On Ferguson: A Call to Medicine

There is little to say once you’ve said this before. Although the sadness brings fresh tears, they are also old tears. The grief becomes familiar and so too the inevitable resumption of everyday life. The pain bores to the soul but settles in the subconscious, where it rests, privately born and quietly hidden, lest frustration and bitterness mire the work we do – trying to forget, but ever-reminded. So although there is nothing new to say, perhaps there is something new to do.

Here, I am looking squarely at you, my fellow physicians. We, who deal in health and disease must think critically and act effectively to address the issues raised by the death of Michael Brown and those who came before him. We are the trusted public servants charged with protecting the populations in our care, to promote health and prevent and treat disease. But are not health and disease simply the crude boundaries of life and death? Then, how will we move to protect the lives of black and brown youth that are threatened by violence? How will we confront the reality that the #1 cause of death for black males aged 10-24 is homicide? What are we doing about the death rate for young black males that is the highest among all adolescents in America? Black male teenagers are 37% more likely to die than any of their peers. And according to the CDC, because these deaths are secondary to external injury, they are by definition, preventable.

So I will ask again, what are we doing about it?

Because, despite the vaccines given to ward off the threat of disease, and the medications prescribed to prevent seizures, kill cancer, and treat infections, black males may not make it out of adolescence alive if we don’t address the violence.

In preventative medicine, we talk about risk factors to identify patients who may suffer from an illness in the future, and prevent it, before suffering and/or death could ever occur. In oncology, we talk about getting to the diagnosis and treatment early, so that in cases where it makes a difference, everything that can be done, will be done. And yet, as black youth die in the streets because of where they live, and how they dress, and the volume at which they listen to their music, we are silent. We, as a collective field, say nothing and we do nothing.

Black lives matter because all lives matter and no one gets that more than we do. So as young black bodies line our streets without reason or recourse, we must start asking what that means for all of us. We must start changing the way we teach and practice medicine. Because if we fail to protect these youth, because we don’t understand their music, or we don’t like the way they dress, or we don’t feel comfortable with the way they speak – whatever the because – then we fail ALL of our youth. We fail to do service to the highest honor of our profession, to protect the lives we care for.

Now, this issue is complicated and deeply rooted in the legacy of discrimination that defines American history and continues to inform America’s present. And you may even avoid talking about it in your personal life, let alone your clinical practice. But your, or my, discomfort does not make it any less our responsibility.

So let’s start dealing with it. I’m talking about poverty. I’m talking about racism. I’m talking about structural inequality. I’m talking about the gender wage gap, the academic achievement gap, and the housing equity gap so wide whole generations fell in and got lost. It is time to engage these topics as legitimate and enduring parts of medical education, public health messaging, and clinical prevention strategy.

No excuses.

If you don’t have the faculty to teach this material, call upon our colleagues in the social sciences to share their expertise. If you don’t know how to address community violence, reach out to non-profits who have made this struggle their life’s work. And if you shy away from the institutional failings that underlie the policies that contribute to the disparities, then call on your local, state, and federal policy makers to change the law.

There is literally no time to waste. Every faceless, nameless brown child who drops dead in the streets could have and should have been prevented. Let this issue not settle in the subconscious recess of our field while children suffer. Because in the end, it is not about Ferguson, it is not about Michael Brown, it is not about the countless others who met a similar fate, it is about what we are doing to ensure that all lives matter, regardless of the color of that life’s skin.


4 thoughts on “On Ferguson: A Call to Medicine

  1. Thank you for speaking sense in the face of senseless tragedy. Yes, it was terrible. Yes, it could have been prevented. No, we will never prevent harm from what we pretend doesn’t exist: racism underlying structural inequalities.

    • Thank you Dr. Jones for reading my piece and providing such thoughtful commentary! Your perspective as a physician thinking about this work as I do is so valuable! Much appreciation 🙂

  2. I am sure you are well intentioned but you are blind to the true causes of social pathogy in inner city black communities. Not racism but corrosive paternalism by progressives that have totally destroyed the black nuclear family. 75% out of wedlock births leads us to millions of fatherless black boys that think violence makes them a man. No respect for women or anyone else. This is the fruit of the welfare state and no misguided search for “social justice” will ever fix that. 95% of black murders are by other blacks yet the outrage
    seems to be reserved for those rare cases when a white person is involved. As long as
    people refuse to admit the true source of the
    mayhem in the inner city (FATHERLESS BOYS)
    and place none of the responsibility on the
    black community, the downward spiral will
    continue. It would take generations to repair
    the destruction that welfare programs and the
    paternalistic attitudes of liberals have wrought
    on the black family and culture. Unfortunately
    it is easier and socially safer for white liberals to blame some “injustice” or another and/or
    racism for these problems than it is to admit that they have achieved what slavery and the real racism and oppression of an earlier time could not, the crushing of the black family structure and cutural dignity.

    • Thank you for reading my piece and for your thoughtful comment! I have to say I categorically disagree with your perspective but I appreciate the opportunity for dialogue. I wanted to share a few thoughts for you to consider and a few articles that you may consider reading on this topic as well. To begin, you are not the first to assert that moral failings and a welfare system that promotes dependency is the primary cause of the ills in the black community, creating problems ranging from violence to poor health. The problem with that argument is that it ignores the impact of generations of public policy and institutional discrimination that have excluded African Americans from opportunities for upward mobility and impoverished African American communities. Here I refer you to what I consider, one of the best contemporary pieces on housing inequality and its effects by Ta-Nehisi Coates The Case for Reparations. I also encourage you to check out his piece entitled Other People’s Pathologies that looks at the difference between cultural failings and poverty. Second, the issue of “fatherless boys” is a particularly complicated phenomenon and again, is an issue with deep systemic roots. Here, I will refer you to an article on I wrote on this blog entitled Structural Inequality and the Future of Medicine. Here I discuss how the incomparably high incarceration rates for black males undermine the core family network, economic viability of the community, and political strength of individuals on behalf of their communities. This phenomenon is rooted in discriminate policing, sentencing, and the downstream effects. So far from choosing an “easier” or “safer” lens with which to critically appraise the challenges facing African Americans, I think interrogating the ways our systems manufacture disadvantage is more complicated to recognize and address. And in terms of the impact of welfare, my short response would be, it is an emergency program that people use in crisis. Equally important aid, are the programs that educate (improve our public schools in low income communities), employ (increase minimum wage, create opportunities for upward mobility for people of color to occupy leadership positions), and support life in black communities (grocery stores, parks, side walks, clean air etc). You cannot solely offer crisis care and then wonder why it is insufficient to produce change. My next piece is on the connections between racism and health, so I hope to flesh out these concepts in more depth. Again thank you for your readership and look forward to continuing the conversation.

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