Oh, sweet Maya

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Dr. Maya Angelou’s words decorate the walls of our classrooms, fete the ceremonies of presidents, and illuminate the conscience of a nation. By formal account, she was a poet, playwright, memoirist, dancer, singer, stage actress, streetcar conductor, single mother, college professor, civil rights activist, and cultural humanitarian. But, perhaps most importantly, she was ours.

With the rare clarity that comes from lived experience, Maya Angelou captured the curious reality of the American black girl; the girl who awakens to a home she is told, is not hers. The paradox of being born black and female in America is that although you are as quintessential to the American story as the slave trade that brought your ancestors, by virtue of your existence, you are displaced. Despite birthing the generations whose unpaid labor sustained the American economy for more than a century, it is the black woman who lives as a foreigner in her own home. As the social construction of race animates and personifies blackness, the color of her skin eclipses the content of her character. Thus historically, it is the African-American woman’s blackness that shrouds her femininity and obscures her nativity. It renders both her beauty and her personhood, foreign. She is the acquired taste. And as she awaits her palatability, she remains in the shadows.

But as Maya showed us, the shadow is not just a vacuous darkness left in the background. It is the evidence that you exist, that you were here, and that the sun shone down on you. By embracing the lived experience of our blackness, Maya helped us embrace the light in which black women were cast into existence. We were aching to be seen and see us, she did.

The lens with which Dr. Maya Angelou captured the African American experience was transcendent. She humanized us. As she recounted the lives of her mother, brother, father, aunts, uncles, cousins, and friends, she gave living testimony to the pain, humor, love, and tension that pulses beneath the surface of American life. She made survival a virtue and cast black girls as repositories of the national wisdom held in the seemingly insignificant happenings that pepper everyday life. She refused to trivialize the lives of children, the poor, or African-Americans, despite the fact that they so often go unnoticed or uncelebrated. Revealing our inner truths like nursery rhymes, exclaiming our bountiful beauty with exacting wit and unwavering reverence, she told us of a woman, who was once a girl, who was once a black girl in the south, who was once invisible (and mute). Rendering us visible with the audacity of her authenticity, she offered us voice and if you are like me, you took it.

Truly good prose looks into the deepest crannies of human experience, and reveals you, to yourself. By bravely telling her story, Maya told our story. Standing in a line of Sojourner Truth’s, Phillis Wheatley’s, Gwendolyn Brook’s, Rita Dove’s, Audre Lorde’s, Nikki Giovanni’s, Alice Walker’s, and scores of other black female poets, playwrights, and authors, she shone a light onto the very soul of us. I know why the caged bird sings. It sings because Maya lifted its very existence, that it might know it was made to soar.

Maya once said that the greatest thing you can say to another person is thank you because thank you is what you say to God. Where words fail to capture the depth of my sorrow for her loss and the extent of my gratitude for the life she lived and the words she left us to live by, I say, Maya, oh sweet Maya, thank you. You will be missed because you were always ours.

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Equal Pay, Now

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Today is Equal Pay Day, or the day that marks how many extra days the average US woman must work into 2014, to earn as much as her average male counterpart in 2013. Given this momentous occasion to spotlight gender wage inequality in America, let’s take a brief look at the wage gap, why it matters, and what our President is doing about it today!

Did you know there is a gap inside the gap?

According to US census statistics, the average, full-time, female worker in America makes 77 cents to the dollar of what the average, full-time, male worker earns. But this statistic only refers to White women. The wage gap is far wider and deeper for women of color in the US, who face both a larger disparity in pay deferential and also fewer opportunities to rectify this great imbalance. The average African-American female worker makes 64 cents to the dollar and the average Latino female worker only makes 53! Part of that deferential is related to lower educational attainment among African-American and Latino women. And yet, “you can’t educate your way out of the gap!” Even as higher education raises everyone’s wage, African-American and Latino women continue to earn less than their White peers with the same educational background. This reveals a racial gap, inside the gender gap that may reflect discriminatory hiring practices, disparate access to meaningful employment by neighborhood or region, and disparate opportunities for upward mobility for professional women of color.

There is also geographic variation in the wage gap. Check out this chart to see how your state compares to Washington, DC or Wyoming, the areas with the smallest and largest gender wage gap in the US!

Why does the gender wage gap matter?

Since 1960, the number of women who are the primary wage-earners for their household has almost quadrupled, such that women now comprise nearly two-thirds of the breadwinners or co-breadwinners in their family. And as it turns out, more than 6 and 10 of the women who are the primary breadwinners in their home, are single mothers.

That means, average American families are increasingly depending on the earning power of women to make ends meet.

So when Mom brings home 23% percent less than her male counterparts (remember, that percentage can be as high as 44% less for Latino women), that is less income for everyday needs including healthcare, less investment in our children’s futures and education, and when added over a lifetime of work, significantly less for retirement.

AND, as a pediatrician, I know that 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. So in many ways, investing in women is also vital to our country’s health and wellness!

So what is today’s big news?

Today, President Obama continued his commitment to the economic empowerment of women by signing one executive order and one presidential memorandum that take the legislative steps necessary to level the pay-ing field for women, well at least, female federal employees. This week the US Senate is also considering the Paycheck Fairness Act, which would extend the standards put forward by the President’s executive order to all employers covered by the Fair Labor Standards Act. To see President Obama’s complete legislative agenda to address gender income inequality click here!

