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.

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I am MLK

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Unprovoked and un-prosecuted police brutality that preys upon people of color.

Separate and unequal education systems that consistently fail poor children of color.

Segregated housing that concentrates poverty and consequently, crime, in communities of color.

A discriminatory wage gap for women and people of color that bolsters growing wealth inequality.

And preventable patterns of disease that plague poor communities of color.

The contemporary threats to equality in American life are disturbingly similar to the injustices that emboldened leaders of the Civil Rights Movement more than 50 years ago. But while the issues that define our time are unsettlingly familiar, the opportunities to act are profoundly different.

With the advent of social media, ordinary individuals now have unprecedented access to both publish and consume publicly curated news. This step to democratize information creates a space for enduring public discourse and a real-time portal into the many faces of racism, sexism, classism, and cultural ethnocentrism that endanger our most basic American values.

The legacy of the Civil Rights Movement freed us from the tyranny of these “isms” at the ballot box, in the classroom, in our neighborhoods, in our work places, and in the public spaces of American life. In so doing, the acts of thousands of courageous Americans set a new precedence for our nation to reaffirm its commitment to liberty and justice.

Today that commitment is under attack. And although the challenges we face are formidable, our responsibility is great. So who will rise to the challenge? Who among us is willing to take the protests and the hash-tags into the daily routines of our lives where the insidious acts of racism, sexism, classism, and cultural ethnocentrism threaten the values we hold most dear? Who will fight for equality today?

Dr. Martin Luther King Jr. was an exemplary American who challenged us to rise to the height of our humanity. But we cannot wait for another visionary to bring us to the mountaintop.

The urgency of justice demands we act now, one institution, one industry, one community, one person, one step at a time.

If you are a teacher or school administrator, challenge the “zero-tolerance” policies that forge the school-to-prison pipeline, disproportionately shunting students of color and students with disabilities, as early as preschool, into the criminal justice system for routine school infractions.

If you are a local government official, question the redistricting policies that dilute the voting power of minorities and overturn voting registration policies that may prevent the elderly, the poor, or people of color from exercising their constitutional rights.

If you are a housing developer or real estate speculator, invest in mixed-income housing that enable people, regardless of race and class, to share the public benefits of education, parks, and recreation that flourish in proportion to local tax appropriations.

If you are an environmental advocate, lobby to protect poor communities of color from the industrial pollution that threatens their air,soil, and water quality and ultimately jeopardizes their health.

If you are a police officer, challenge “stop and frisk” policies that disproportionately target Black and Latino individuals and confront the biased assumptions that may lead you to suspect persons of color or treat them with excessive force.

If you are an writer, publisher, producer, or actor, demand that our films and books offer a genuine look into the lives of all Americans. This requires equal representation on the written page, behind the camera, and in front of it, to reflect the diversity of the American experience.

If you are a student, consider if women are disproportionately subject to sexual violence on your campus, and stand in solidarity with the victims in demanding that your faculty and administration protect young women and their bodies.

If you are a business administrator or owner, critically look at your workforce, from the leadership to the average employee to the staff and ensure that the process by which you recruit, hire, and compensate employees reflects equity in opportunities for women and people of color.

If you are a physician, confront your implicit bias and how your differential treatment of patients by race, gender, or class may contribute to deadly health disparities.

As Dr. King sagely foretold, “injustice anywhere is a threat to justice everywhere.” The racism exacted with the lethal precision to take the life of Eric Garner is just as pernicious as the sexism that ostracizes and threatens the lives of victims of sexual assault on our college campuses. It is time to connect the dots between all forms of oppression in American life and work towards justice.

The modern movement for equality will be powered by the daily diligence of the masses, not the brilliance of one leader. We all must summon the courage to go to into our work place, our classroom, our community, and our home, and engineer justice, create equality.

As we remember, with pride and gratitude, the life of Dr. King, let us not rely on his memory to ensure our liberty and justice. Without his living example, let us be his voice for change.

I am MLK.

This week, join @schumerj and I, as we tweet out our commitment to change our workplace, community, or social networks using the hash-tag #IamMLK and let’s build a coalition of leaders for justice. Also look for an upcoming 2-part piece on racism in the American health care system and what we can do about it. In solidarity, Rhea MD

Walking the Talk

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I’m back!

After a 3 month hiatus from writing, I’m back! And although things went radio silent on my blog, I’ve been busy working on projects that I am excited to share with you guys! But first, let me tell you why I took a break.

For those of us who think critically about the delicate social safety net that is fraying under mounting pressures of growing inequality and finite public resources, it is clear that more than thoughtful rhetoric is required to bear this heavy load. It is also clear that there are new opportunities for the healthcare industry to unite with the social sector to address the most egregious impacts of poverty in our society – death and disease. So while I took some time away from talking the talk on here, it is in part because I found new opportunities to walk this walk in my professional life.

