Tribute & Truth: Experiencing the National Museum of African American History

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2 weeks ago, my family and I visited the National Museum of African American History.

It is said the museum was a century in the making.

When you walk in the doors, you know exactly what that means.

We happened to enter behind a black family of four. Two parents, who appeared in their mid-late 30s, and two young boys, both of whom could not have been more than 5. It was raining that day and they were all bundled up – hats, vests, scarfs, boots. Despite the aggressive gear, as soon as we got inside, off those boys ran, like they were in their own playground. While a lot of kids run everywhere they go, to see these little black boys, brothers, running free and unencumbered in this building, their building, on the National Mall, erected to honor their ancestors, standing in honor of them, was the perfect prelude to what lay before us.

The whole day, we saw babies and watched children, crawling, running, sitting, climbing. Like the little one, maybe 3, who walked up, alone, and sat next to me on a bench. Together, in silence, we watched a short video about the contributions of African American athletes. Shortly afterwards, his father and brother arrived, obviously happy to have found him. But there he was, drawn to the images, sitting still and watching intently, as people who look like him did great things. I can’t imagine what the moment felt like to him. Perhaps it was simply another age-appropriate act of independence and environmental curiosity. But sitting next to him, the moment felt full and hopeful.

But it wasn’t just the young who captured the moment, it was also the elderly. Those who entered the museum with canes and walkers, who moved with the support of their family or church or neighbors. Those draped in t-shirts commemorating their visit, who traveled across states just to be there.

I think of one woman in particular.

She walked slowly, with her weight heavily upon a cane, her white hair curled, her lips peach with pigment. A women who seemed like her daughter walked at her side, supporting her, and a young woman, maybe age 20 or so, walked in front of them guiding them towards an exhibit on Greenwood in Tulsa, OK. The walls were flanked with images of a town that looked ravaged by a natural disaster. The air in the small exhibit felt thin and heavy. You stood, surrounded, by a town decimated in ash. Only the actor was not an unruly Mother Nature, but rather the destructive, unpredictable, and irrepressible swell of White Supremacy that leveled, literally burned, an entire neighborhood, notably one of the wealthiest black neighborhoods in the country at that time, to the ground. As I stood, solemnly confronting the wall-sized photos and recovered personal items, next to what appeared to be a family of women, I watched as the elder asked the youngest to read the inscriptions to her. I don’t know if it was the photos, the women, or the collective recognition of what black people have endured, suffered, and lost in this country they have called home – but I cried openly there. Left my tears, my heart, my gratitude, to those women, to that place, to the grit that rose from those ashes to trouble and inspire me.

My experience of the newest Smithosonian museum was captured in small moments and big. Moments when I stood shoulder to shoulder with history and watched as the future crawled along the floor, with a certain mix of joy and pride I can only remember having felt so vividly the morning after Barack Hussein Obama became President of the United States. There was a palpable shift in the world as this black girl turned black woman saw and was seen. Standing with my family only added to the consequence of the moment.

As science, history, literature, the arts, and public consciousness inch towards full acknowledgement, engagement, inclusion, and elevation of our presence, our personhood, our importance, and our centrality in the American experiment, this building will stand in tribute and truth. The gift is our ability to return to it, in reverence and expectation, to share that truth with our future generations.

Black History Month and Health Inequity: The Connection between Social Realities and Clinical Norms

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Black History Month is probably one of the most underutilized opportunities to re-ignite the national conversation around social justice in America. As it is typically celebrated, like a random recollection of various contributions by “notable” African-Americans, it feels more like a stale tradition on the verge of irrelevance, than the opportunity to engage issues of racism and social inequality as historical American values that continue to define modern American life.

Last year, I shared why Black History Month remains an essential moment to nationally recognize the lives and works of African-Americans. Right? The original #BlackLivesMatters movement started in 1926.

This year, I want to flesh out examples of how historical American values around race continue to inform national issues and particularly examine how those issues impact health. I’ve talked about mass incarceration, gun violence, and gender inequality a bit in the past.

This month, I’m going to take on the industry of poverty, and child poverty in particular, and how national, state, and local public policy may engineer disadvantage in ways that have profound impacts on health. I also want to talk health systems transformation and consider new models for healthcare delivery that may uniquely serve low-income, communities of color.

And lastly, I want to speak openly and honestly about my dismay with the medical community and our lack of public acknowledgement of the deaths of Oscar Grant, Michael Brown, Tamir Rice, and the other recent victims of police brutality. Lest, we begin to believe that police are the only modern manifestation of our nation’s tragic history with race, I am going to talk about institutional racism and how physician bias directly impacts the health of communities of color, threatening their lives in quantifiable ways.

