The Urgent Fight for Health Equity

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mrs sarah johnson from my home state of

louisiana

was just a few years younger than my

grandmother at the age of 86

she had committed her life to caring for

others as a mother

as a grandmother and as a nurse

according to her family at the time that

mrs johnson contracted covet 19 she was

independent and feisty still able to

balance her checkbook and

recite scripture her age certainly put

her

at higher risk of dying from cove at 19.

her being black all but guaranteed it

you see when mrs johnson was admitted to

the hospital

which was overwhelmed with patients at

the peak of the pandemic

an encounter with a doctor deemed mrs

johnson’s life unworthy

of being saved as was the case allegedly

for other black patients at this health

care system

now under investigation based on mrs

johnson’s medical records

this physician pretty much wrote mrs

johnson off as non-viable

when she pushed for her to have dnr

status

do not resuscitate she documented in mrs

johnson’s chart that

she was of advanced age that she had

severe malnutrition

renal failure and advanced dementia

except she didn’t because also in her

medical records as noted by other

healthcare professionals

she was only mildly malnourished but

significantly dehydrated

and her altered mental status was not

that different than other patients with

covet 19

who present it with similar symptoms and

instead of

the hospital calling the family to

inquire about her functional capacity

her nutritional status her mental status

they informed the family that there was

nothing that the hospital could do to

save their matriarch

and so the family reluctantly agreed to

hospice and mrs johnson was discharged

home

a later investigation revealed that not

only had mrs johnson improve prior to

discharge

she no longer had renal failure her labs

did reveal that she had an elevated

blood sodium level likely due to ongoing

dehydration

or something as simple as iv fluids and

close monitoring

would have saved her life as she was

only mildly symptomatic

with covet 19. instead she was sent home

to die

and her family was put at risk for covet

infection and death

in having to take care of her when i

read this story

i was both infuriated and heartbroken as

it hit

really close to home and it left me with

questions like

what if she was younger would she have

survived what if she had been in a

different

hospital a different city a different

state what if she was white

this incident isn’t specific to covet 19

and it certainly

isn’t an uncommon occurrence as i’ve had

something similar happened with my

grandmother just a few years ago while i

was seeing patients i got a frantic call

from my aunt

who had taken my grandmother to the

hospital because of delirium and

difficulty breathing

she’d only been admitted for a couple of

hours when an attending physician

wanted to talk about her dnr status and

her end of life plan

he hadn’t even figured out what her

diagnosis was but he wanted to talk to

us about

her dying so i had to leave my patients

in the lurch i dropped a thousand

dollars on a flight from maryland

to louisiana to advocate for my

grandmother

the outcome was a diagnosis of pneumonia

for her and thankfully i still have her

in my life

but it was also an opportunity to school

this position on bias and medicine

and in equities in healthcare

unfortunately unlike my grandmother mrs

johnson didn’t have someone at her

bedside to fight for her

as is likely the case for numerous black

and brown people across the country

as the age adjusted covet 19 death rates

for blacks

is over three and a half times that for

once and in the native american

and latinx community it’s at least two

and a half times higher

now let’s be clear before march

conversations about

race-based differences in health

outcomes were limited to

public health lectures and academic

settings

then came kovit when 30 percent of a

state’s population

makes up almost 80 percent of the deaths

related to covet clearly this pandemic

has revealed the ugliness within this

country that has existed

since its inception simultaneously

we beared witness to the murders of

ahmad arbury brianna taylor

and george floyd hearing yet again those

gut-wrenching words

i can’t breathe

as we witnessed mr floyd call out for

his mother

as a person paid to protect us ended his

life with a knee

to mr floyd’s neck

people like myself have invested our

entire careers

into dismantling the systems that

facilitate disparate morbidity and

mortality

revealed by this pandemic we understand

that these health disparities were

rooted in health inequities that existed

well before covet showed up

we also understand that this isn’t

simply about disproportionate

burden of diseases like diabetes heart

disease

and obesity but about social norms and

legislative

racism that influence the social

determinants of health

those factors where we are born

grow learn live work play pray and age

that define 80 of our health outcomes

and either provide access to resources

like healthy food and

safe space for physical activity or

facilitate

the devaluation of black life society

the medical community included would

have us all believe that

disease risk police assault

and early death are all due to

individual behaviors

especially within communities of color

if we

act right if we eat right then we’ll be

all right

as if the inevitability of diet-related

diseases

and dying on the streets is simply based

on personal choice

and not the systems in which those

