racismreview.com

In mid-July Jessie did a post on the AMA apology, but I would like to add a bit more on this issue, especially about how racism works in US medicine. One good result from anti-racism efforts in the last decade may be that we are getting more serious apologies from white organizations about slavery or Jim Crow segregation. Harriet Washington reports in a late July 2008 New York Times article on one of the most institutionally racist sectors of our society, U.S. medical care institutions. Highly (photo of AMA building: Steve and Sara) and blatantly segregated until the late 1960s, she notes, the American Medical Association has recently apologized the National Medical Association, the country’s leading black medical association:

An apology to the nation’s black physicians, citing a century of ”past wrongs.”

From the beginning, U.S. medicine’s institutions have been racially and gender segregated, but Jim Crow and gender segregation increased in the early 1900s with the implementation of private and government “reforms” designed to get rid medical practitioners who were not officially licensed—which usually meant they were not from the more elite (almost all white) medical schools and often practiced various kinds of folk medicine (including midwives). These reforms did raise U.S. medical standards, at least for allopathic mainstream medicine, yet also effectively excluded many white women and practitioners of color from their traditional medical practices. And Jim Crow segregation became very central to this newly reformed medical system:

. . . black patients and doctors were often relegated to subterranean ”colored” or charity wards or banned from hospitals altogether; they had responded with their own hospitals and medical schools, at least seven of which existed in 1909. By 1938, the situation had grown so dire that Dr. Louis T. Wright of Harlem Hospital declared, ”The A.M.A. has demonstrated as much interest in the health of the Negro as Hitler has in the health of the Jew.”

Washington notes that the American Medical Association continued to be a problem until the end of the civil rights movement era:

The Civil Rights Act of 1964 passed without active support from the A.M.A. Title VI of the act closed the Hill-Burton loophole: segregation within hospitals became illegal….But for African-American and other antisegregationist physicians, there remained a final bastion of racial exclusion to conquer: the A.M.A.

Demands by African American physicians and some white allies that the association desegregate were ignored by its leadership until the late 1960s. From 1963 to 1968 the association had to endure public protests against its racist practices. In 1968 the association finally took action to end legal segregation in its constituent state societies.

Still, today, the percentage of U.S. physicians who are African American (2.2 percent) is still smaller than it was in 1910 (2.5 percent). And our medical care system is riddled with numerous kinds of institutional racism, as recent research reports (see various chapters here and chapter 7 here) frequently make clear. There are some very good scholarly bloggers like U. Dayton’s Prof. Vernellia Randall (see her great website here) who have given even more details on how such institutionalized racism works and how it is a violation of international human rights and anti-discrimination laws.

Note: I have given more than 100 invited lectures over the years on my research on racism at many schools and colleges within our top universities and liberal arts colleges across the country, and I have only had one invited lecture cancelled–ever. This was after two faculty members saw at the xerox machine the handout (it had quotes from whites making various racist comments, from my research interviews) that I was going to talk about. This was a Florida medical school, which had invited me and other researchers to talk about racial matters because they had had racist graffitti in their medical school classrooms. They reportedly still have problems today.

ABC News’ Ron Claiborne reports a likely slip of the tongue on National Public Radio last week by the Democratic National Committee chair, Howard Dean, who said: (photo: Stroup)

“If you look at folks of color, even women, they’re more successful in the Democratic party than they are in the white, uh, excuse me, in, uh, Republican party.”

The McCain folks of course pounced on this, and called it “insulting,” while a DNC spokesperson just said that Dean “misspoke and corrected himself immediately.”

Claiborne, however, accents how important this issue really is. It is literally, the Elephant in the Room. This issue is

rarely discussed in public and almost never by politicians: the marked racial division by party in American politics. Members of the country’s largest minority groups — blacks, Latinos, Asian-Americans — are predominantly Democratic.

He is right, but of course there is a lot more to it than that: The Republican Party has been the white party since African Americans left it in large numbers for the New Deal Democrat, Franklin Roosevelt in the 1930s. It was then no longer the “party of Lincoln” civil rights issues, and economic issues were hitting African Americans very hard.

