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Kendra Outler, MD, MPH

Founder, Uzima Health & Wellness

our do the right thing MOMENT

October 2020

In November 2019, the Association of American Colleges published the breakdown of medical school enrollment by race and gender. Those persons identifying as Black or African American was 5,356 in 2015-2016. In 2019-2020, all total the number was listed as 6,783 Black medical students. The total number of all students listed in medical school is listed as over 85,000. This would mean that by best estimates Black medical students and by assumption future black doctors would be about six percent of all doctors in American medical schools. It does not seem meaningful until now. We are in the fight for our lives and our communities against corona virus.

We are in the fight of our lives and our communities against corona virus.

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If I could turn these numbers into a vignette it would look like the following; The text on my phone read “please go get your doctor appreciation gourmet cookie.” This last month has been stressful for us all.  Don’t judge me; a little emotional eating is allowed right now. I approached the colorful box, looking at the cookies they were painstakingly decorated with faces with masks and stethoscopes. Hmmm. I shifted some cookies around and around. Finally, I said aloud, “No black doctor cookies.”

You would think after over twenty years the scene in the classic Spike Lee movie, “Do the Right Thing” would not play out again and again.  Remember…the character, Buggin’ Out asks Sal, the owner of the Italian Pizza joint in the “hood, “How come You Ain’t Got No Brother’s on the Wall?”  Spike Lee’ s brilliance brought the subject of racial inequality to our American consciousness.  Racial inequality in health care is something that is elusive. It is akin to beauty; It is in the eye of the beholder.

 

The pain and rage of exclusion can fester and bring about what anthropologist call structural violence. The feeling that one’s life is not recognized and unequally balanced against the survival of another person can cause real physical destruction; even loss of life. Here we are in 2020, one nation, indivisible under God, trying to figure out how to preserve life. Black leaders from the National Medical Association (NMA) and NAACP are sounding the alarm that African American’s are dying of coronavirus at disproportionately higher rates than our white counter parts. Mayor Lightfoot who can be commended for her quick to action lock down her city. She looked into the camera and lamented aloud “the disease is devastating our community.”

 

For some communities today, HIV, gun-violence, maternal morbidity and mortality, asthma, sickle-cell, mental-illness and drug-abuse combine to make a solid base of historical health problems with coronavirus proving to be a concrete brick on top.

For some communities today, HIV, gun-violence, maternal morbidity and mortality, asthma, sickle-cell, mental-illness and drug-abuse combine to make a solid base of historical health problems with coronavirus proving to be a concrete brick on top. The worry and pain the current Chicago mayor expressed and the outspokenness that our nation’s Black leaders are doing is déjà vu. In the late 80’s and early 90’s the fear and sadness of “this disease” that was killing black men and women.  It was HIV/AIDS. From Arthur Ash to the faceless brothers and sisters, we lost them and some of them died alone.  

As a medical intern on the AIDS service, at Grady Hospital in Atlanta, I took care of those suffering; AIDS devastated the Black community. In 2009, staring out the window of Cook County Hospital as a resident in Anesthesiology, I see the sun and begin to shutter. I wonder do we have enough blood tonight. The shooting of young black men by black men will start soon.  The Trauma ICU will overflow and so will the tears of Black Moms. Between Jan first and March 31st, of this 93 people were killed in Chicago. For some communities today, HIV, gun-violence, maternal morbidity and mortality, asthma, sickle-cell, mental-illness and drug-abuse combine to make a solid base of historical health problems with coronavirus proving to be a concrete brick on top.  

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John H Stroger Jr. Hospital of Cook County, Chicago, IL

Washington, D.C news on April 4th, showed Black people gathered at the Wharf trying to do what they have always done despite CoVid-19; it was time to buy fish. The expose prompted the Mayor to close the Wharf for seafood purchase but leave the other new more developed parts to the Wharf open for carry out delivery.   As various walks of lives and the need to fight illness are balance, the city will have to reevaluate the changing landscape of The Wharf.  The Wharf is a 2.5 billion dollar, 32million square foot waterfront neighborhood and the largest development in the city. Slaves and freed people of D.C. built it and families who cannot afford to buy or rent there still go out of tradition. It is now a place where the survival of the fish market owners who attract weekly crowds must be balanced against an encroaching new establishment that seeks to redefine D.C.   Housing and gentrification are just one example of how we have allowed structural violence to permeate without thinking of the casualties.  Now the cities can blame the deaths on corona. The reason corona is so lethal for our communities of color is due to the racial inequalities that are driving geographical and structural changes. Covid-19 has made us all pause and reflect on the definition of health disparity.

