Dr. Fleck published in ‘Hastings Center Report’ on Black Lives Matter and inequities in the U.S. healthcare system

Leonard Fleck photo

In the current issue of the Hastings Center Report, Center Acting Director and Professor Dr. Leonard Fleck shared a perspective on “Some Lives Matter: The Dirty Little Secret of the U.S. Health Care System.”

Abstract: Our health care system in the United States reflects the inequities that are part of the larger society, which is why our system for financing access to needed and effective health care is so complicated and unfair.

Visit the journal’s website for free access to the full text. Dr. Fleck is one of more than 200 Hastings Center Fellows.

Racism and the Public’s Health: Whose Lives Matter?

Bioethics-in-the-News-logoThis post is a part of our Bioethics in the News series. For more information, click here.

By Karen Kelly-Blake, PhD

“Strange Fruit”

Southern trees bear a strange fruit
Blood on the leaves and blood at the root
Black bodies swingin’ in the Southern breeze
Strange fruit hangin’ from the poplar trees

Pastoral scene of the gallant South
The bulgin’ eyes and the twisted mouth
Scent of magnolias sweet and fresh
Then the sudden smell of burnin’ flesh

Here is a fruit for the crows to pluck
For the rain to gather, for the wind to suck
For the sun to rot, for the tree to drop
Here is a strange and bitter crop

– Billie Holliday, recorded 19391

In order to create the conditions that allow for health and well-being for all people in the US, we must boldly address the causal relationship between racism, discrimination, bias and poor health.3,4,5,6,7 As a medical anthropologist, I must clearly state that race is not a biological fact, but instead is socially constructed. Having satisfied that disciplinary requirement, let me be even clearer—an individual’s lived experience in the world from birth to death is shaped by the color of their skin (as so hauntingly illustrated in the “Strange Fruit” lyrics above). Over the past year, there has been a seemingly endless stream of media images2 of black people being killed or brutalized: Trayvon Martin, Michael Brown, Walter Scott, Eric Garner, Freddie Gray, Tamir Rice, Renisha McBride, and the Emanuel Nine. The images starkly illuminate the profound relationship between racism and black people’s health. Unfortunately, these events are not new nor are they anomalies in the US, but they have captured national attention. The hidden subtext of these events is the extent to which racist social interactions and institutional structures affect the daily lives of millions whose suffering is not broadcast on the nightly news.

Justice for All March - Dec. 13, 2014
Image Description: an individual is holding a sign above their head that reads, “We revolt simply because, for many reasons, we can no longer breathe.” Image Source: fuseboxradio on Flickr

A growing body of literature highlights the ways in which racism and discrimination affect the health status of people of color.3,4,5 The American Journal of Public Health6 and the DuBois Review: Social Science Research on Race7 devoted entire issues to those concerns. Note a few examples. Persistent discrimination in housing and mortgage lending effectively sustain residential segregation which in turn restricts access to educational and employment opportunities, nutritious food, safe spaces to exercise, and high-quality medical care.8 The widening wealth gap—for every dollar of wealth held by white households, black households held 6 cents, and Latino households 7 cents.9,10 Research has shown that black people, when compared to whites, are less likely to be offered the latest health care treatments for cancer,11 heart disease,12 and depression.13 Studies also reveal significant bias in the criminal justice system, leading to higher arrest, conviction, and incarceration14 rates for black people for similar crimes and at higher rates than whites. Data indicate that self-reported incidents of discrimination are psychosocial stressors that negatively affect physical and mental health.13,16 In sum, racism is a public health problem.15,16,17,18,19 It contributes to higher levels of stress, greater exposure to risk factors, reduced access to medical and social services, and ultimately to excess levels of disease, disability, and death.5

So, whose lives matter? Georges Benjamin, Executive Director of the American Public Health Association argues that “good intentions and good science are no longer enough”.20 Public health has the capacity, the tools, and the knowledge to connect and act on the ways in which racism and discrimination in all their forms become personified and observable as health inequities.21 Essential to the mission of public health is the capacity to analyze and promote social justice and health equity and inform the interconnected call for social justice, racial justice, economic justice, environmental justice, community justice, and climate justice.17,22

We are perhaps at an inflection point. Unlawful police killings, exemption, and health inequities are not new phenomena, nor is the related struggle to counter them.17 Public outrage and the cries for social justice demand that we move beyond antiseptic bromides about “diversity,” “cultural competency,” and the inane claim that we live in a “post-racial” society. Such a move requires accountability, open discussion, and candid self-assessment, of individuals and of our institutions, about the complex realities of racial injustice and the resulting historical trauma.20 The ability to unpack and forthrightly address the causal relationship of racism and discrimination to disease, disability and death is part of the charge and responsibility of public health programs. Equally, it is incumbent on medical schools to transmit that knowledge to future practicing physicians and public health experts and prepare them to address racially generated contemporary public health issues.15

Justice for All March - Dec. 13, 2014
Image Description: A person speaking at a podium is surrounded by a crowd of people, some of whom are holding signs that read “I Can’t Breathe,” “Hands Up Don’t Shoot,” and “Black Lives Matter.” Image Source: fuseboxradio on Flickr

If we want to truly achieve social justice and health equity, these recent high-profile incidents, and the rising social movement,23,24,25 might create an opportunity to confront and acknowledge the racist, discriminatory, and biased legacy of our history. To that end, we must be ready and willing to dismantle the systems that perpetuate inequality.20 The time to achieve these aims is now, and if not now, then when?

kelly-blake-crop-facKaren Kelly-Blake, PhD, is an Assistant Professor in the Center for Ethics and Humanities in the Life Sciences and the Department of Medicine at Michigan State University.

Join the discussion! Your comments and responses to this commentary are welcomed. The author will respond to all comments made by Thursday, August 6, 2015. With your participation, we hope to create discussions rich with insights from diverse perspectives.

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