Is the United States a fundamentally oppressive society, beset with entrenched “structural racism”? That is what many may believe after reading “Structural Racism and Supporting Black Lives—The Role of Health Professionals,” in the current edition of The New England Journal of Medicine.
Rachel R. Hardeman, Ph.D. and Katy B. Kozhimannil, Ph.D. (neither of whom are physicians) authored the piece along with Eduardo M. Medina, M.D., a family medicine physician at the Minneapolis-based Park Nicollet Clinic (who graduated from medical school all of three years ago). Their article is bitter and tendentious, using classical radical-leftist arguments and rhetoric one might encounter in the neo-Marxist manifesto of Black Lives Matter.
The New England Journal of Medicine appears eager to join the ranks of Hollywood and the mainstream media—not to mention other high profile, apolitical institutions—in touting progressive principles and rhetoric. In publishing this piece, the august and famous journal seems to have become an organ of the left’s propaganda machine.
What Philando Castile and Health Care Have In Common
Hardeman, the article’s lead (and sole African-American) author, told a St. Paul, Minnesota ABC News affiliate that she was inspired to write about “pervasive” societal racism after the fatal shooting of Philando Castile in July. The incident, which occurred during a traffic-stop in St. Paul the day after an officer-involved shooting in Baton Rouge, caught national attention. President Barack Obama declared at the time that such incidents were not isolated, but indicative of “racial disparities” inherent in the U.S. criminal-justice system.
The authors use the shooting tragedy as a springboard to launch their tirade against racially motivated police brutality. This is quickly conflated with the issue of disparities in health outcomes (which they attribute to racial bias), thus formulating the premise that clinical teaching, practice, and research are all tarnished by America’s history of white supremacy and slavery. Those who engage in medical practice in the United States are culpable by extension (or association), “despite [our] best efforts.”
Evidence for this claim, however, is not provided in any scientific sense. Instead, the reader is referred to other works that deal primarily with the various societal incarnations of racism, and how they have at times interfered with the practice of medicine.
Having admonished their audience, the authors proceed to sermonize on necessary lessons for the guilty reader. Adopting a stridently authoritarian and didactic tone, the authors mete out these instructions, proffering explanations that belittle, rather than educate, the reader. “First, learn about, understand and accept the United States’ racist roots,” they write. “Second, understand how racism has shaped our narrative around disparities.” “Third, define and name racism.”
Political Correctness Can’t Fix Medical Disparities
The authors conclude their manifesto by exhorting us to “center at the margins”—a thoroughly meaningless concept that appears to be another way of saying what they in fact spell out, in textbook Marxist-Black Lives Matter fashion: “helping to ensure that oppressed and underresourced people and communities gain positions of power.”
The authors’ withering, arrogant, and fraudulent perspective is, more than anything, an exercise in the art of moralizing and political correctness of the highest order. It is indeed a maladroit thesis with totalitarian overtones, framed in ideology rather than science. Its publication seems inappropriate for a prestigious medical journal whose mission is the publication of dispassionate medical science. Nevertheless, it no doubt pleases some (likely the Journal’s editors or their masters, judging by some of the shocked reactions of readers in the online comments section).
It is true that racial bias does play a significant role in the genesis of suboptimal health outcomes, particularly for African-Americans—but also for Hispanics, Native Americans, and other minorities. That infant mortality rates and many other parameters of the health of a society are so unevenly distributed—often in a pattern that accords with race and/or ethnicity—are egregious matters in need of correction.
But the authors, misleadingly, do not actually consider other reasons for these problems. Indeed, on some level, according to data from the Centers for Disease Control, statistics are improving (e.g., in heart disease, life expectancy, and deaths from any cause). This alone serves as a countervailing argument to any suggestion of stubborn structural racism.
On the subject of racially-determined disease, the authors might be interested to learn that people of African descent—as well as Hispanics, Asians, Australian aborigines, Maoris and others—are more predisposed to type 2 diabetes and certain diabetes-related complications than those of white ancestry, while unique challenges to treating high blood pressure in African-Americans are well-documented. These are health inequities that will persist no matter how sanctimonious one feels driven to be.
