Addressing Racism to Improve Population Health

Mary Bassett’s M.D., M.P.H, Commissioner, New York City Department of Health and Mental Hygiene, experience as a young doctor and researcher in Zimbabwe continues to frame her perspective as a doctor today.  In an honest and powerful TedMed talk she discusses her regret at not speaking out more on the structural inequality that framed the early years of the AIDS epidemic in Africa.   She experienced hands-on the frustrating distance between the one-on-one care she was providing to the best of her ability and the larger forces that affected her patients.  It inspired in her a determination to not be quiet, but rather to speak out in the face of the large structural forces that determine the health of populations.

For Dr. Bassett this now means, among other struggles, an honest confrontation with racism in medicine. In a previous blog post we highlighted her comments in a JAMA editorial  #BlackLivesMatter — A Challenge to the Medical and Public Health Communities in which she takes the lessons learned in Zimbabwe and applies them legacy of racism in the United States.  At the core of her vision is the belief that doctors have an ethical responsibility to address the structures of power that affect the health of the patients.  As she wrote in JAMA:

“Should health professionals be accountable not only for caring for individual black patients but also for fighting the racism — both institutional and interpersonal — that contributes to poor health in the first place? Should we work harder to ensure that black lives matter?”

At a recent CUNY forum: “Dismantling Racism in the NYC Health System,” she explained how choice replaced genetics in understanding health disparities:

“We went from [a belief in] genetic inferiority to saying black people make bad choices. I don’t think anyone decides, ‘I want to live in a neighborhood with really bad housing, or poor air quality,’” she said. “Nobody says, ‘I really prefer a neighborhood where there is only fast food available.’ … These are not personal choices. These are a lack of choice.”

Or as she wrote in the American Journal of Public Health  “To frame chronic disease risk as a consequence of ill-conceived personal choices and inadequate medical care is a modern day version of hand washing to prevent cholera: not wrong but tragically misguided.”

This is the background for Dr Bassett’s understanding of the 2014 Summary of Vital Statistics which was recently released.  She says:

“Long-term improvements in life expectancy and premature mortality mask the reality of long-standing inequity in NYC’s communities of color – inequity which has been driven by a legacy of persistent injustice. This report once again confirms that critical work that must be done to reverse the continuing and, in some cases, widening health disparities between NYC’s poor and rich neighborhoods.”

A notable finding in the report is that,  “The difference in life expectancy in very high poverty neighborhoods compared to low poverty neighborhoods rose to 7.4 in 2013, compared to 5.8 in 2005, indicating a widening health disparity.”

What is a union’s role in this?  Increasingly Doctors Council is committed to providing the means by which doctors could successfully intervene on the institutional level.  The decision to get involved or speak out about structural inequality, in our view, must be both collective and ultimately successful.  Doctors Council wants to become the place where the abstract ethical responsibility to the patient becomes a collective practice.