Why It Matters
To truly address issues around equity and racism means to engage in sometimes surprising self-reflection.
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Get Comfortable with Discomfort and Other Health Equity Lessons

By Livia Mucciolo | Thursday, August 16, 2018
8/16 Blog

I was six years old when I had my first experience with the US health care system. My family had recently moved to the United States, and we needed to get additional vaccines to finalize our green card applications. In addition to the ostentatious décor of the doctor’s office, I also remember the multitude of languages and ethnicities around me.

This is America, I thought — the so-called melting-pot that Brazilians associate with the US. Little did I know that nine years later I would go on to receive my American passport and become a full-fledged Brazilian-American.

As I have been working on the Latin America team at IHI, I have been diving into the complexities of my identity and how it has shaped my lived experiences. I have been helping to develop an equity training for leaders in the Projeto Parto Adequado initiative to improve maternal health in Brazil.

I’ve learned that to truly address issues around equity means to engage in sometimes surprising self-reflection. As I’ve learned about how IHI and its partners are working to make health care more equitable in Brazil, I encountered an aspect of my identity that I had never considered.

Like many Latinx, in the US I am considered a person of color. In Brazil, however, I am considered white. Identity, I’ve discovered, is more fluid than I realized.

Through mediating between these two aspects of identity, I have learned that the belief that white people are superior to those of all other races and should, therefore, dominate society is present in many countries and ingrained in many health systems around the world.

Learning about equity in Brazil and in the US has provided me with a means to analyze my duality with privilege. In Brazil, I have been granted certain privileges that are withheld from many darker-skinned Brazilians, especially in the sphere of health care. This includes getting better access to care and having credibility when I report being in pain. In the US, my Latinx background has provoked certain people to question my legality or reduce me to stereotypes.

Those of us considered minorities in the US — but not in the countries of our ancestry — can play a unique role in complicated conversations about privilege. As people who have experienced inequities but have also experienced certain privileges in our home countries/communities, we have a perspective that allows us to help bridge divides.

I would also argue that we all have our part to play in bringing people of different perspectives together. We’ve all been in situations in which we have been treated with less respect or treated unfairly because of other people’s perceptions, assumptions, or stereotypes about us. This can vary for a wide range of reasons, including our job title, department, education, income, skin tone, accent, language proficiency, race, gender, and sexual orientation — to name just a few.

We may sometimes forget how all of us have experienced biases or unwanted judgements at some point. It is possible for even well-intentioned, highly trained health care providers to bring their own unconscious biases into their interactions with patients. It is thus all our jobs to learn about racism and health equity. Eliminating racism means more than just being nicer or more respectful to others.

Get comfortable with discomfort is a phrase I always go back to when working on equity. In many societies, talking about race is a taboo. But nothing will change if we don’t. We must try to understand each other’s experiences. We must be open to disagreeing and growing, and we must acknowledge that the journey to equity is a long and winding one.

Livia Mucciolo is a Health Career Connection intern for the IHI Latin America team.

You may also be interested in:

IHI white paper Achieving Health Equity: A Guide for Health Care Organizations

IHI Latin American Forum on Quality and Safety in Healthcare

Reducing Health Inequities in Brazil: Institutional Racism and the Effects on Maternal Outcomes


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