelGizzo for their contributions to this Dean’s Note.

Previous Dean’s Notes are archived at: https://www.bu.edu/sph/tag/deans-note/