National Medical Association

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National Medical Association
Racism in Medicine Health Parity for African
Americans
Authored by Rodney G. Hood, M.D. Immediate Past
President
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A Historical Perspective of Racial and Ethnic
Health Disparities

• The Impact of Racism on the
• Health Status of African Americans

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Carnage of Racism
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The Beginning

• The Evolution of Man

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Palaeonto-logical Evolution Evidence

• Lucy

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Origin of All Languages
Africa
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Genetic Evolution Evidence

• In 1987 geneticists at UC Berkeley (Cann/Wilson)
  analyzed partial mitochondrial DNA (mtDNA)
  sequence (less than 7) of different people
  worldwide and found more genetic mutations among
  indigenous Africans than any other people.
• Max Ingman, et. al., at the University of Uppsala
  in Sweden recently described global mtDNA
  diversity in humans based on analyses of the
  complete mtDNA sequence of 53 humans of diverse
  origins. Nature Mitochondrial Genome Variation
  and the Origin of Modern Man, Dec. 7, 2000.

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The Migration of Man
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The African Eve

• The UC Berkeley geneticists postulated that the
  entire population of the modern world was
  descended from a relatively small group of people
  that left Africa 100,000 years ago.
• This group postulated the African Eve theory
  (Newsweek), that every human being alive today
  carries the mtDNA of just one African woman
  (Lucys cousin) or a small number of female
  African ancestors who lived more than 10,000
  generations ago.

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Imhotep the Physician

• This great African physician was deified in
  approximately 2850 B.C.
• Imhotep was the first person known as a doctor
  throughout the world and acknowledged as the god
  of medicine 5000 years ago.
• Some 2500 years before a Greek laid claim to this
  same title.

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Historic African Surgery
Edinburgh Medical Journal, 1884

• Cesarean Section performed by a Banyoro surgeon
  in Uganda in 1879 with the use of aseptic
  technique, sutures and hot cautery irons.

Illustration from Dr. RW Felkins description of
the Cesarean Section.
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Human Genome Project
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A Portrait in Diversity
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Human World Clans The Seven Daughters of
Eve Whose Your Mama?
Lucy
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LAYLA Rodneys Mama
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Conclusion of Evidence

• Thus, we have Fossil, Linguistic and Genetic
  evidence that persuasively point to the
  conclusion that every person alive today is
  descended from modern humans (Homo Sapiens) that
  existed only in Africa until approximately
  100,000 years ago.
• The origins of humanity, civilization,
  intelligence and modern medicine (Imhotep) have
  evolved from Africa.

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The Evolution of Racism in Medicine

• Racism has roots in medicine
• over 2500 years

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Race and Ancient Scientific Precursors
The Great Chain of Being
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Pseudoscience of Racism
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Early Forefathers of Racial Bias
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The Roman-Greek Contributions to Racism
in Medicine

• The teachings of Galen (c. 130-201), a famous
  second century Roman physician of Greek origin,
  were accepted as sacrosanct by teachers of
  Western medicine for 1500 years.
• Galen promoted the racist concepts of Black
  physical and psychological inferiority in his
  teachings and writings.
• Bernal M.Black Athena/ The Fabrication of
  Ancient Greece 1785-1985, Rutger Univ. Press,
  1987.

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European Contribution Racism in Medicine

• Many European physician-scientists during the
  16th, 17th, 18th and 19th centuries contributed
  racist teachings into the medical corpus of
  knowledge.
• A few notables
• Paracelsus A famous Swiss physician and
  philosopher.
• Anton van Leeuwenhoek Father of Microscopy.
• Marcello Malphighi Father of Histology

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Hottentot Venus Lady

• Exploitation of Saartjie Baartman by Baron
  Georges Cuvier

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The Round Up Period
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The Slave Ship
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Living Africans Thrown Overboard The Slave
Ship Zong in 1781
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Transatlantic Slave Period
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The Assault on Black Humanity Continues
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American Health Professional Contribution
to Racism in Medicine
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Benjamin Rush, M.D.
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The Beginning of Womens Health
Father of Gynecology J. Marion Sims,
M.D.
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Medically Prescribed Punishment
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First Black Health Reconstruction Period
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Organized Medicines
Race-Based Policies

• Three periods of AMA official rejection of Black
  physicians
• 1. June 1869 the Medical Society of the
  District of Columbia.
• 2. May 1870 at the 21st AMA National
  Convention in Washington, D.D.
• 3. In 1872 the AMA Convention again rejected a
  similar biracial delegation.