Last December I made these additional points about the Republican Party being, in effect, the “white party” of the United States (for research see here):

With the presidential campaign of Barry Goldwater in 1964, the Republican Party intentionally abandoned black voters for a strategy openly targeting what are seen as the primary interests of a majority of white voters. This explicitly pro white political strategy has put emphasis on the interests of whites in suburbia and the southern states. Codewords such as “quotas,” “states’ rights,” “busing,” and “crime in the streets” have been substituted for the more explicitly racist terms of the days of legal segregation. The southern strategy was effectively used by Richard Nixon in 1968 and 1972 to win the first two Republican elections with that racialized strategy.

The neo-segregationist strategy targeting southern and suburban whites was also used effectively in the Ronald Reagan and George H. W. Bush campaigns of the 1980s and early 1990s. Reagan began his presidential campaign asserting strongly a states’ rights doctrine, and he intentionally picked Philadelphia, Mississippi–where civil rights workers had been lynched in the 1960s—to make this symbolic appeal to southern white voters. Reagan and his associates sought to dismantle further federal civil rights enforcement efforts, including weakening the U.S. Commission on Civil Rights and Equal Employment Opportunity Commission and attacking affirmative action programs, to please white constituents.

When George H. W. Bush undertook a run for president, he ran a racist campaign. In 1988 Bush and his advisors conducted an infamous advertising campaign that used visual images of a disheveled black rapist, from his opponent’s home state, to intentionally scare and recruit white voters to the Republican Party. Most recently, after losing elections in the 1990s to moderate Democrat William Clinton, the Republican Party succeeded in electing George W. Bush. Bush gained the presidency in two consecutive elections, 2000 and 2004. In both, the Republican Party focused heavily on securing white voters in the South and suburbs, and some Republican officials sought to restrict black voting in key states.

At one time centered in the states of the East and upper Midwest, today the Republican Party is, as a result of its recent political remaking, now centered in the South, parts of the Midwest, and the Rocky Mountain states. In recent political campaigns, the Republican Party has continued to be the “white party,” the one aggressively representing white interests, albeit often in disguised language. Thus, in elections between 1992 and 2004 the Republican Party got a remarkably small percentage (8-12 percent) of black voters, and a minority of most other voters of color as well.

Not only has there been only a handful of black delegates at recent Republican party conventions, but the Republican National Committee has had few black members. Service at the highest decision-making levels of the Republican Party has in the last few decades been almost exclusively white. Thus, in late 2004 there was only one African American from the fifty U.S. states (plus a black member from U.S. Virgin Islands) among the 165 members of the Republican National Committee. This compared to the 97 black members on the Democratic National Committee, more than one fifth of the total membership about the same time. This pattern still pretty much holds today. Today, all black members of the U.S. Congress, and something like 98 percent of the 9,000 black officeholders at all government levels across the United States are members of the Democratic Party.

This highly segregated pattern of political party interests and participation has characterized U.S. politics now since the civil rights movement of the 1960s. In the southern and border states, the Rocky Mountain states, and numerous states of the lower Midwest, white voters now tend to vote overwhelmingly for the Republican Party in presidential elections, and for that reason some people now explicitly refer to the Party as “white party.” The Republican party has brought about its political resurgence since the major losses in presidential elections of the early and mid-1960s by explicitly using a politics of “race” that works mainly because of the racist legacies of slavery and legal segregation have persisted aggressively into contemporary U.S. society. It continues to do this today, and will even more in coming months.

How can we claim to have a democratic country and have a democratic media when these strong data on the racial differences in the two major parties are almost never seriously discussed? It seems to me, that this is the real issue in this election: democracy.

In the last few days, there has been a telling confluence of events related to racism in medicine. In the story that’s getting the most coverage from major news outlets and a few blogs, the American Medical Association (AMA) has issued an apology for more than a century of discriminatory policies toward black physicians, including those that effectively restricted membership in the AMA to whites only. The way the AMA did this in the 1890s was to restrict access so that the only physicians eligible for membership were those doctors who already belonged to a state or local medical society. The state and local medical societies were almost all racially restrictive, meaning only open to white membership. The AMA never took any action to challenge the racist practices of the state and local societies. So, the AMA could say they had a “race blind” policy, when in fact, they were complicit in the same racist exclusionary practices that ended in the same result: African-Americans were not allowed to become members in the AMA.