The reason corona is so lethal for our communities of color is due to the racial inequalities that are driving geographical and structural changes. Covid-19 has made us all pause and reflect on the definition of health disparity.

Disparity of Health is the significant disproportionate human suffering experienced by socially disadvantaged populations as a result of preventable differences in the burden of disease, injury, violence, and/or opportunities to achieve optimal health. Gripping. Are we really ready to have an honest conversation about how to address this illness?  The cure in to understand the importance of health for a society before a public health crisis.
 

Coronavirus is illuminating our failure as a modern nation that has closed public hospitals like Big Charity in New Orleans in 2005 under the guise of too expensive to repair after Hurricane Katrina. Charity Hospital was one of only two teaching hospitals for the state of Louisiana. It’s level 1 trauma center was only second to Cook County in Chicago, Illinois. This destruction of hospitals that have a history of treating the sickest of the sick continues to happen today. Hahnemann hospital, a teaching hospital for Drexel School of Medicine recently closed its doors permanently on September 2019. The list also includes King-Drew in 2004. Rep. Maxine Waters (and many others) who represented South Los Angeles for over two decades, could not save the hospital that had saved many.

The goal of the modern MLK Community Hospital, according to an article by Politico in 2017 was to improve the lives and protect the health of its residents. The corona virus will be the test to see if South Los Angeles leaders were correct. D.C.General Hospital lasted for two hundred years; leaving in its wake patients and doctors in training with very few options. In 1970 a D.C Mayor’s Task Force on Public Health wrote: “The present system perpetuates a double standard of medical care, one in which the poor receive poor care at an inadequately supported public hospital and the rest of the population receive a uniformly higher standard of care.” Higher rates of Covid-19 deaths in Black People is proof that we still suffer disproportionately as citizens because of preventable causes of disease burdens that have not been addressed.  Health disparities are discriminatory and directly related to the historical and current unequal distribution of social, political, economic and environmental resources.

 

As we find ourselves as a nation fighting Coronavirus, we will have to address that racism and inequality has shaped our health care system and medical society. Recently, MSNBC invited Dr. Vickers from the University of Alabama School of Medicine to discuss Healthcare Inequity. The definition of health inequity refers to the systematic differences in health outcomes. A big reason for health inequity is health disparity. One of the strategies to eliminate health care inequity and health disparity is to produce more Black Doctors. There is the glaring problem of the shortage of Black students entering health care and medical school. The University of Alabama School of Medicine housed in the birthplace of the civil rights movement, list for the medical school class of 2017 only seven black medical students.  At University of Texas Health Science Center San Antonio in 1999, I was one of ten Black medical students. There are historical, political and economical reasons that the Black medical student enrollment is still low; this ultimately continues a dearth of physicians that can take care of Black patients who would be more prone to illness and disease burdens.

As we rebuild, we will need to examine our health care infrastructure. The private-public partnerships that replaced our public health clinics are not measuring up in this crisis.

We have got to raise the level of the conversation.  This is not simply a matter of hand washing, social distancing and masks. This is our “Do the Right Thing” moment.  We want solutions to the corona virus pandemic that will not disproportionately adversely affect communities of color.  Right now Black communities need easy accessible and free testing. This will allow for better surveillance and better medical resource allocation. Recovery must start corner by corner on a grassroot level.  As the country reopens, in order for Black communities not to be assaulted twice from corona or structural violence we have to get back to civics.  As we rebuild, we will need to examine our health care infrastructure. The private-public partnerships that replaced our public health clinics are not measuring up in this crisis. Your civic duty, if you want to fight health disparity is to stop the bartering of Black family’ s health in exchange for business and wealth. The Nation still needs a public health system.
 

Dr. King said “Nothing in all the world is more dangerous than sincere ignorance and conscientious stupidity. We have to work against this danger.  Let’s not only be safe, but let’s be informed about how to move our communities of color forward to better health. I don’t want a cookie that is painted brown and communities of color do not want headliners that restate the facts of our disease burden. As the nation rebuilds in health, we want to be seen. 

 

Dr. Outler, thank you for your commentary on Coronavirus and health disparity. Your contribution to this conversation is critical at this time. Continue to help us join together to move the conversation forward on understanding the determinants of health both social and political.

Daniel Dawes, J.D.

Director Satcher Health Leadership Institute
Morehouse School of Medicine

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