In healthcare, we are no strangers to the systematic, unhealthy and ultimately deadly effects of racism and inequality. Doctors see the effects every day in their clinics and wards. As a profession, doctors have long discussed health disparities, and have fashioned interventions large and small to deal with its many effects. A recent call to take racism seriously as a public health issue come from New York City’s health commissioner Dr. Mary Basset. According to a Politico New York Article, “Bassett’s more expansive view of public health counts racism as a social determinant. It means universal pre-K and affordable housing are as much public health issues as immunization rates. It also means gun violence and police violence are just as much a public health concern as cigarettes and sugary drinks. ”
Dr. Bassett’s comments are part of a growing drumbeat focusing long overdue attention to inequality and discrimination in America, especially in regards to communities of color.
In Chicago, teachers and their union, working alongside community members and their organizations, have mobilized together to try to stop the closure of already crowded and under resourced schools and demand increased staffing and funding for classrooms. From Staten Island, Missouri, and Texas, to street corners and public squares across the nation, citizens have united under the banner of BlackLivesMatter to call for an end to discriminatory and violent policing practices, and assert the fundamental humanity of people of African descent, in a country that till this day argues over the meaning and use of the flag that rallied the armed supporters of the enslavement of African Americans –150 years after the end of the Civil War.
Healthy People 2020 defines a health disparity as “a particular type of health difference that is closely linked with social, economic, and/or environmental disadvantage. Health disparities adversely affect groups of people who have systematically experienced greater obstacles to health based on their racial or ethnic group; religion; socioeconomic status; gender; age; mental health; cognitive, sensory, or physical disability; sexual orientation or gender identity; geographic location; or other characteristics historically linked to discrimination or exclusion.”
They go on to define Health Equity, as the “attainment of the highest level of health for all people. Achieving health equity requires valuing everyone equally with focused and ongoing societal efforts to address avoidable inequalities, historical and contemporary injustices, and the elimination of health and health care disparities.”
Paula Braveman, MD, MPH makes the important point that health disparities are not health differences. She uses the example of higher rate of arm injuries among tennis players as a difference but not a disparity. The difference is the underlying concern with social justice that lies at the heart of the Health Equality movement —“that is, justice with respect to the treatment of more advantaged vs. less advantaged socioeconomic groups when it comes to health and health care.”
As doctors who have taken an oath of service to our patients, we are called to heed the voices of those of them who suffer in the midst of injustice, and do what we can as profession to add our voices to a growing chorus calling for our country to finally confront the structural inequality and resultant disparities in care and outcome that shape and drive the damage done to the health, and lives of our patients, their families and the communities in which they live.
As members of Doctors Council, we have committed not only to treat the end effects of inequality, but to organize and help lead towards addressing the root cause: a lack of Justice.
Doctors Council hopes in days, weeks and years to come to be a steady advocate to secure Justice, and hope you will join us in that effort.