Depending on what scale one looks at, different combinations of factors could be adduced. My bias / favored explanation tends toward a combination of economic and health stress which potentiates underlying implicit racism/bias, the latter empowered by systemic racism — and the whole turbocharged by a certain set of "safe ways" or dog whistles in which it's "permitted" to encode misogyny/racism in public but are potentially invisible to pollsters ("I don't trust her," e.g.).
I wish I had some idea of what to do. On the Thursday of election week I cried behind my locked office door. I still feel desperate and depressed and rage-y, but perhaps I have reached some sort of equilibrium in my professional and personal life taking account of the new realities. I also assume that the what-to-do question hinges to some extent on the what-will-happen question. No prophet I , I estimate that the chance of something absolutely awful happening (war, pogroms/camps, ….) is about 10%, the chance of everything staying more or less the same is 5%, and the chance of everything getting substantively worse in non-catastrophic but insidious ways makes up the rest of the dial.
I see everything in terms of levels (too many conceptual models maybe!).
On one level I want to continue to provide excellent care, and precept with residents — but more and more, at least with residents, I feel comfortable and bound to mention SDOH and the patient's identity as an individual. I am less and less patient (ha) with patient blaming and stigmatization and lumping.
Educationally, I more and more want to emphasize such things as well.
Research wise, well I'm always at a bit of loose ends b/c my interests are varied and my support ~0, but I want to characterize peoples' decision making as individuals b/c I think vulnerable people are most likely to be "bucketed" and algorithmized out of independent existence.
The new element is advocacy which I think I rolled my eyes at just a few months ago. No offense if you're a single payer person (it's a strong argument and an ideal!), but I used to put that sort of advocacy in the same category as give-me-a-pony-for Christmas. Now, with everything upended, it has become something I pay attention to. Probably too much time to.
I have no idea if any of this will help anything.
There's a big discussion about how best to approach racial disparities. Does a rising tide lift all boats, and so we need to pursue a class-conscious politics? Or are we better off with more racial consciousness? Easy for me to ask, I think, as a white guy. Would an African American consider the national/racial liberation thing self evident?