Co-Author: Roger Mitchell, Jr., MD, FASCP - Co-Chair of the National Medical Association's Workgroup on Gun Violence
We are living in a time of intense and urgent dialogue about race and racism in our country. Amidst the images and sounds of protests and police, debates and punditry, we cannot lose sight that this conversation is about health and humanity. The Movement for Black Lives has reminded us of this.
The Movement has further mainstreamed a national dialogue about race relations by creating a list of policy demands. And just as race relations in the US are far more expansive than policing and criminal justice, the agenda seeks to address the multiple channels of discrimination and injustice in our nation. In the context of a contentious political season, it should not be surprising that much of what the Movement has been calling for has been framed as a polarizing, political agenda, when at much of its core, it is a public health agenda.
It is a public health agenda because it speaks to the various social factors, now widely acknowledged by health professionals, that determine and have tremendous influence on our health such as access to quality education, fair employment, affordable and quality housing, equitable policing practices, and inequitable mass incarceration. The Movement's policy demands reinforce that our individual choices in health are a reflection of the community conditions we live in and what resources we have access to.
And that the pursuit for optimal health cannot be separated from fundamental issues facing our communities, such as feelings and realities of powerlessness caused by racism and all types of discrimination. This has all contributed to the persistent gaps of good and bad health in this country.
According to the Centers for Disease Control and Prevention (CDC) in 2013, Black babies are twice as likely to die in the first year of life compared to White babies. This gap is even greater in certain areas of the country, especially the South. This difference persists across a lifetime and Black adults are at least 50% more likely to die of heart disease or stroke before the age of 75 years and twice as likely to die from diabetes than are Whites. And Black women are three to four times more likely to die during childbirth than Whites.
Overall, there are varying gaps between Blacks and Whites in terms of everything that influences health, life, and death--even in US Cities that have overall better health. The bottom line is Black people are consistently dying too early. Researchers have noted that 100,000 Black persons die prematurely each year that would not have died, if there were no racial differences in health. This is a result of not just bad health behaviors but of the structural and social inequities that exist.
What would it mean in terms of saving lives if social inequities were resolved?
Let's look at education. The Movement calls for, "A reallocation of funds at the federal, state and local level from policing and incarceration to long-term safety strategies such as education, local restorative justice services, and employment programs". According to a 2007 study in the American Journal of Public Health, addressing inadequate education--which disproportionately impacts Black youth--could potentially save eight times as many lives as compared to medical advancements. And this makes sense given that education is one of the most protective factors for good health.
Another example is employment--the Movement calls for a livable wage through "Federal and state job programs that specifically target the most economically marginalized Black people, and compensation for those involved in the care economy". This past March the New York City Health Department published a study that found that a $15 minimum wage could have averted 2,800 to 5,500 premature deaths (deaths before the age of 65) between 2008 and 2012 in New York City, representing about 4% to 8% of total premature deaths.
Consequently and importantly in this election year, excess deaths among Black people impact who can vote and voting outcomes, therefore our political system, according to a recent study. Looking back at the 2004 election year, if Blacks had the same life expectancy as Whites, nearly 2 million more would have been of voting age in 2004 and about 1 million would have actually voted. In addition to the inability to actualize the ideals of democracy, these types of numbers can shift entire election outcomes.
While the discourse to advance the Movement's policy demands will likely continue to be contentious, the additional framing as a health agenda is helpful. This is a dialogue about how all people deserve to live their healthiest lives without fear of persecution, violence, and poverty. Achieving health equity is not just an intellectual or academic pursuit, it takes action. It is only through relentless advocacy and activism that the necessary social justice advancements will be made to transform the health of Black communities.
And many of us leaders, especially in health, need to be a part of this dialogue and action.