Beyond Three-Fifths of Health With Dr. America

I'm proud to be an American. I was born in this country, and my pride in America is based in this country's potential for acknowledging problems, improving ourselves, and the possibility of turning the ideal into the real. Indeed, it is that promise that drives me as a doctor and health justice advocate. However, in the midst of all that language of potential and possibility, there is undeniable struggle with no guarantee of outcomes. That is true for all of us as individuals, as communities, and as a country, right from the beginning of America. It is also true that too many of our struggles are due to man-made apathy and inaction.

One of our first sins as a country was abandoning an ideal of the Declaration of Independence: "all men are created equal." When it came time to write our Constitution, we included a three-fifths clause that said if you fit the slave profile, then you only count as three-fifths of a person. If you fit the white profile, you will be counted, but even within that category, if you have lady parts then you can not vote.

Some amateur and professional historians look at the three-fifths clause as an unfortunate but necessary evil: a desperate compromise between the different colonies to build a united country. But no matter how you reason it, we wrote into law that all men are not created equal.
Ever since then, we have struggled to see "all the fifths" of a person. We have struggled to see the humanity of families different from our own. The ideal of equality is still a work in progress. Despite all the sacrifices made by abolitionists, women suffragists, labor activists, LGBT activists, and various civil rights movements, it feels like we still fail to see a human being as a whole person in 21st century America. We are still only seeing three-fifths of our fellow Americans, either individually or as communities.

This is particularly evident in health. We have been locked into the biomedical paradigm of seeing a person's health as their organs and cells; what happens when these things go wrong; and what kinds of drugs and devices can be put in there to fix it. This is not to dismiss the work of biomedicine, but it is still only three-fifths of health.

It has been my privilege to serve as a pediatrician in southeast Washington, D.C., one of the poorest neighborhoods in the country. I want to share the experiences of my patients and their families so their fellow Americans can get to know "all their fifths" and see them as more complete people.

This fall, I joined We Act Radio to start "Dr. America," a radio show about health and its politics. Our journey tells truths to power and gives power to the truths of underserved, unheard, and unseen communities. "Dr. America" is about exploring "all the fifths" of health.

This show seeks to expand our notions of health beyond biomedicine. After all, what is the point of all the research endeavors if the fruits of those labors are not available to everyone through equitable access to healthcare?

Our show will put a health spotlight on events and issues that impact the health of millions, but are sometimes overlooked because there is no flashy drug or device to market. As we make our way through the current flu season, there are millions of Americans who go to work sick, or they send their sick child to school -- not because they are cruel or negligent of their health, but because millions of low-income workers in America do not have paid sick days. Again, our failure to recognize "all the fifths" of our fellow Americans leads to imposing a false choice upon them: you can have your little bit of health or your little bit of wealth, but not both.

"Dr. America" will discuss how health fits into places beyond our clinics, hospitals, laboratories, and doctors' offices. From the courthouse to the schoolhouse to the warehouse and to the statehouse, there are "fifths" of health to be explored. Wellness depends on our zip codes as much as if not more than our DNA codes, so we must have conversations with our fellow Americans living in poverty, struggling to put food on the table, trying to get by with low employment and high pollution, and so on.

My ardent hope is that through the dialogue on "Dr. America," we will gradually see beyond the broken "three-fifths of health" model to a new framework: SALUD. In Spanish, it means health, it means bless you, and it means cheers. On "Dr. America," we will distinguish the scientific facts from the fiction about health issues. We will discuss the health benefits of strengthening the socioeconomic and cultural bonds between us. Our society's broader spiritual health depends on that connectivity. Finally, we will celebrate health or health policy accomplishments and learn from our heroes.

Our concept of health should be multidimensional, and through "Dr. America" I am excited to take that journey with you.