That’s the way they did it. The reason? Decrease competition for patients, and the revenue that patients represent. If you have any doubts about this, read Paul Starr’s compelling The Social Transformation of American Medicine (1982). And, an excellent companion to that book is Harriet Washington’s recent Medical Apartheid (2007).

And, the result? Quite simply, the racial discrimination by the AMA is part of:

“a litany of discriminatory practices that have had a devastating effect on the health of African-Americans,”

according to Dr. Nelson L. Adams, president of the National Medical Association (NMA). The NMA is an African-American physician group founded in 1895 when black physicians were excluded from the AMA. In his written statement, Dr. Adams goes on to commend the AMA for their “courageous step” and encourages us all to “seize this opportunity to move forward to correct these injustices.” It’s a noble move on Dr. Adams’ part, unfortunately, these injustices are do not exist exclusively in the distant past.

UPDATED (5:20pmEST): For example, in New Jersey just two days ago, three EMS workers were fired by the University of Medicine and Dentistry of New Jersey over a racist incident. The university’s president said that the three were terminated after cell phone camera images surfaced of paramedic trainees at University Hospital in Newark garbed in white sheets resembling Ku Klux Klan robes (photo from here).  On a local news report in the area, they interviewed a person on the street and got their reaction to this, and it reminded me of some of the accounts in Living with Racism (Feagin and Sykes, 1993).  The man, who was black (and yes that’s relevant to this story), said something along the lines of: “If this is what they got caught doing, you know that there’s other stuff going on that they didn’t get caught doing!” This is the kind of everyday racism that black people live with in this country (and elsewhere).  The harm here is not only in this incident, it’s also in the wondering about “what else” is happening in the back stage of white people’s behavior.   And, for their part, white people engage in this sort of behavior and then call black people “paranoid.”     What’s interesting too, here, is the language.  How is this ‘hazing” - a ritual following which someone is inducted into a group, club or state of being?  I don’t think that applies here.  The lead-in to the local news report I heard also referred to this incident as “horrifying for the memories it evokes of another time.”  It seems to me that such an analysis misses the harm of such acts in the present.    Of course, this kind of ongoing racism has serious health consequences for in the present tense; and, indeed, the white EMS workers in this incident are working and making emergency calls in a predominantly black and Latino neighborhood.  So much for our putatively “post-racial” society.

FIrst, apologies for being away from posting, but the ISP at my apartment has been intermittent of late (indeed, I’m typing this post really quickly and saving often, in the hopes that the ISP doesn’t crash again before I can click “publish”). I’m also finishing up the last details on the book and, it being summer, getting out papers for peer-review (three so far, the goal is two more), all of which can distract from the much more compelling blog-related tasks. So, with all those excuses firmly in place, I return to blogging here.

Second, I discovered a fairly cool new tool, “Slideshare,” wherein you can view, download, and share slideshows created by others, and upload your own. Exceedingly groovy, in my opinion, although a tier below most of the presentations at TED Talks, which are quite simply addictive.

And, finally, on to the actual substance of this post, racism as the root cause of infant mortality. Infant mortality is one of those “index measures,” that demographers and public health officials use to measure quality of life. High rates of infant mortality indicate that people in the general health and well being of a group of people, whether the ‘group’ is a city neighborhood, developing country, or a racial/ethnic group. Most of the time that scholars and researchers talk about infant mortality it’s in terms of large, structures of inequality as contributing factors, such as poverty. More recently, however, researchers have begun to pay attention to racism as a root cause of high rates of infant mortality, independent of poverty, educational levels, living conditions, or even maternal health behaviors. The following slideshow from Barbara Ferrer, PhD, MPH, M.Ed., the Executive Director of the Boston Public Health Commission, makes a convincing case for racism as a root cause of infant mortality:

| View | Upload your own

We could improve overall health if we would address economic and racial inequality. That is the message of new documentary, “Unnatural Causes,” directed by Larry Adelman, and airing beginning tonight on PBS stations throughout the U.S. This short post is just a programming alert for those interested in viewing, recording or teaching about the series. I’ll be back after it airs with a post or two about individual episodes. You can check your local listings here.

