by Mary T. Bassett, M.D., M.P.H.
N Engl J Med 2015; 372:1085-1087March 19, 2015DOI: 10.1056/NEJMp1500529
Two weeks after a Staten Island grand jury decided not to indict the police officer involved in the death of a black man, Eric Garner, I delivered a lecture on the potential for partnership between academia and health departments to advance health equity. Afterward, a group of medical students approached me to ask what they could do in response to what they saw as an unjust decision and in support of the larger social movement spreading across the United States under the banner #BlackLivesMatter. They had staged “white coat die-ins” (see photoUniversity of Vermont Medical Students during a “Die-In” Protest.) but felt that they should do more. I wondered whether others in the medical community would agree that we have a particular responsibility to engage with this agenda.
Should health professionals be accountable not only for caring for individual black patients but also for fighting the racism — both institutional and interpersonal — that contributes to poor health in the first place? Should we work harder to ensure that black lives matter?
As New York City's health commissioner, I feel a strong moral and professional obligation to encourage critical dialogue and action on issues of racism and health. Ongoing exclusion of and discrimination against people of African descent throughout their life course, along with the legacy of bad past policies, continue to shape patterns of disease distribution and mortality.1 There is great injustice in the daily violence experienced by young black men. But the tragedy of lives cut short is not accounted for entirely, or even mostly, by violence. In New York City, the rate of premature death is 50% higher among black men than among white men, according to my department's vital statistics data, and this gap reflects dramatic disparities in many health outcomes, including cardiovascular disease, cancer, and HIV. These common medical conditions take lives slowly and quietly — but just as unfairly. True, the black–white gap in life expectancy has been decreasing,2 and the gap is smaller among women than among men. But black women in New York City are still more than 10 times as likely as white women to die in childbirth, according to our 2012 data.