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Nineteenth-Century Academic
Thinking on Race

• Nathaniel Southgate Shaler (1841-1906)
• Joseph LeConte (1823-1901)
• Edward Drinker Cope (1840-1897)

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National Medical Association
Birth
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The Civil Rights Era The Second Black
Health Reconstruction Period

• The 1964 Civil Rights Act, hospital desegregation
  court rulings, passage of Medicare and Medicaid
  and the health centers movement, all created a
  Civil Rights Era in health care for Blacks.
• This initiated the Second Black Health
  Reconstruction Period from 1965 - 1985.

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The Slave Health Deficit A National Crisis

• 35 more Blacks than the general population die
  from cancer each year.
• 40 more Blacks than the general population die
  from heart disease each year.
• 35 of Black men suffer with hypertension
  compared to the national average of 25.
• Diabetes Mellitus is 70 higher among Blacks.
• Blacks suffer much higher rates of ESRD but
  Whites are twice as likely to receive a life
  saving kidney transplant.
• The impact of HIV/AIDS, violence, substance
  abuse, unintentional injuries, infant mortality
  many other preventable conditions is greater for
  Blacks.

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Causes for the Ethnic Health
Disparities

• Inadequate Access
• Socioeconomic
• Cultural Differences
• Genetic Differences
• Environmental Exposures
• Dietary Habits
• Unhealthy Life Styles

• Culturally Incompetent Health Care Systems
  Providers
• Racial Bias
• Racism

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Modern Racism in Health Care

• An Unspoken Risk Factor for the African
  American Health Deficit and Ethnic Health
  Disparities in the United States

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Of All Forms of Inequity, Injustice in
Healthcare is the Most Shocking and
Inhumane. - Martin Luther King
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Assault on the Black Intellect

• Centuries ago scientists taught Blacks were
  inferior both physically and intellectually
• 20th Century Scientific Accusers
• Sir Francis Galton, Arthur Jensen, William
  Shockley, Richard Herrnstein and Charles Murray
• 20th Century Scientific Defenders
• Stephen Jay Gould, Alvin Poussaint and Richard
  Atkinson

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The Evidence forModern Racism in Medicine

• Health Care Racial Profiling

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Racial Bias in Medicine Health Care Racial
Profiling

• JAMA, 1994 A study in Los Angeles revealed
  Hispanic patients were twice as likely as white
  patients to receive no analgesia when presenting
  to the ER with a fresh bone fractures.
• The Annals of Emergency Medicine, Jan. 2000
  (Emory University School of Medicine) concluded
  that Black patients with broken arms and legs
  were less likely than white patients to receive
  painkillers when presenting to an Atlanta ER.

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Racial Bias in Medicine Health Care Racial
Profiling

• Race, quality of care and prescribing practices
  in psychiatric emergency services, Psychiatry
  Service March, 1996.
• Conclusion Clinicians, mostly Caucasian,
  prescribed more psychiatric medications to
  African Americans than to other patients and
  devoted significantly less time to their
  psychiatric evaluations.

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Health Care Racial Profiling

• The Schulman// Georgetown Cardiovascular Study
  (NEJMFeb. 1999).
• The Lung Cancer Sloan-Kettering Study
  (NEJMOct.1999).
• The Renal Transplant Harvard Study (NEJM Nov.
  1999).

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Health Care Racial Profiling

• Brigham Womens Hospital and Harvard Medical
  School Study, Quality of Care by Race Gender
  for CHF and Pneumonia, by Ayanian, et al
  (Medical Care Dec. 1999, 37(12)1260-9)
• The Michelle van Ryn Study, Effects of Race and
  SES on Physicians Perception of Patients
  (J. Social Science and Medicine March 2000)
• Yale University Cooperative Cardiovascular
  Project, Racial Differences in the Use of
  Cardiac Catherization after Acute Myocardial
  Infarction, by J. Chen, et al (NEJM, May
  2001, Vol.344)

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Defining Racism

• Camara Phyllis Jones gives a theoretical
  framework for understanding and defining racism.
• Internalized Racism
• Personally Mediated Racism
• Institutionalized Racism

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National Medical AssociationConsensus
Panel

