#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?