Stevens Blog Post 5

In his book, Tommie Shelby argues against what he calls “the medical model” for solving social and economic issues in impoverished communities and instead advocates for “a systemic-injustice framework.” (Shelbie 2-3). The medical model strives to address inequalities through narrowly targeted and pragmatic interventions. The systemic-injustice framework takes a broader approach and focuses on the need to ensure the overarching social and economic system in society is just. In Shelbie’s view, the medical model fails to consider the background conditions affecting American political, economic, and social structure — a structure created by the historical and ongoing consequences of racial discrimination and exploitation. Only a systemic-injustice framework that recognizes ghettos as a matter of injustice can truly address the underlying causes.

 

While Shelbie provides a convincing argument for the systemic-injustice view, one tradeoff seems to be that targeted reforms via the medical model can sometimes be implemented more quickly than restructuring social and economic opportunity in society. Are there circumstances in which the need to act quickly justifies favoring the medical model? Afterall, to make another medical analogy, if someone has a heart attack, the long-term solution may be better nutrition and more exercise (analogous to the systemic-injustice view), but in the short-term an immediate cardiac bypass surgery might be necessary (medical model). If we have reforms that only offer surface-level solutions but nevertheless provide some immediate help to disadvantaged communities, should we focus on implementing those reforms quickly or long-term structural changes?

 

Shelbie’s discussion on housing integration reminded me of another Harvard professor, economist Raj Chetty, who gave a talk at the Ath earlier this semester on social mobility within neighborhoods in the US. One of Chetty’s recent papers focused on giving poor Seattle residents housing vouchers that allowed them to move to nicer neighborhoods. The program was a huge success and Chetty is now working with the federal government to start implementing it nation-wide. While racial integration was only a consequence of Chetty’s main goal of economic class integration, I wonder if Professor Shelbie would criticize his approach as part of the medical model. If we follow a systemic-injustice framework, should we advocate for approaches that bring opportunities into ghettos instead of moving people to opportunities, as Chetty’s program does? Would Professor Shelbie oppose the federal government funding Chetty’s program if it took away resources from truly structural reform?