March 2016

The Chairman’s Blog

Race, Racism and Health

            Gross inequalities in health across populations have been recognized for centuries.  With modern health systems these inequalities can be measured in great detail.  The disadvantage experienced by black Americans is one of the best studied and most important inequalities in the US.  For example, death rates among black Americans have been 50% higher than for whites ever since vital statistics data were first collected in 1900, and life expectancy is 4 years shorter.  Despite the vast recounting of this experience, and the many interventions – most often on a small scale - that have been mounted to reduce the health gap, we can at best point to only modest progress in the last several decades.

            There is no mystery lurking below the surface here – health is determined by where we group up, the school we attend, what job we hold, and our access to a secure and health-promoting life style.  What is all too often missing from this story, however, is a recognition of the vital importance of active, organized institutional racism within our society.  Discrimination against people of color cannot have gone undetected by anyone who lives in this society, or even the casual visitor from abroad.  Yet while discrimination is all too apparent in our daily experience - in residential segregation, police violence and the grossly skewed patterns of employment - just how the institutions of our society give racism its enormous impact as a living social force is often invisible.  No doubt historical practices of racism gain momentum on their own, and are passed down through collective behavior.  That alone, would not be sufficient to maintain the impregnable barriers to racial equality that have been with us for 500 years of US history. For the 300 years when that institution took the form of chattel slavery racism not only saturated every aspect of life in the US, it was applauded and fanatically defended; a “second revolution” and the deadliest war we have ever fought was required to bring down that barrier. Racial history since 1864 has been one of great progress, yet with continuity.  Our challenge today is to understand the much more complex structures that continue to limit life’s chances for people of color.  Understanding and confronting this reality is not a dry academic exercise; it is a life or death challenge faced by millions of our friends, work-mates and neighbors every day.  More. Racism is a poison that seeps into the interstices of every social domain – wreaking havoc on our cities, undermining the political will to support public education and insure that all employment offers a living wage.  Our founding document, still honored as a literal handbook for the operation of government, proclaims as a self-evident truth that “all men are created equal”.  The original sin of our society was yielding to the temptation to the vilest hypocrisy – defining “all men” and “equal” to mean precisely the opposite.  The pretense of moral authority enshrined in that document has granted us license to live a lie.  Yet you reap what you sow and, while perhaps not self-evident to the founding fathers, no matter what their skin color or ethnic background, “all men” -  and women – have an unalienable will to assert their demand for equality.  We continue to pay dearly for the choice to our build society on a foundation of injustice.  Illness and death have no respect for pretense.  Health inequalities demonstrate an inescapable truth about the state of justice and equality in our society. 

            The goals of this blog are 3-fold: 

1) To explore the structure and way of operating of those institutions that constantly rebuild, extend and modify the barriers to racial equality.

2)  To illuminate how those institutional practices rob black Americans and other minority groups of their good health. 

3) To generate an urgency, a “fire in the belly” outrage, that will move us all to fight racist institutions, their practices, and the people who promote them.  Only by taking up these challenges can we expect to win in the struggle against the immense power that racism wields in our society.