The Fish. The Pond. The Groundwater. Imagine that you have a personal pond filled with fish. When viewing your pond, you notice that one fish has died, floating belly-up. You decide that the fish must have been ill and think nothing more of it. The next day, you notice that half of the fish in your pond are now dead. You are alarmed and decide to contact the neighborhood management services to investigate your pond. Something must be wrong with the local system. The following day, however, you discover that all of your neighbors with ponds have noticed the same thing. In fact, half of the fish are dead throughout all waterways in the entire state. At this point, it is clear something deeper must be wrong. This is when you need to analyze the groundwater feeding these ponds. The fish are not at fault, and not even the local systems. Rather the underlying structures through which the fish seek life has failed. Imagine that instead of fish, we are discussing patients.
—Paraphrase of Groundwater Approach Metaphor by Love and Hayes-Greene of The Racial Equity Institute.
Keywords: clinical research; ethnic groups; health equity; healthcare disparities; minority health; racial factors; racism.