And finally, any quality discussion of income inequality would be remiss to leave out the debate on minimum wage. Suffice it to say, raise the wage! Doing so, would especially benefit women who are more likely to occupy low-wage sectors of the labor force or to participate in part-time work (given many women’s commitment to their education or their growing family). It is also estimated that increasing the national minimum wage may be essential to lifting more than half of our working poor families out of poverty.

As Martin Luther King Jr said in his 1965 commencement address at Oberlin College, “The time is always right to do right.” And for income inequality in America, that time is now.

 

 

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.

Good Girl, Up Speak and Thinking In

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I have a confession.

It is a secret I have held for more than 10 years and it is a lesson I have learned from other women.

As society continues to debate the terms and conditions required for women to be leaders, what is often missing is the lens of the woman of color. It is time to talk about the socialization of girls, and brown girls in particular, and the guise we are raising women to wear to navigate the complexities of race, gender, and politics in the classroom and the workplace.

So here goes…

I change my voice to make other people comfortable.

In general, I have a high-pitched voice. It’s genetic. My grandmother spoke in a higher register and I guess I’m following in her shrill footsteps. But my grandmother had style and when she squealed in laughter or sang the soprano out of a church hymn, it sounded like wind chimes in a summer breeze. Her piercing tone commanded authority and carried assurance. She was authentic and her voice was the instrument that ushered her power.

My voice may be naturally high, but when I’m the only African-American or woman at the table, or when I hold a particularly contentious opinion, I go EVEN higher. Instead of wielding the power of my pitch, I ritually sacrifice my self-expression somewhere in the back of my throat and barter my pride for the perceived benefits of social normalcy. I phonetically transform what I physically cannot change, I am an educated black woman with an opinion.

My sister calls this guise “good girl, up speak.” It is the rising tone of voice I enter to placate others. I summon the “good girl” voice as a part of a physical transformation I have grown accustomed to, first in the classroom and now in the workplace. At some point, I have, consciously or unconsciously, accepted the misogynist edict that women, and women of color in particular, are to be seen and not heard. And I have learned that edict from other women.

Careful experience has taught me that speaking assertively may make males, and white males in particular, uncomfortable. Why else would intelligent women, in the media, in my classroom, and in my profession, soften their voice almost to the pleasant vacancy of a child, to communicate their thoughts? We’ve all seen it. So rather than fully challenge my male colleagues to engage in the mental and social exercise of trying to understand what my black, female body is communicating, I too make my words, however cutting, fall softly on their ears, lest they be offended by both my point of view and my tone of voice.

It is not so much playing dumb as it is playing docile. But what’s the difference when you are trying to be heard? In Harvard Business Review, Deborah Tannen, a sociolinguistic researcher, wrote a piece called The Power of Talk: Who Gets Heard and Why. In it she says, “Language is a learned social behavior.” As such, it is infused with the power dynamics that are socialized into each of us as children; dynamics that communicate competence and confidence, and dynamics that can translate into stereotyped gender roles. According to her, “Language negotiates relationships” and the way you address people and how you are addressed, reveals an unspoken social order that defines how we understand each other and how we value each other.

Lately, much has been made of the sociopolitical posturing (“leaning in,” if you will) women must undertake to exercise their power and influence. Yet our greatest instrument of power is our authentic voice. Any time we silence that voice, we miss the opportunity to value other women. For example, by assuming “good girl, up speak,” I validate the antiquated social order that decrees women, and women of color in particular, must infantilize their voice to be heard. Each time I do this, I implicitly encourage women around me to adopt similar positions of subordination to express their feelings. In so doing, I am complicit in the creation and maintenance of the very systems that oppress women in leadership and suppress female thought.

So instead of “leaning in,” the real exercise women may need is “thinking in” or creating a space to re-evaluate how our patterns of behavior undermine our authentic voice and contribute to our disenfranchisement as a group. One of those patterns of behavior is how we speak, another is how we conceptualize our role as leaders. If we continue to define ourselves between a 2-dimensional chasm of “should” and “should not” quandaries that pit domestic aspirations against professional salience, women will always lose. This rigid dichotomy ignores the important and dynamic roles women can fulfill over their lifetime and the opportunity we carry, either in our wombs or our briefcases (or backpacks, as the case may be), to shape the world in which we live with our authentic presence and voice.

When we, as women, strip away the guise, we can be more “I am woman. Hear me roar.” and less “I am woman. Don’t call me bossy.” Instead of being afraid of words, let’s own them. Let’s speak with the authority that our education, experience, and the roles we fulfill, provide us, be that sister, mother, student, physician, or CEO.

New feminism is about women, work, and the will to be authentic. And future generations will rely on us to use the tools at our disposal – the vote, free speech, globalization, and growing numbers of college graduates – to dismantle the structures that demand we conform to misogynist inventions of who we are. For modern American women, we don’t have to be the “good girl” to be the boss. As Deborah Tannen says, “The way we speak is who we are and who we want to be.” Our influence spans the home, office, clinic, and classroom, and who we can be and what we can be is defined by how we use our voice to empower other each other. At its best then, feminism is a collective notion that lifts each of us, despite our color or creed, to live authentically.

Update: This post is also being featured on Kevin.MD. Click here to check it out!