Race, Healthcare and America’s Legacy: Another Generation of Stories with Unfinished Endings

 Two years ago yesterday, a young man wore his sweatshirt the “wrong” way in a society that wasn’t ready for him to hide the scars it had put on his back behind a hoodie, Arizona Iced Tea, and audacity to stand up for his right to exist. We’ve heard this story a few times now, on our streets, in our courts, pervasively across this country where law and legacy are at war and legacy is winning. A few days back, Ta-Nehisi Coates, per his usual fashion, captured the heartbreak, anger and shame these stories evoke in a piece on the unfinished life of Jordan Davis, declaring, “When Michael Dunn killed Jordan Davis, he obliterated a time-stream, devastated an open range of changes… Michael Dunn killed a boy, and too robbed a man of his chance to be.”

Jordan Davis

Trayvon Martin

The intersections of power and race persist in virtually all corners of our society and shape so much of the discourse we as a country are willing or not willing to have on this topic. But power and oppression are complicated things, and sometimes the conversations that are heard the loudest do not necessarily frame the issues we need to be discussing. Steven Lukes, one of the more prolific contemporary voices on power theory, outlines different dimensions of power that challenge our conventional understanding of the concept. The first dimension, referred to as the “intuitive idea of power” by Robert Dahl, goes something like this: “A has power over B to the extent that he can get B to do something that B would not otherwise do.” Intuitively, this decision-making view of power is how we conceive of the word. A few decades later, this definition was challenged and a second dimension was added, as theorists stated, “Power is also exercised when A devotes his energies to creating or reinforcing social and political values and institutional practices that limit the scope of the political process to public consideration of only those issues which are comparatively innocuous to A.”

Is this not exactly what is happening with regards to race in America now? With the way the conversation is being shaped around individual tragedies the best we can seemingly hope for is a conviction or some small victory of legal justice. In our wildest dreams, Stand Your Ground might be repealed or at least distributed equitably. These conversations do not bring to the fore any issues that would significantly alter the status quo or change race relations beyond a superficial complacency in our newspapers and at our dinner tables that justice has been served.

But this is a health blog and at this point you’re probably wondering what any of this has to do with health. The short answer is that it has everything to do with health. Dr. King once said, “Of all the forms of inequality, injustice in health care is the most shocking and inhumane.” According to the 2013 CDC Health Disparities and Inequalities Report, the rates of premature death (death before age 75 years) from stroke and coronary heart disease were higher among non-Hispanic blacks than among whites. The infant mortality rate for non-Hispanic black women was more than double that for non-Hispanic white women both in 2005 and 2008. Life expectancy and expected years of life free of activity limitations caused by chronic conditions are significantly greater for whites than blacks. Preventable hospitalization rates are higher for non-Hispanic blacks and Hispanics than non-Hispanic whites. Non-Asian racial/ethnic minorities continue to experience higher rates of HIV diagnoses than whites and compared with whites, a lower percentage of blacks diagnosed with HIV are prescribed anti-retroviral therapy or have suppressed viral loads. Preterm birth rates are approximately six times higher for blacks than whites and hypertension, diabetes, asthma and obesity are more endemic among non-Hispanic blacks and Hispanics.

The tired arguments seeking to dull these facts claim that this is a socioeconomic issue and not a health one. Quantitatively, these arguments are just wrong. Racial and ethnic disparities in health persist even when controlling for socioeconomic status. For example, the infant mortality rate for college educated black women is more than two times higher than that for white women with similar education (11.5 vs. 4.2 per 1,000 live births). There is no denying that race is an independent variable impacting the quality of life and health care a person can expect in this country. Qualitatively, these arguments attempt to diffuse this racial causation with a socioeconomic middleman, questioning our intelligence as readers to recognize that the issues are one and the same, “that the hands that draw red lines around the ghettoes of Chicago [are] the same hands that drew red lines around the life of Jordan Davis,” that concentrate poverty, violence and poor health in minority communities.

Class, race, poverty and health are not separate issues that can be manipulated to dissolve America’s racist heritage or deny the structural violence of its present. We can no longer claim that because this is about class it is not about race, that it is poverty and not health. At the end of the day, these are human lives; stories of people young and old, white and more likely black or Latino, that have been robbed of their constitutional and human rights by a society that hides behind a façade of colorblindness while its people die in its streets, prisons and hospitals.

Ta-Nehisi Coates ended his piece on Jordan Davis with this statement:

“An American courtroom claiming it can be colorblind is a drug addict claiming he can walk away after just one more hit. Law and Legacy are at war. Legacy is winning. Legacy will always win. And our legacy is to die in this land where time is unequal, and deeded days are unequal, and blessed is the black man who lives to learn other ways, who lives to see other worlds, who lives to bear witness before the changes.”

It’s not just our courtrooms that are failing. It is our healthcare system and a society that is all too willing to admit that “Slavery is America’s original sin,” but too ignorant, or ashamed or self-serving to recognize that “racism is its chronic disease.” In the words of the great Langston Hughes,

“I tire so of hearing people say,
Let things take their course.
Tomorrow is another day.
I do not need my freedom when I’m dead.
I cannot live on tomorrow’s bread.”

 

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