We are never farther than our willingness to look at where we’ve been allows us to be. In our plight for justice, to move forward, we have to understand where we’ve come from. In February, we are sitting in a powerful moment to look honestly at our nation’s troubled history with race and inequality and find clarity around the pressing issues of our time. Join me this month in discussing how those issues impact our health!

And if there are topics you’d like to talk about, join the conversation and leave a comment below.

Structural Inequality and the Future of Medicine

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4 weeks ago, I published an article on Kevin.MD that garnered a lot of attention. It was titled The Myth of the Entitled Single Mother Remains as Relevant as Ever.* In it, I reversed the popularized notion that single mothers are a societal liability and suggested that instead, they are powerful forces in our local economies and influential leaders of future generations. I presented the idea that how society thinks about single mothers affects how we fiscally prioritize their needs. The point was, stigmatizing public rhetoric informs pubic policy in ways that perpetuate inequality and contribute to poor health. In response, however, I received a number of comments, many from other physicians, suggesting that such a topic was not “medical” enough to warrant physician concern.

That sentiment sits at the crux of one of the most contentious debates in medicine and frames one of the most important questions facing clinicians today. If inequality drives poor health, what is the physician’s role in addressing the structural forces in society that perpetuate inequality?

To answer this question, we must first unpack the ways enduring public narratives inform our institutions and shape opportunities in America. We must talk about how structural forces in society can align to create predictable patterns of disenfranchisement, including inter-generational poverty and poor health. Let’s get started!

The archetypes society erects to distinguish populations, commonly by race, gender, socioeconomic, marital, or immigration status, are not simple social tropes that define broad categorizations of people. Over time, and historically in fact, these social constructs lay deep roots in the political processes that govern society, processes that in turn, inform many of the institutions on which society relies, including the justice system, the education system, and the public health system. This pattern of influence is problematic because it allows shared public stereotypes to drive major public policy. This institutionalizes bias and creates inequality. And as we know, inequality drives poor health.

Let’s take one example of this and flesh it out. Look at the effect of race and gender on incarceration rates in America and the associated health consequences.

African-Americans make up 13.1% of the US population and yet African-American males alone, make up 38% of those incarcerated in federal and state prisons today. That means Black males are 6 times more likely to be incarcerated than White males and if these trends continue, 1 in 3 Black males will be imprisoned at some point in their lifetime.

The origin of the stark racial disparities in the US criminal justice system is complex and multifactorial. It is, in part, related to the disproportionately high rates of poverty,** unemployment, and low educational attainment in African-American communities. But it is also driven by a public narrative that associates Black males with criminality. That is why, even when you control for the crime rate, Black males are more likely to be arrested, once arrested, more likely to be convicted, and once convicted, more likely to face longer prison sentences than their White peers. This criminalization of African-American males is far from benign and, in fact, may have adverse health consequences for Black children and Black families.

When 1 in 3 African-American males are projected to be removed from their communities, often at the age of greatest productivity, it has profound effects on the communities in which these men live.*** Without their earning potential, these families disproportionately rely on the income of single mothers, many of whom live on the brink of poverty.**** Children who live in poverty are more likely to have poor health as adults, including increased risk for cardiovascular disease, high blood pressure, diabetes, arthritis, and depression. What is more, there is evidence to suggest that these risks persist, despite changing social class in adulthood. That means, there are physiologic pathways whereby systems of inequality and social stress may act to create immutable changes to children’s bodies, affecting everything from their brain development to their DNA. These changes can potentially be passed down to future generations, allowing under-resourced social environments to create predictable patterns of disease.

When considered in this way, it is easy to see how shared public narratives can become entangled in policies that systematically disenfranchise families and communities, dismissing productive members of society, shaping local economic opportunities, and informing the health of our future generations. When the life expectancy of a child can be predicted by the zip code in which they live, it exposes important drivers of health and disease in America. As physicians, we must dissect the threads that connect sociopolitical environments to biological consequences. If that is not “medical” enough to warrant our concern, I don’t know what is.

This is the future of medicine and it requires physicians confront issues of stigma and inequality as a function of their clinical duty to promote health and wellness. Doing so will certainly be a challenge. Success will rely on our ability to understand the impact social, political, and economic environments have on the population’s health and, to systematically incorporate this framework into the canon of medical scholarship and medical education. From there, we will need to build interdisciplinary models that bridge political action with health impacts. Jonathan Metzl and Helena Hansen have mapped a way to do that in their article entitled, “Structural Competency: theorizing a new medical engagement with stigma and inequality.” There is much to do be done. Let’s get to work!

Footnotes:

* Kevin.MD. is an online medical publication. You can also find this article on my site here!

** Communities in poverty have higher rates of crime regardless of racial composition.

*** This lends a new urgency to addressing the national gender wage gap, a gap that is wider for women of color, as communities of color may disproportionately rely on the income of women. It also underscores the importance of creating pipelines to higher education for men and women of color, to both supplant the pipeline to prison and to position women of color to occupy leadership roles in the community.

