Anyone who genuinely is interested in social entrepreneurship - the use of business to achieve social gain, as well as financial gain - must, at some point, spend some time considering issues of social justice. One has to ask: Who gains? What do they gain? How does that affect everyone else in society?

Thinking about social justice requires thinking about power. In any given society, power is not evenly distributed; some people always have more and some always have less. An aspect of social power is social privilege, and addressing privilege can be one of the most challenging aspects of social entrepreneurship. So, what is privilege and how does it work? And how does this apply to an acupuncture practice?

In order not to get too bogged down in theoretical language, I am going to use myself and my practice as an example of how privilege works in the real world. Areas in which I hold privilege basically are areas in which I can take my social power for granted. Privilege represents all the things I don't have to worry about; all the little "perks" of being myself that I didn't do anything to earn. For example, let's look at my age. There is privilege in American culture connected with being between 25 and 40 years old, and I'm 38. If I apply for a job, a bank loan or an insurance policy, I can pretty much trust that my age won't count against me. No one is likely to tell me at this point in my life, directly or indirectly, that I am too old or too young to do something I want to do.

Another area in which I hold privilege is that I am white. There is an excellent essay, available on the Internet, titled "White Privilege: Unpacking the Invisible Knapsack," by Peggy McIntosh. The author offers a list of ways that being white in the U.S. makes her life consistently easier; structural things that she can take for granted. It's a long list and includes things such as: "I can turn on the television or open the front page of the paper and see people of my race widely represented," "I can be sure that my children will be given curricular materials that testify to the existence of our race," "I can be pretty sure that if I ask for 'the person in charge,' I will be facing someone of my race," and "If a traffic cop pulls me over or the IRS audits my tax return, I can be sure I have not been singled out because of my race." (A timely addition to this last one might be, "if airport security pays particular attention to me").

Yet another area in which I hold privilege is that I am able-bodied. When I first rented my current clinic space, the front entrance had a 3-inch step up, and the bathroom was tiny and very narrow. Because I don't use a wheelchair, these things didn't get in my way. But I knew they prevented anyone who did use a wheelchair from coming into my clinic, and I could see that some of my patients who used walkers had trouble with the bathroom and the front step. I knew these things were problems and when, three years later, I was able to have a different entrance and an ADA-accessible bathroom, I was delighted. The point is, though, that my privilege as an able-bodied person meant I could choose to not put these changes at the top of my "To-Do" list. I could ignore them for three years with no adverse consequences to me, personally.

An area in which I have not held privilege in my life is class. I grew up working-class, and the neighborhood I live in now is working-class. Class privilege in America means being middle-class or owning-class. Class does affect my life: I have to think about it in order to do the things I want to do. Because of this, I am acutely alert to class issues, as opposed to being acutely alert to racial issues or issues of disability. I knew that in my acupuncture practice, I wanted to treat people like myself (in general). I didn't have to do anything at all to ensure I would be able to treat other white people, or other able-bodied people. They could, quite literally, very easily come through my door.

But I had to think hard and work hard to get working-class people to come through my door. That is because a conventional acupuncture practice is not accessible to working-class people. If you are middle-class, you probably won't even notice all the ways that such a practice is not accessible, in exactly the same way that I didn't really notice how narrow my bathroom was. First, of course, is the cost of a conventional treatment. If you are middle-class, your privilege allows you to assume that $75 per treatment is a reasonable fee, and that health insurance is something most people have; furthermore, if someone balks at the price, you can assume there is something wrong with them, not with your price. They are "not committed to treatment" or they "don't value their health." Your privilege means you can count on other acupuncturists and acupuncture institutions to reassure you that these things are true.

Middle-class privilege also means being able to assume that an upscale environment, whether it looks like a conventional doctor's office or a spa, will be comfortable for your patients. It means assuming that adopting a professional demeanor will not alienate your patients or make them feel they are being put down. From a working-class perspective, this is exactly like my assuming that everyone should be able to use my bathroom.

Privilege has the magical ability to make things visible or invisible, depending on whether you have it. Recently, an acupuncturist wrote in an online forum that a certain large city was "saturated" with acupuncturists, meaning there are more than enough of them to serve the potential patients in that city. The funny thing is, though, the mother of one of my patients lives in that city. She has severely painful arthritis and would benefit greatly from acupuncture. She and my patient have tried to find an acupuncturist for her, but there is no one whom she can afford to see. So, if it's widely accepted that her city is "saturated" with acupuncturists, what does that mean? She doesn't exist?

Working-class people essentially are invisible to most acupuncturists. My lack of privilege allows me to see that. It took me three years to widen my door enough so disabled people could come in. How long is it going to take the acupuncture world to widen its doors? Working-class patients are waiting everywhere to come in.