I recently got back home from the International Massage Therapy Research Conference in Alexandria. If you’re not familiar, basically this is a nerd conference where massage therapy nerds can nerd out together. It is exactly up my alley, and I left feeling mostly inspired, energized, and just a little bit smarter.
On the surface, most of the conference was about pain. Chronic pain, the opioid epidemic that grows from (mis)treatment of chronic pain, the efficacy of massage as a treatment for all kinds of pain. For me, however, one other theme emerged from the conference, and that theme was: Health Equity.
During the first panel, three presenters talked about integrating massage therapy as a way to address the opioid epidemic. The first presenter threw out a sentence or two about cost, and quickly moved on to other things. The second presenter talked about integrating massage therapy and other integrative practices into the VA healthcare system, and the positive results that followed.
Yay, massage, right?
But as I sat there, I grew more and more uncomfortable. What about people who didn’t have access to either money or the VA healthcare system? What about the many (many) people in chronic pain who don’t have the extra income to spend on massage therapy, or other integrative practices that are not included in health insurance? What about the many (many) people in chronic pain who have no health insurance?
I struggle with this at some level almost every day. I am a sole practitioner, trying to make my living with a private massage practice. I do not take insurance, for a number of reasons. My services are out of reach for some people. I have an uneasy compromise, in that I offer a sliding scale to anyone who tells me they need it. But still, just the location of my office puts me out of reach for some people who don’t have access to a care.
And, being a human, I do not want to suffer this dilemma alone. I want the entire massage therapy profession to spend more time thinking about equity, about creative ways to make our services available to more people.
Let me clear: I am not talking about volunteering. The truth is that we live in a world that often equates value with money. The things we value are the things we pay for, and in order for massage therapy to be valued, it needs to be paid for. We are healthcare professionals who should be compensated, just as a physician, physical therapist, or nurse practitioner would be compensated.
Later in the conference, one of the speakers put up a colorful pie chart which showed the factors that really influence health outcomes. In her chart (and others I have looked up since,) clinical care (doctor visits, etc.) accounts for only about 10% of health outcomes. The largest pieces of the pie chart were health/lifestyle behaviors (30%) and socioeconomic factors (40%.)
Socioeconomic factors. 40%.
The speaker completely ignored this part of the chart. It sat there on the giant slide projected over her shoulder, and she didn’t mention it. Instead, she spent about a third of her presentation talking about health behaviors, and the influence we could have on these behaviors.
I get it. It feels good, and doable, to talk about influencing smoking cessation or encouraging movement. We can wrap our heads around health behaviors.
Socioeconomic factors are big and tough and scary. To really look at these things, we have confront things like institutionalized racism, housing disparities, and a long American history of devaluing humans based on their perceived otherness. We may even have to confront our own unconscious biases and prejudices. It will get messy, and there will be no such thing as uncomplicated success.
But we ignore that 40% of the pie at our peril, and the peril of our fellow humans. As several of the speakers at the conference said, we don’t just have an opioid epidemic in this country. We have an epidemic of epidemics. Pain. Opioids. Dysfunction. So many ways that people are suffering, often needlessly.
I have been reviewing the Health Equity Report for Louisville. In most of the report, the maps for different diseases are darkest in areas of economic disparity. We can not, must not, ignore this. It is inspiring to talk about integrating massage into total care, to research the effects of integrated care, but if we do not also consider how to bring integrated care to those darkly shaded areas of the health equity map, we are just watching ourselves move around a mirrored funhouse.
I don’t have an answer. Right now, what I have is frustration and emerging awareness of my own blind spots. Also, a resolve to never unsee what I am seeing now. I am seeking to educate myself, to listen, to work even more with groups who are trying to address health inequity in my own city.
I have no answers, just open eyes and ears willing to listen. So, tell me, what do you think we can do to address health inequity in our neighborhood?