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 "Racism,
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"Racism, Sexism and Poverty are Hazardous to Our
Health"
African American History Lecture Explores How Discrimination
and Disadvantage Wreak Havoc on Health
How do racism, sexism and poverty affect an individual's health?
What effects do those pernicious forces have on society as a whole?
Why do minority populations often view the U.S. health care
establishment with mistrust? What needs to be done to persuade those
persons to become blood donors, organ donors, bone marrow donors,
and clinical trial participants? And how can society eliminate the
glaring gaps in mortality and morbidity that exist among different
racial and ethnic groups?
These and many other questions formed the basis of this year's
African American History Lecture, "Racism, Sexism and Poverty are
Hazardous to Our Health." Speaking to a packed Lister Hill
Auditorium on March 16th, Dr. Vickie M. Mays raised many points
about subtle and not-so-subtle forms of discrimination, and how
these undermine the nation's efforts to improve the health and well-
being of all residents.
Her lively lecture was long on bar graphs, pie charts and
historical references, but also very personal and up-to-date. As she
admitted at the outset, Dr. Mays culled many of her anecdotes from
her own experiences, and from those of family members.
Dr. Mays, a professor of clinical psychology at the University of
California, Los Angeles, has also got a solid grip on the federal
health system. Having served as a consultant to several NIH
Institutes, an advisor to the 1995 White House Conference on AIDS,
and in other Public Health Service roles, she has gained a
perspective on what the federal government does well with regard to
health, and areas where improvement is warranted.
Professor Mays noted that obviously one's health is affected by
factors such as race, gender and socioeconomic status. What
intrigues her more are the subtleties of discrimination, or the
nuances in attitude and behavior on the part of ethnic minorities -
factors that don't usually show up in statistics.
For example, members of minority groups don't mean to miss health
appointments. They often can't find the transportation to get there.
They'd like a healthy diet that includes fresh fruits and
vegetables, but there's no store in their neighborhood that sells
those things. Emergency room care takes the place of scheduled
doctor's appointments for many minority patients -- they can't leave
their jobs during their day and the ER is the only thing that fits
their schedules.
"It's in the subtleties that we'll find the information we need
to build strong foundations, in order to be able to do efficacious
interventions that will close the gap," Dr. Mays said. "And I know
that this is a time at which eliminating the gap is something that's
very important in terms of the programs that are at the Institutes
right now."
A long history of mistreatment at the hands of researchers has
had a chilling effect on African Americans and other minorities. Dr.
Mays mentioned that, in the 19th century, slaves were often drafted
for medical experimentation against their will, or the bodies of
dead slaves were spirited off without their families' permission for
dissection or autopsy by so-called "night doctors." That such
stories remain in memory helps explains many African Americans'
reluctance to trust medical researchers, or to register as organ
donors.
Such breaches of trust have persisted, hitting a low point with
the infamous Tuskegee Syphilis Study (1932-72), in which 399 African
American males were denied treatment for their condition and
deceived by officials of the Public Health Service. Also, there was
a widespread sickle cell screening campaign in the 1970s that lacked
genetic counselors and, although created with humane motives,
backfired horribly. This federal initiative should have included
genetic counselors to explain the screening results, Professor Mays
alleged. Instead, it gave many the mistaken impression that they
should refrain from having children altogether.
Dr. Mays had many other thought-provoking examples of injustices
done to minority populations by the health system:
- The testing of oral contraceptives on Latino women in the
1950s and 1960s. Although five subjects died and many fell ill,
this group was never examined by physicians, and their health
problems were chalked to their being overly emotional, or other
questionable factors.
- The testing of a hepatitis vaccine on Native American children
in 1991. The Indian Health Service maintained that the test was
completely safe, but later had to retract that statement when it
was revealed the vaccine could pose a host of risks.
Professor Mays ended her talk by commenting that "a dear price is
paid by the health care system when we ignore this legacy of
mistrust." But she sounded a hopeful note, too, describing how
researchers and health professionals, by becoming sensitive to the
viewpoints of minorities and developing creative ways of
communicating, can reverse the long legacy of mistrust.
The African American History Lecture is organized each year by
NLM's History of Medicine Division. |