Now, I’m back, and with new experiences that will hopefully inform our conversation on this blog. So look forward to new posts as I continue to think about the intersections of race, gender, social inequity, structural inequality and health in our society and ponder aloud how we might address these issues together, through our unique work.

Here are the questions that will drive my next posts:

1. Is worse care better than no care? Do new models of care trialed by pharmacies (think CVS, Walgreen’s) and internet giants (think Google and Facebook) suggest access is more important than quality? How should what we know about quality drive how we provide care across the medical infrastructure?

2. How can technology bridge the gap between the healthcare and social sectors, as we both endeavor to address the impacts of poverty on society? This question is intimately related to a question I frequently ask on this blog: If patients bring doctors their social needs and doctors know those needs impact their health, what is the physician’s role in addressing social needs?

3. Cultural Competence vs Cultural Consciousness. What is the correct framework for understanding and addressing health disparities? How should we teach physicians and trainees to engage their unconscious bias in clinical encounters such that all patients receive and perceive quality care, regardless of their “cultural” background?

Okay, those are a few teasers to tide you over for now 😉 And if you have other topics you’d like me to address, please leave a comment and I will do my best to include them in upcoming pieces. Looking forward to walking the talk together!

Until then, be well!

Rhea

What’s Your Poverty IQ?

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As growing income inequality continues to divide the nation into the have’s and have not’s, more and more families are finding themselves having not. For too many, the tight rope of financial stability has frayed and as we are realizing, more is dangling in the balance than dollars and cents. America’s future is on the line.

With many struggling to survive without basic necessities, like quality education, meaningful employment, affordable housing, nutritious food, or accessible healthcare, poverty is the contemporary atrocity that challenges our most fundamental American values; that everyone is created equal and endowed with rights to life, liberty, and the pursuit of happiness.*

Today, liberties are constrained by access to resources, the plight of the poor is hardly a pursuit of happiness, and for many, their very lives are at risk. Just look at this graph that illustrates the association between income and life expectancy. I guess rapper 50 Cent had it right. In America, if you don’t get rich, you will certainly die sooner, trying or not.

The implication here is that poverty not only threatens the health and well-being of a growing population of Americans, but its persistence also threatens the foundation of our democracy. So, at a certain level, understanding the impact of poverty is central to understanding what it means to be an American today.

So let’s talk about it. What do you know about poverty?

Take this 10 question quiz from Marketplace public radio and see how you stack up!

How’d you do? Post your score or thoughts on this exercise in the comments below!

Now that you’ve seen the facts and figures, let’s look at what those numbers mean.

To understand the impact of poverty, we have to engage the context and ask the right questions. For example, take the statistic that says, “of all working age people living in poverty, about half (7.2%) had full or part-time employment in 2010.” I took this fact directly from our handy quiz link above. You can translate that figure into a number of questions. One question might be, “Why don’t poor people work harder to lift themselves out of poverty?” Or if you are Paul Ryan** you might ask, “Why don’t poor people value work?” These questions create value-laden assumptions about individuals and communities and ignore the local systems that contribute to poverty.

Better questions might be, “What is the relationship between employment and poverty in the United States?” “If half of the poor are already working, what role do for-profit corporations play in the perpetuation of poverty?” “Should conditions of employment include provisions for basic needs, like a minimum wage that approximates local housing costs or health insurance coverage for part-time employees?” “How does race, gender, or educational status influence opportunities for upward mobility?” These questions interrogate the economic, political, and social systems that disseminate resources, structure local opportunities, and define the face of poverty in the US. Asking questions in this way allows us to formulate an actionable agenda to address poverty.

It is time to transform the national conversation around a topic that is literally redefining what it means to be an American. Today, the long reach of poverty extends throughout every state and city in this country, influencing lives from cradle to grave, and intimately shaping the ways we live, work, and play.  If all meaningful action starts with knowledge, what’s your poverty IQ?

* Here, I should clarify that the Declaration of Independence specifically declared “all men” created equal. This of course purposefully excludes women and people of color. Slaves were not considered people until 11 years later, when it was decided they would be 3/5 of a person. This was known as the three-fifths compromise.

** Paul Ryan was quoted on the Bill Bennett Morning Show in March 2014 indicting “a culture, in our inner cities in particular, of men not working and just generations of men not even thinking about working or learning the value and the culture of work.” Here, he conflated institutional failures with cultural pathology. Given his influence over the federal budget, it is concerning to hear him voice this deep misunderstanding of the forces of poverty in the US. Charles Blow, an op-ed columnist at The New York Times addressed this point here. For a bit of a longer read on the nuances between culture and poverty, check out this beautifully written piece by Ta-Nehisi Coates, an op-ed columnist from The Atlantic.