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Removing the Pump Handle

By Dr. Teeb Al-Samarrai

Frederick Douglass

By Robert Hayden

When it is finally ours, this freedom, this liberty, this beautiful
and terrible thing, needful to man as air,
usable as earth; when it belongs at last to all,
when it is truly instinct, brain matter, diastole, systole,
reflex action; when it is finally won; when it is more
than the gaudy mumbo jumbo of politicians:
this man, this Douglass, this former slave, this Negro
beaten to his knees, exiled, visioning a world
where none is lonely, none hunted, alien,
this man, superb in love and logic, this man
shall be remembered. Oh, not with statues’ rhetoric,
not with legends and poems and wreaths of bronze alone,
but with the lives grown out of his life, the lives
fleshing his dream of the beautiful, needful thing.

As we celebrate black history month and the incredible contributions of African Americans to American society and the foundations of this country, it’s also important to acknowledge the persistent health disparities that still exist between African Americans and other racial groups in the US.  

For example, it’s astonishing to realize that the average life expectancy of an African American man is 18 years less than an Asian woman!  In addition to lower life expectancy, African Americans experience disproportionately higher rates of infant mortality, heart disease, and stroke. It’s overly simplistic to dismiss these disparities to poverty, socioeconomic differences, or differential health care access. We only have to talk to our patients and look to our communities to see the ways in which social policies, whether intentionally or not, perpetuate and exacerbate these inequities.

As Dr. Tony Iton, former director of the Alameda County Department of Public Health said, these policies have over time “taken many forms, including racially restrictive covenants on property, economic redlining in banking practices, school segregation, [unfair] housing and urban renewal policies, disinvestment in public transportation, discriminatory zoning practices, law enforcement racial profiling, [discriminatory] incarceration policies, and other deliberate governmental policies and practices.” (In Hofrichter, Richard. Tackling Health Inequities Through Public Health Practice, National Association of County and City Health Officials: 2006; p. 124)

To gain some insight into these issues, I urge you to take a moment and watch some of the clips from a recent documentary Unnatural Causes.  This remarkable series demonstrates the ways in which the social and structural issues such as racism, disempowerment, wealth inequality, environment, and geography impact health outcomes.  It’s also not just the social and structural environments in which we are born, grow, work, and play but the emotional and psychological environments in which we live our lives, and our conscious or subconscious reactions to them, the subterranean physiologic reactions that manifest themselves insidiously through the years through psycho-neuroimmunological pathways we are just beginning to unravel.

In watching these clips, I ask you to reflect on what in your daily experience as a health professional be it a nurse, student, or physician resonates with some of these clips.  Can you see the ways in which the social and structural determinants play out in the lives of your patients and in your communities? How does stress affect your own physical and mental health and well being?

While universal health care coverage and increased access to health care through healthcare reform is part of the solution, what other interventions are important to implement? What social and policy changes are necessary for these gaping health inequities to be resolved at the hospital, the community, city, state and federal level?

If we look at the lives of our patients throughout the life course, from cradle to grave, what are the loci in which we can intervene so that we are not simply addressing the symptoms of illness in our society but going after the root causes and in the tradition of John Snow, removing the proverbial pump handle?

How much further must the struggle of Frederick Douglass, Rosa Parks, Malcolm X, Martin Luther King, Jr, and so many others continue until the “lives grown out of his life, the lives fleshing his dream of the beautiful, needful thing” can thrive?

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