choices are made

when i think back through what’s an

excellent example of this i think back

to slavery i

think about my ancestors being stolen

from places like sierra leone

and having to travel through the middle

passage and the impact that that had on

their hypothalamic pituitary adrenal

axes

and how those effects have transferred

from generation to generation to

generation

if the dutch potato famine of 1944 in

europe

can facilitate increased risk of obesity

and heart disease among adults

born to women who were pregnant at that

time imagine the transgenerational

impact

of the combination of slavery jim crow

segregation and modern-day racism on the

health

of the black community and then you

combine that with policy driven

purposeful design of communities that

minimize access

to healthy food safe space for physical

activity and affordable housing

and instead maximize the deluge of fast

food establishments

liquor stores and dialysis centers this

isn’t about individual behavior or

personal choice

but about systematic discrimination and

systemic racism with roots that run deep

from the federal government

to corporate america and it isn’t simply

about

access to doctors like myself when we

know

that policies passed have implications

on health

in all ways from creating disparities to

facilitating

equity we can look at housing as a

perfect example

the federal housing administration is

notorious for having

historical institutional racial

preferences

that allow whites to have access to

capital and purchasing land

while simultaneously blocking out that

opportunity for african americans

and it isn’t just at a federal level we

see it locally in states and cities like

the district of columbia

where race-based policies and

exclusionary zoning practices

have facilitated the concentrated wealth

within white communities

while shrinking it in black so much so

that the segregation created by these

policies

can still be seen now imagine

the multi-generational wealth loss based

on this institutional racism

and how that has impacted health but

i’ll tell you you don’t have to imagine

it

because it’s still happening now it’s

called gentrification

when developers partner with governments

to infuse resources and cash

to revitalize neighborhoods that results

in a demographic shift and a push of

communities of color into concentrated

areas of poverty

with inadequate resources subpar schools

and a fractured

health infrastructure this is just

limited

to federal and local policies if they’re

legislating health disparities

corporate america is orchestrating them

and there’s no better example

than the beverage industry they’ve

pledged their allegiance

to supporting the black lives matter

movement but their money speaks a

different tale

they over the past five years have

infused over a billion dollars

in advertising of sugary drinks with a

disproportionate amount of that funding

targeting black and brown youth to

increase consumption

while simultaneously vehemently opposing

any legislative action

used to curtail consumption of these

sugary drinks that are killing us

all while simultaneously making

record-breaking

profits and what’s the result black and

brown children seeing at least twice as

many

advertisements for sugary drinks that

then facilitates increased consumption

and heightened risk for chronic diseases

like diabetes

hypertension and obesity but for all the

challenges within community

of color in terms of health disparities

and health inequities

all is not lost when we join our forces

together like superheroes

communities come together that’s how

change happens

when they came for our music we fought

back and we won

when they came for our campus we fought

back and we won

when they came for our civil rights

we fought back and we won we’re putting

everybody on notice

because now is the time to fight for our

health

our voices will not be muted and neither

will our health we will join together

and we will shut big food and big soda

down

from targeting our communities and

bringing poison to our children

we will call on our elected officials to

create norms practices and policies

to dismantle the institutionalized

racism that facilitates

these health inequities that’s how

change happens

it’s the foundation upon which i have

built my career as a physician

as a public health expert as a mother

and as a black woman

i use my position as a clinician to not

only

help my patients in their health issues

but to address the social determinants

that drive those health issues i use my

position

as a professor at the milken institute

school of public health at the george

washington university

to raise up the next generation of

culturally competent

community engaged public health

professionals

i use my expertise as a public health

professional to not only help craft

legislation

to decrease things like sugary drink

consumption

but i also call on big soda and big food

to stop their deceptive practices in

influencing our national and global food

policies

as a community member i advocate to make

sure that black

lives do matter and i write

testimony and give oral testimony to my

elected officials to make sure that they

legislate in a way that allows each of

us

to reach our full health potential

and when they don’t i use my pin to vote

this journey although rewarding can be

quite challenging

but in the amazing words of the late

great incomparable

congressman john lewis if not us

then who if not now

then when

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you