As I wrote here awhile back, the effects of racism on health are not insignificant. The Kaiser Family Foundation’s Daily Reports put me on to this story from the Portland (ME) Press Herald. Leigh Donaldson sets this medical news story in eloquent relief with his opening:

During my high school years, I helped my father maintain his residential rental properties in Detroit.


This meant low wages and hard work. It’s not always easy working for a parent, especially for my father, who raised the work-ethic bar on a daily basis.


He expected the best effort with minimal complaint, short of a near-death experience.


One day, I was mowing the lawn surrounding one of his buildings when he yelled from a tenant’s apartment window for me to bring up his toolbox from the car.


Entering the living room, I overheard the tenant, a gray-haired white woman, refer to my father this way: “You know how they are. God knows how long it will take. I doubt if he even knows what he’s doing.”


My father must have overheard as well, yet he continued to work. The tenant, who was behind on her rent, asked him if he knew the landlord.


My father said: “I should, I’m him. I own the building.” The woman’s mouth dropped.


Since that day, he has never mentioned the incident, and I often wonder just how he felt and if he was hurt by these less-than-subtle insults.


What did members of the Rutgers University women’s college basketball team internalize after listening to radio talk show host Don Imus’ racial slurs?


There has been a quickly emerging field of research that demonstrates that racism hurts the health of the body. According to Madeline Drexler, a medical columnist and visiting lecturer at the Harvard School of Public Health, more than 100 studies now document the effects of racial discrimination on physical health.

Toward the end of the piece Donaldson goes on to note that:

Too many Americans are reluctant to deal with racism on any level. Exploring it scientifically has met resistance from funding sources.

He’s partly right here. It’s true that (white) Americans are reluctant to deal with racism on any level. And, exploring racism scientifically isn’t just met with resistance from funding sources, it’s that scientists are asking the wrong questions. Instead of exploring the science of racism funding is allocated to study racial differences. So, for example, instead of asking questions about what the physical impact on the body is from racism for those who are targets of it - or perpetrators of it - funding goes to study racial differences between Black and white behavior and biology. Asking research questions framed exclusively in terms of behavioral and biological racial differences without looking at racism simply reinscribes racial hierarchies rather than producing knowledge that might disrupt them.

Laura Smart Richman, an assistant research professor in Duke University’s Department of Psychology and Neuroscience, is the lead investigator on a new study that finds that people who previously experienced discrimination –- especially optimistic and trusting people — suffer larger jumps in blood pressure when performing a stressful task such as talking about a situation that made them angry. Richman, interviewed by Science Daily, says:

“These results are consistent with discrimination being a chronic stressor that is related to acute stress responses, particularly for blacks. It also may help to explain why people who experience more discrimination in their lives tend to have worse health outcomes. It’s being understood more and more that discrimination may be an important contributor to racial health disparities.”

The health consequences of racial inequality is a theme I’ve talked about here before, and it’s interesting to see more research - this from neuroscience - piling up to suggest that racism and discrimination, perhaps as much as structural inequality, is responsible for the negative health consequences. I do wonder where the research is on the people who are doing the discriminating. Is there a health benefit, say a lowering of blood pressure, when people act to discriminate? Things to ponder on a Friday morning.

There’s an interesting story in the Baltimore Sun from yesterday, reporting on the results of a recent study (again by psychologists) on the physical consequences of racism, especially for Black men. Susan Brink writes:

Statistically, black men in America are at increased risk for just about every health problem known. African-Americans have a shorter life expectancy than any other racial group in America except Native Americans, and black men fare even worse than black women. Some of it can be chalked up to poverty, the most powerful determinant of health, or to lifestyle factors. But even when all those factors are accounted for in studies, the gap stubbornly persists. Now researchers are beginning to examine discrimination itself. Racism, more than race, may be cutting black men down before their time. …. heart disease, stroke, hypertension, diabetes, obesity and most cancers strike black men sooner, and cut them down more often, than white men. And the higher incidence of disease among black men is set against a backdrop of an increased incidence of poverty, which carries with it a multitude of health problems. Poor people smoke more, exercise less and are more likely to be victims of accidents and violence.