**** Many states also legally revoke prior felon’s voting rights and increasingly, laws and policies are being enacted to limit prior felon’s ability to: obtain employment, receive government benefits like food stamps, access public housing, or qualify for student loans. This results in 1 in 13 African-Americans no longer being able to vote today and prevents countless others from making meaningful contributions to their families and communities.

The Final Word on Black History Month: My Manifesto

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Every February, some of you invariably ask, why do we have Black History Month? Predictably, some of you will pose this question to the black people you know. As a black person, I offer you my final word on the subject, my manifesto, if you will.

Why Black History Month? Consider these reasons.

#1. You don’t know black history and if you are an American, that means you don’t know part of your own story.

The struggle to teach African-American history in our children’s classrooms continues. Take Chicago Public Schools, for example. They represent the 3rd largest school district in the country and despite having a mandate to teach African-American history for more than 2 decades, it was not until December of 2013 that they officially announced plans to implement a formal, yearlong, integrated African-American Studies curriculum into their public schools.

Without normalizing and institutionalizing African-American history into our collective forums for public discourse, we segregate ourselves from the breadth of the American experience. In so doing, we fail to capture an essential truth about America, that we are a multi-cultural, multi-ethnic population that has benefited from the contributions of people of color from our founding.* Every time we resist that central truth, we deny the very thing that makes us American, our shared history.

#2. You need to say thank you.

As does everyone who has benefited from the contributions of African-Americans to American life. Whether it be for the traffic light that safely regulated your morning commute (thank you Garrett A Morgan!) or the blood transfusion that saved your loved one’s life (thank you Charles Richard Drew!) or the vaccine that prevented your child from dying from a preventable illness (thank you Henrietta Lacks!), we must acknowledge the ways in which our lives are enriched because black people consistently made, and continue to make, defining contributions to our society.

And here I’ve only listed a few examples of notable inventions.

What of the impact of African-Americans on the evolution of music in this country? It is almost unquantifiable. From the folk music, bluegrass, and jazz that drew from the tonality of negro spirituals to the rhythmic beats of rock-n-roll, doo wop, disco, funk, soul, rap, and hip hop that emanate from urban America, African-American culture has created or influenced virtually every aspect of American pop culture through music, including the trending fashion, dance, and American vernacular that grew out of these popular genres. Just ask Elvis Presley’s modern-day protegĂ© Miley Cyrus. Twerkin’ ain’t easy and that charismatic rump-shakin’ didn’t start at the VMAs.

Generations of Americans are being raised in a culture that has deep and expansive roots in the African-American experience, but one that is equally devoid of public and enduring recognition of the contributions of African-Americans. Assuming the cultural expression of a group of people, without acknowledging said group, undermines their importance and in some ways, denies their humanity as it assumes they do not have the right to own their own expression. This is called misappropriation and it is the result of an amnestic historical memory, that is so short, it fails to encompass the areas in which our stories are linked and our lives find common ground. But fear not, the cure for misappropriation is simply a proper thank you.

And what of the countless unknown African-Americans who have given of their lives to protect the honor and safety of our country? Next month, President Obama will celebrate some of those men for their distinguished military service and award them the nation’s highest commendation given for combat valor, the Medal of Honor.** If the President’s actions here may serve as an example, when people give of their time, service, and sometimes their lives, for the betterment of our free republic, we must, even if belatedly so, say thank you.

Finally, I think it generally true, that when you honestly appreciate another person’s culture and life and consider their past and their future indelibly connected to your own, you are less likely to instantly think them a criminal, and “stand your ground.” Perhaps what we should “stand our ground” for is the recognition of the humanity in each other. Because when you appreciate people, you don’t shoot them and if Black History Month offers nothing else, perhaps it can serve as a moment for you to embrace African-Americans and in so doing, help bring our sons home safely at night.

#3. You don’t know black people.

If you keep a running tally of how many black people you know or feverishly defend the fact that you “have black friends,” you may not have had the intimate interactions that allow you to disconnect individuals from the stereotyped characteristics you associate with their race. In other words, if Joe is your “black friend,” he’s not really your friend and you don’t really know Joe.

But that’s okay. Perhaps you live in one of the few ethnically monolithic enclaves in our country, or somehow your only exposure to black people has been through The Cosby Show, or The Chappelle Show, or when Kanye upstaged Taylor. If this sounds like you, maybe it is time to branch out, meet new people, new BLACK people, and see what all the hype is about. The African-American experience is as varied as it is rich and our limited representation in the media doesn’t nearly approximate what it might be like to actually know us, dine with us, laugh with us, grow with us.

