Article by Dhanyashree Ramanathan
In Public Forum debate, there’s one impact that seems to pop up no matter the resolution: poverty. Whether we’re debating immigration policy, civil resistance movements, or even niche topics like generative AI in education, poverty always finds a way to sit at the heart of the conversation.
At first, I just treated it like any other impact, something to weigh against nuclear war or climate change in my summary speech. But round after round, I started noticing a pattern. Poverty wasn’t just a convenient tag, it was the thread that connected so many of the injustices we were debating. That realization made me wonder: what does that look like in real life? And how does it show up in one of the most basic human needs - healthcare?
From there, I started paying closer attention. Through both my experiences in hospitals and what I researched in debate, I began to see how deeply racism and poverty influence who gets care, how soon they get it, and how well they’re treated. The barriers aren’t always visible, but they’re everywhere. And they’re costing lives.
The Unequal Cost of Care
Healthcare is often described as a universal need, but in the United States, it’s far from a universal right. Racism and poverty together create a system where the same illness can have vastly different consequences based on your zip code, your income, or the color of your skin.
Patients in under-resourced communities, often people who are low-income and predominantly communities of color, face structural barriers at every stage of care. From long wait times and language gaps to a shortage of nearby hospitals, every step becomes harder to navigate. And by the time these patients do receive care, it's often after a condition has worsened, not because of poor personal choices, but because the system made prevention inaccessible.
This isn’t hypothetical. It’s the lived reality for millions of people.
Racism in the System, Not Just the Symptoms
Many people assume racism in healthcare looks like outright discrimination, and sometimes it does. But more often, it hides in protocols, policies, and patterns.
Black women in the U.S. are three times more likely to die from pregnancy-related causes than white women, even when education and income are accounted for (CDC, 2019). Studies show that pain in Black patients is frequently undertreated because of long-standing biases in medical training. Indigenous communities are often forced to rely on underfunded Indian Health Service clinics that lack critical resources.
Racism in healthcare isn't always loud. Sometimes it's a form not offered in your language. A provider not believing your symptoms. A clinic located two bus transfers and a three-hour wait away.
Poverty: The Pre-existing Condition No One Talks About
In every PF round I debated, poverty was described as a “root cause.” And in healthcare, it truly is. Poverty shapes every single aspect of a person’s access to care, from the ability to afford insurance, to finding time off work to attend appointments, to purchasing basic prescriptions.
Even in relatively affluent areas like Bellevue, I’ve seen the way financial instability stops people from getting the treatment they need. I’ve watched patients hesitate before picking up medication because they’re worried about the cost. I’ve talked to families who delay routine care because a single ER visit could send them into medical debt.
These aren’t isolated cases, they’re patterns. And they reflect a country where healthcare is not structured around equity, but economics.
The Deadly Intersection of Race and Class
The most painful reality is that racism and poverty don’t just exist side by side, they compound each other. Centuries of discriminatory policy, from redlining and housing segregation to unequal education and wage gaps, have left communities of color disproportionately impacted by poverty. So when they try to access healthcare, they face double the burden.
And it shows. People of color in low-income neighborhoods face higher rates of chronic conditions, lower life expectancies, and poorer health outcomes across almost every metric.
It’s not just about doctors or hospitals, it’s about the systems we’ve built. And who we’ve left out of them.
Why This Matters to Me
As someone who hopes to enter the medical field, this isn’t just a debate topic or a research project, it’s a call to action. Through debate, I learned how to make arguments. Through patient care experiences, I learned why they matter.
I’ve met patients whose lives are made harder not by their diagnosis, but by the system that’s supposed to care for them. I’ve seen how policy gaps become personal losses. And I’ve realized that fighting for equity in healthcare is just as critical as any scientific breakthrough or medical innovation.
Because no matter how advanced our medicine becomes, it won’t matter if people can’t access it. This isn’t just about healthcare. It’s about justice.
References
- Centers for Disease Control and Prevention (CDC). (2019). Racial and Ethnic Disparities in Maternal Mortality. https://www.cdc.gov
- Williams, D. R., & Mohammed, S. A. (2009). Discrimination and racial disparities in health: evidence and needed research. Journal of Behavioral Medicine, 32(1), 20–47.
- Bailey, Z. D., et al. (2017). Structural racism and health inequities in the USA: evidence and interventions. The Lancet, 389(10077), 1453–1463.
Author: Dhanyashree Ramanthan