Typically, researchers have chalked the disparities in health between Blacks and whites to “race,” or the structural elements of racial inquality, rather than looking at racism and discrimination. For example, in a 2001 article in Public Health Reports, David Williams and C. Collins at the University of Michigan, explores the influence of racial residential segregation on health and find that this is a “fundamental cause” of health disparities. And, racial residential segregation was certainly a factor in the devastating health consequences of what happened in New Orleans. Yet, there’s a growing trend in this body of research toward also looking at the effects of racism and discrimination on health, along with these structural elements of racial inequality. Another article by David Williams, this one in the Annals of the New York Academy of Sciences, examines what he refers to as “the added effects” of racism and discrimination. Williams finds that:

“Racism can also directly affect health in multiple ways. …. racial bias in medical care, the stress of experiences of discrimination and the acceptance of the societal stigma of inferiority can have deleterious consequences for health.”

Vickie Mays, psychologist at UCLA and author of the study reported on in the Baltimore Sun, is quoted as saying:

“We have always thought of race-based discrimination as producing a kind of attitude. Now we think we have sufficient information to say that it’s more than just affecting your attitude. A person experiences it, has a response, and the response brings about a physiological reaction.”

There’s a lot of research that still needs to be done here, but I think one of the most interesting features of this particular piece of research is that here you have a psychologist who is making the case for moving away from racism “just affecting your attitude.” Of course, as a sociologist I’m a bit biased, but I think it’s progress when even the psychologists are arguing that we have to move away from an attitudinal approach to understanding racism.

Researchers at Princeton, Jessica Salvatore and J. Nicole Shelton, have studied the effects of different types of racism on the brain. They call these “blatant” vs. “ambiguous” racism, and their findings speak to the physical impact of even subtle racism. Louise Chang, writing for WebMD, describes their study:

Salvatore and Shelton enrolled 122 African-American and 128 white Princeton undergraduates in their study. They were told they were going to participate in two different studies (in reality, they were two parts of the same study).

In the first part of the study, participants were told they would be evaluating a company’s hiring decisions. They were shown résumés from job candidates. One was from a candidate who was clearly unqualified because of mediocre grades from a “mediocre” school. Another was from the most-qualified candidate, a Yale graduate with good grades, strong job experience, and impressive school activities.

It was clear from the résumés whether the job candidates were white or African-American. Half the time the unqualified candidate was white and the highly qualified candidate was African-American. For the other half, the conditions were reversed.

The study participants were also shown hiring recommendations from what they were told were human resource officers for the company. Participants were told the officer was a white male when the unqualified job candidate was white and the highly qualified candidate was African-American. They were told the officer was an African-American male when the unqualified job candidate was African-American and the highly qualified candidate was white.

Participants were assigned to one of three groups: blatant prejudice, ambiguous prejudice, or no-prejudice. The no-prejudice group saw recommendations that advised hiring the most-qualified candidate. The prejudice groups saw hiring recommendations that always chose the least-qualified subject — a person of the same race as the officer.

Under the blatant prejudice condition, the hiring recommendations contained obviously racist comments (such as noting that the African-American candidate “belonged to too many minority organizations” or that the white candidate “was a typical white prep-school kid”).

Under the ambiguous-prejudice condition, the hiring recommendations contained no such racist comments — the least-qualified, same-race candidate was recommended without a clear reason.

In the second part of the study, participants then were given a test requiring full concentration, in which they had to name the color in which words such as “red” or “blue” were written.

The bottom line:

“Targets of prejudice may experience cognitive impairment as they try to determine the cause underlying the negative events they encounter in their lives,” Salvatore and Shelton conclude.

They report their findings in the September issue of Psychological Science.

The folks at Teachers College along with their impressive advisory board have put together a terrific resource on “Teaching The Levees,” a curriculum to accompany Spike Lee’s documentary. And, they also have a blog that Ellen mentioned yesterday, and a post here includes more about the mental health devastation left after Katrina.