#blacklivesmatter: a challenge to the medical and public ...€¦ · local institutions norms...

#BlackLivesMatter: A Challenge to the

Medical and Public Health Communities

David Sanders Lecture

in Public Health and Social Justice

July 2015

Mary T. Bassett, MD, MPH

Commissioner

New York City Department of Health and Mental Hygiene CONFIDENTIAL AND PROPRIETARY Any use of this material without specific permission of DOHMH is strictly prohibited

Widely Publicized Deaths

“This is Not a Moment, but a Movement”

Black Lives Matter affirms the lives of Black queer and trans folks, disabled folks, black-undocumented folks, folks with records, women and all Black lives along the gender spectrum.

Artists Respond

Artist: Shirin Barghi #LastWords

Artist: Oree Originol #Justiceforourlives

Journalists Respond

The Guardian The Counted: People Killed by Police in the US

“The legacy of slavery, Jim Crow,

discrimination in almost every institution of

our lives -- that casts a long shadow, and

that's still part of our DNA that's passed on.

We're not cured of it. Racism, we’re not

cured of it.” - President Obama, June 22nd 2015

Politicians Respond

International Community Responds

1968 Olympics Black Power Salute

DO WE NEED A PUBLIC HEALTH &

MEDICAL RESPONSE?

Medical Students:

WhiteCoats4BlackLives

1. Raise awareness of racism as a public health concern

2. End racial discrimination in medical care

3. Prepare future physicians to be advocates for racial

justice

Public Health as Social Justice

Call to Action: Broaden debate to premature death 1)Critical Research 2)Internal Reform 3)Public Advocacy

Bassett MT. N Engl J Med 2015;372:1085-1087.

Black Panther Party

Free Medical Clinic, Boston

EXPOSING THE SOCIAL ROOTS

OF SUFFERING AND DISEASE

Critical Research

“Ideology and politics penetrate scientific theory and research. […]To unravel and eliminate black-white differences in disease, we must begin by politically exposing, not merely describing, the social roots of suffering and disease. […] In order to target the social forces which produce disease, we must begin to develop an antiracist model of disease causation”

Socio-ecological model

Source: Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion. (2011). Social Ecological Model. Retrieved September 21, 2012. From http://www.cdc.gov/cancer/crccp/sem.htm. .

Ecosocial Theory

Slide prepared by Nancy Krieger

JIM CROW

Jim Crow states (red): US states

with legal racial discrimination

outlawed by US 1964 Civil Rights

Act

Oklahoma City, OK,

1939

Durham, NC, 1940

Memphis, TN, 1943

Source: Krieger et al Am J Public Health, 2013 (RWJF/Harvard Seed Grant & NIH/NCI: R21CA168470)

Differential Decline in Infant Mortality Rate (per 1,000 LB)

in New York City by Race

0.0

2.0

4.0

6.0

8.0

10.0

12.0

14.0

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

Black, non-Hispanic

White, non-Hispanic

RR=2.5

RR=2.8

Source: NYC DOHMH Bureau of Vital Statistics; compiled by BMIRH

Maternal Mortality Ratio (per 100,000 LB)

New York City, 2000-2012

0

10

20

30

40

50

60

70

80

90

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

Mate

rnal M

ort

ality

Rati

o p

er

100,0

00

Liv

e B

irth

s

Year

Non-Hispanic White

Non-Hispanic Black

RR=11.3 RR=11.1

Source: NYC DOHMH Bureau of Vital Statistics; compiled by BMIRH

Harlem Hospital Intern

Death in Harlem

Survival to the Age of 65 in Harlem, Bangladesh, and among U.S. Whites in 1980. McCord C, Freeman HP. N Engl J Med 1990;322:173-177.

Approximately 176,000 deaths in the United

States in 2000 were attributed to racial

segregation and 199,000 to income inequality.

MAKING INJUSTICE VISIBLE

Critical Research

Residential segregation

by race/ethnicity and

socioeconomic position

Inequalities in

resource

distribution

Neighborhood physical environments

Environmental exposures

Food and recreational resources

Built environment

Aesthetic quality/natural spaces

Services

Quality of housing

Neighborhood social environments

Safety/violence

Social connections/ cohesion

Local institutions

Norms

Behavioral

mediators

Stress

Health

Personal characteristics

Material resources

Psychosocial resources

Biological attributes

Source: Diez Roux, A. V., & Mair, C. (2010). Neighborhoods and health. Annals of the New York Academy of Sciences, 1186(1), 125-145.

NYC’s Sickest Neighborhoods

Asthma Hospitalizations

HIV/AIDS Deaths

Diabetes Deaths Drug Hospitalizations

Residential segregation by Race

in New York City

Data source: NYC DOHMH population estimates, matched

from US Census Bureau intercensal population estimates, 2010-

2013, updated June 2014

U.S. Census Bureau; American Community Survey, 2013 3-year

Estimates, Table S1701; generated using American Fact Finder

(http://factfinder2.census.gov/)

Dissimilarity Index

Access to Quality Health Care

Premature Mortality in NYC

OneNYC Goal:

• Reduce

premature

mortality by

25% by 2040

Neighborhood Based Initiatives

Because New York City

is highly segregated

residentially by race and

poverty-level, place-

based approaches and

geographical targeting of

resources are by default

health equity strategies.

PUBLIC ADVOCACY

Partner with community advocates

providing relevant

Schools segregation

Race Relations in US – a problem?

0

2

4

6

8

10

12

14

16

Q1 2014 Q2 2014 Q3 2014 Q4 2015 Q1 2015 Q2 2015

Blacks

Whites

GALLUP Survey :What do you think is the most important problem facing this country today? Mentions of Race Relations

Questions?

QUESTIONS?