On a deeper level, if, as a society, we continue to live segregated lives in which we form ethically homogenous social circles, we will never have a basis from which to collectively digest, interpret, and process the complicated transactions that take place between the disparate cultures represented in our communities. Furthermore, challenges that require understanding another culture’s experience and the historical impacts of institutionalized discrimination, like for example, health disparities, or the educational achievement gap, or the disproportionately low rates of African-American women in the health professions, or the disproportionately high incarceration rates of African-American males, will remain insurmountable.

#4. You don’t like black people.

And frankly, black people may not like you either. And yet here we are, continuing to co-exist. So what should we do about it?

Get over it!

There is a reconciliation that needs to occur around issues of race in America and I’m not talking about tolerance. Tolerance is complacency in the face of continued unrest. It is offering separate but equal, instead of demanding that equal be the standard for equal. To heal the massive division in this country around racial injustice, we have to actively confront our bias to move on, even when that bias is unconsciously harbored.*** Black History Month offers us the first step to do this. As the great American poet, Maya Angelou said, “History, despite its wrenching pain, cannot be unlived, but if faced with courage, need not be lived again.”

Today, we face continued affronts to equality in this country as some Americans seek to marginalize groups they just don’t like. Look what is happening in North Carolina and Ohio to undermine voter’s rights, or in Arizona, where a bill to refuse service to gay Americans made it all the way to the Governor’s desk before being vetoed! Here, our broken history repeats itself and if we aren’t careful, we may all eventually find ourselves less free to pursue liberty and happiness. As Dr. King said, “Injustice anywhere is a threat to justice everywhere” and we must take a lesson from black history to see the trend repeating itself and threatening all of our freedoms. The solution is to challenge prejudice at every point it rears its ugly head, starting with ourselves.

#5. You are black and yet you feel disconnected from the African-American experience and the Africana Diaspora.

When historian Carter G. Woodson started Negro History Week in 1926, it was a part of a larger effort to cultivate ethnic pride. As the trans-Atlantic slave trade scattered Africans across the western continents, it violently divorced black people from the rich ancestry that informed who they were. The absence of that foundation created a dangerous space for black people to be defined outside themselves, by their new roles and their new lives.

One dynamic of racism that is as inconspicuous as it is pernicious, is the effect of internalized racism on the African-American psyche. It is the wilted acquiescence to the accusers taunts, that you are as they say you are, be that ignorant, useless, dirty, ghetto, lascivious, pugnacious, unworthy, or unlovable. Internalized racism breeds a self-hatred that dissolves the bonds between people who share the detested characteristic.

In short, racism shames blackness.

And internalized racism is the insidious acceptance of inferiority. It acts to separates people from their value and their ethnic community.

For these people, for us, Black History Month is a moment to affirm and accept our value; to remember who we are and where we come from. Despite the positions of poverty and war in which many of our peers struggle today, both here in urban America and abroad in Latin America, Haiti, and Africa, we are not how and where we live. Our worth is not defined by our struggle but rather by the fervor with which we reclaim what has always been our gift, our blackness.

Now, I am not as presumptuous as to conclude that a month is sufficient time to heal a pain that stretches centuries into our past and finds new meaning in the systematic marginalization of black people across the globe. But I will say this, we have to start somewhere and we need to start together. Perhaps, at its very best, this month can cultivate the ethnic pride needed to combat racism, whensoever, and howsoever, we may face it. Because when you don’t feel worthy, you don’t act worthy and racism has become a self-fulfilling, self-injurious prophecy in the African-American community, and I would argue across the African diaspora. It is time to mend the broken fences in our community, to let people in and heal together. Let this be our chance.

Here’s my final word.

As the thread of African-American culture weaves throughout the American experience, it informs who we are as a nation. While a month is hardly sufficient time to truly appreciate the weight of the African American influence on American culture, perhaps it can serve as both a reminder and an invitation:

A reminder to engage in the self-exploration required to overcome the distraction of modern racial discourse that dichotomizes and compartmentalizes our history in a way that disconnects the culture we consume from the historical process by which it was created;

And an invitation to collectively share in the creative brilliance, ingenuity, and public service that defines the contributions of Black artists, musicians, writers, activists, playwrights, poets, scientists, philosophers, physicians, engineers, civil servants, lawyers, filmmakers, educators, servicemen and women, entrepreneurs, athletes, and entertainers.

These contributions enrich our experience as Americans. So on this, the last day of Black History Month 2014, let this be the start of celebrating our shared America history. Because, we, too, sing America.

* Although I must clarify here, that sovereign nations existed on this soil prior to the arrival of Europeans or Africans and the true founding of this land must always be credited to the Native, indigenous people of this continent.

** This award was also given to Jewish and Hispanic soldiers who were previously overlooked for recognition because of discrimination.

*** If you are ready to confront your unconscious bias, take the Harvard Implicit Association Test here!