Growing up, I had this absolute fascination with Spider-Man. He was one of my favorite superheroes in large part because his story felt like a story that could happen to anyone. Ok, sure, there was that radioactive spider that gave him super powers, but short of that, Peter Parker was just an ordinary high school student. I loved getting lost in the various storylines of what villain Spider-Man would be up against that month.
There’s a high likelihood that you could have never read a Spider-Man comic or watched any of the movies to know that there’s a point in the story where Peter’s Uncle Ben tells him that “with great power there must also come great responsibility.” For the full context of the quote, you can read about Spider-Man’s origin story here. Needless to say, but it’s an important time in Peter’s life where these words begin to make sense; and of course, he goes on to become everyone’s favorite friendly neighborhood Spider-Man using his power to help his city.
Throughout history, this theme of power and responsibility is not new, in fact, this quote and overall philosophy has been attributed to such writers and philosophers like Voltaire (1700’s); however, literary sleuths have found Voltaire shouldn’t get all the credit as many others before him used this philosophy in their writings. For most of us, we were exposed to the concept in Amazing Fantasy #15 published in August 1962 that gave us Spider-Man and this now famous quote.
Power plays a vital role in our lives. But today, for this Substack, I want to focus on power in health care. This is a theme I think on a lot because one would be hard pressed to find examples of power that are as egregious as those seen in health care, where power dynamics position some much further up the hierarchy than others.
In Paul Starr’s epic 1982 book, The Social Transformation of American Medicine, he describes the history behind our current health care system and how we created the structures that position some in a place of power whereas others are powerless. From his opening paragraph:
“The dream of reason did not take power into account.
The dream was that reason, in the form of arts and sciences, would liberate humanity from scarcity and the caprices of nature, ignorance and superstition, tyranny, and not least of all, the diseases of body and spirit. But reason is no abstract force pushing inexorably toward greater freedom at the end of history. Its forms and uses are determined by the narrower purposes of men and women; their interests and ideal shape even what counts as knowledge. Though the works of reason have lifted innumerable burdens of hunger and borrow, they have also cast up a new world of power. In that world, some people stand above others in knowledge and authority ad in control of the vast institutions ta have arisen to manage and finance the rationalized forms of human labor.”
Paul Starr is beautifully making the point that the idea that reason and knowledge would solve all of humanity's problems was flawed because it didn't take into account the fact that people with power and their own interests would shape how reason and knowledge are used. How true is this? Sure, while reason helped alleviate many problems like hunger and poverty, it also created a new world where some people hold more power and control over others through the institutions that have been created to manage and finance the use of reason. In other words, reason is not an automatic solution to all our problems, but rather it can be used to reinforce existing power structures and inequalities.
Health care, are your ears burning?
Power dynamics in health care are complex and multifaceted. On one hand, health care providers hold significant power over their patients' lives, as they are responsible for diagnosing and treating illnesses. This power imbalance can leave patients feeling vulnerable and dependent on their providers. On the other hand, health care institutions, insurance companies, and pharmaceutical companies also wield significant power over health care providers and patients. These entities have the ability to shape health policy, determine the availability and affordability of certain treatments, and influence the overall quality of care. Addressing power imbalances in health care is crucial for promoting equitable access to quality care and ensuring that patients are treated with dignity and respect.
Flattening the hierarchy in health care and renegotiating who has power is a significant challenge not for the faint of heart. But isn’t it needed?
Sharing power involves addressing power imbalances and promoting inclusion and diversity. To achieve this, active participation and open dialogue are crucial, along with transparency and accountability in decision-making processes. Two issues that are not health care’s strong suit. We have to build trust ad have to have transparency in our process. Building trust can be accomplished by respecting everyone's contributions and creating a culture of empathy. Empowering individuals and communities can be achieved by investing in education and training programs, building capacity and promoting leadership roles, but perhaps most importantly, letting the community actually lead initiatives. When we actively seek out and amplify underrepresented voices, promote diversity and inclusion, and challenge biases and discrimination, we end up promoting power-sharing and power-shifting therefore creating a more equitable society.
Health care has a long way to go to begin to share and shift some of this power. However, and I firmly believe this, if we don’t regularly make this a point to address or call out in our dialogues, nothing will change.
If you are in a position of power, in health care or out of it, you have great responsibility. So how do you know if this is you or not?
Well, traditionally, being in a position of means you have the ability to influence or control the actions and decisions of others. It's important to remember that power can be both formal and informal. Formal power would be more like a job position or title, while informal power comes from personal qualities such as charisma, expertise, or social influence. You might want to check which one of those that applies to you so you can best make a positive impact on others. Regardless, being aware of your power is a great first step in starting to share it and be conscious of how you show up, where you show up, and what you do.
It’s critical to remember that power is a tool. We should wield it with care assuring that it creates, not destroys. Wherever you are in life, there’s a chance you yield some power. How will you use it to advance mental health? Improve the community you live in? This is our challenge, our opportunity, and our responsibility.