• Racism in Medicine Health Parity
• for African Americans

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NMA Consensus Panel Racism in Medicine
Health Parity for African Americans

• Rodney G. Hood, MD - Chair
• President NMA
• W. Michael Byrd, MD, MPH
• Harvard School of Public Health
• L. Natalie Carroll, MD
• Chair BOT, NMA
• Linda A. Clayton, MD, MPH
• Harvard School of Public Health
• Gary C. Dennis, MD
• Chair Neurosurgery Department
• Howard Univ. Medical School
• Michael A. LeNoir, MD
• NMA Trustee

• Kweisi Mfume
• President CEO, NAACP
• Lucille C. Norville Perez, MD
• President-elect NMA
• The Honorable Louis Stokes
• Squires, Sanders and Dempsy
• Augustus White, III, MD, PhD
• Professor Orthopedic Surgery
• Harvard Medical School
• Richard A. Williams, MD
• Clinical Professor of Medicine
• UCLA School of Medicine

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Desperate Diseases Must Have Desperate
Remedies. -Shakespeare
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Health Care Solutions 5 Principles to Address
Disparities

• Health Disparities Quality Problem.
• Data Collection is Inadequate.
• Stratified Clinical Performance Measures.
• Population-wide Monitoring.
• Race/Ethnicity Payment Strategies.
• Kevin Fiscella, et al.,Inequality in
  Quality, (JAMA 2000 May 17 283(19)2579-84)

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Health Policy and Research Institute

• Health Institute Centers
• African American Health Center Think Tank
• Health Policy and Advocacy Center
• Research, Surveillance and Educational Center
• Community/Public Media Information Center
• Mobilization and Participation Action Center

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NMA Recommendations to Create Health Parity

• Racial bias and racism to be considered as a risk
  factor toward poor health for African Americans.
• Healthy People 2010 must address the impact of
  racial bias and racism in medicine to achieve
  health parity for all Americans.
• Emphasize healthy lifestyles and alternative
  health modalities such as prayer, meditation, and
  otherholistic approaches.
• Culturally competent and diverse health care
  workforce
• Congressional Hearings on Racism in Medicine
• Congressional/Presidential Advisory Committee
• Comprehensive Universal Health Insurance Program

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Health Parity Recommendations

• Education
• Support UC President Atkinsons recommendation to
  eliminate the SAT I scores as undergraduate
  admission criteria. Further support a moratorium
  or de-emphasis on the MCAT and other similar
  standardized test proposed to measure aptitude.
• Cultural competency education to incorporate the
  ethical issue of racial bias and racism in
  medicine.
• American public should be educated around the
  positive benefits that come with the elimination
  of all health disparities.
• Health education must emphasize responsibility
  for good health practices with healthy lifestyles
  and the unique considerations imposed by their
  cultural experiences.
• Initiate innovative programs to increase the
  number of underrepresented minorities in health
  sciences and combat anti-affirmative action.

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Understanding Racism through Jazz
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A Question to Explore

• Is there a correlation between the
  centuries-old racist theories taught by the
  western medical profession and the current
  studies that reveal persistent race-associated
  differential health status and outcomes based
  upon the degree of melanin in the population?

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Health Disparities the Vision for the Future
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The Hope and The Future

• We will, We can, and We must stop the insanity of
  racism!
• Insanity is when we keep doing the same thing
  and expecting a different result.
  
• by Albert Einstein
• presented by Ariannah Hood

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Linguistic Evolution Evidence

• Afro-Asiatic languages in Ethiopia North Africa
  have the oldest linguistic roots and are heard
  today in East Africa close to the sites where the
  oldest fossils have been found.
• J.Reader Biography of the Continent Africa,
  1997, pg. 109-110

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He Who Has Health, Has Hope and He Who Has
Hope Has Everything. - Arabian Proverb
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African American Health Crisis

• The 1998 Age-Adjusted Death Rates
• Black Americans suffered overall mortality rates
  53 percent higher than for Whites.
• Stroke death rates for Blacks were 78 percent
  higher than Whites.
• Heart disease death rates were 50 percent higher
  for Blacks.
• Cancer death rates were 33 percent higher for
  Blacks.
• And - HIV death rates for Blacks were almost 700
  percent higher than for Whites.
• Health, United States, 2000, DHHS, Center for
  Disease Control and Prevention, National Center
  for Health Statistics, July 2000 (Table 30).