Addressing Bias Must Begin With the Community, Not the State
Dr. Keith C. Ferdinand, President of the Association of Black Cardiologists acknowledges that physicians must address three types of barriers in order to achieve treatment goals in all patients: patient-related, treatment-related, and physician-related barriers. With respect to the physician-related barriers—and to an extent, treatment-related barriers—there is no doubt that elements of racial bias continue to exist within the healthcare community.
However, this bias is almost always unconscious and unintentional. The automatic conclusion that such biases are therefore the result of an inherently racist system—the default argument of those on the Left—is a mischievous and intellectually dishonest attempt to perpetuate a narrative that coheres with their ideological worldview, and that succeeds in cultivating and maintaining a victimhood mentality.
The authors appear unwilling to address some of these hard realities in their demonization of American society. A more useful way of thinking about health disparities and inequities—rather than assuming racist attitudes and a victim mentality—might be to explore all the potential causative factors that potentially contribute to the problem. The national community-based organization PolicyLink proposes such a position. They consider the social and political determinants of health: the economic environment, social environment, physical environment, and access to necessary services.
Such a model relies on civic engagement and robust “mediating” institutions (schools, churches, and other community-based services), and is based on the concept of subsidiarity—the idea that social problems are best addressed by the nearest and smallest competent authority, rather than by a faraway state.
How to Empower African-American Communities
This of course is the antithesis to centralized bureaucracy. It is something the left would do well to consider, but will not—because it would diminish our reliance on the liberal philosophy of centralized power, governance, and redistribution of wealth. These are central planks of Democratic administrations. Any serious observer of American society over the last five or six decades—as Yuval Levin eloquently explains in The Fractured Republic—doesn’t need to be reminded how many times this has been tried and shown not to work.
Jason Riley, senior fellow at the Manhattan Institute and a conservative African-American commentator, chronicled in his 2014 book Please Stop Helping Us: How Liberals Make It Harder for Blacks to Succeed how Great Society-era government welfare programs, affirmative-action programs, and soft-on-crime laws (among other well-intentioned policies) have had the paradoxical effect of inhibiting the potential for black Americans to succeed. They’ve fostered a dependence mindset and made black neighborhoods more dangerous. In fact, these efforts form “massive barriers” to moving forward.
Another regrettably underappreciated social phenomenon prevalent among many African-American communities across the nation (although not unique to them) is, in the words of the economist Walter E. Williams, emblematic of “the decline of civility.” As Williams points out, the 1960s saw an attack on values that were elementary to civility, including a ban on corporal punishment and the launch of a liberal educational-establishment agenda that “undermined lessons children learned from their parents and their church.”
He continues: “Sex-education classes undermined family and church strictures against premarital sex [and teaching the merits] of abstinence were ridiculed… Further undermining of parental authority came with legal and extralegal measures to assist teenage abortions, often with neither parental knowledge, nor consent.” Williams argues that the abandonment of such traditional values has had a deleterious on society in general, asserting that “blacks have borne the greater burden… seen by the decline in the percentage of black two-parent families.”
The Social Justice Agenda Doesn’t Help Fight Racism
That last point cannot be overstated. Today, about 30 percent of black children live in an intact family. Illegitimacy among blacks is 73 percent, compared to 30 percent among whites (compared with 11 percent and 3 percent, respectively, in 1938). Leaders like the Rev. Jesse Lee Peterson champion communitarianism within African-American communities, seeking to fill the damaging void left by absent black fathers. Peterson describes this void in his book The Antidote: Healing America From the Poison of Hate, Blame and Victimhood. He has dedicated himself to providing psychological and spiritual support for members of his community disenfranchised by family enucleation, while also re-tooling them with life skills and leadership training. Unfortunately, too few such good men exist.
As if the current conditions afflicting African-American civic and social cohesion weren’t problematic enough, the NAACP and the Democratic Party will soon vote on a resolution calling for a moratorium on charter schools. As The Wall Street Journal noted recently and again last week, black and Hispanic students who attend charter schools in New York City scored nearly 75 percent higher grades than their counterparts at local publicly-run schools, according to a recent analysis by Families for Excellent Schools. Thomas Sowell has been a prominent voice in drawing attention to this travesty.
This is not some trope pushed by African-American conservatives, as Joy Pullman of The Federalist notes in her detailed analysis of the issue. In an appeal to the NAACP in September, the160 black leaders called for an urgent meeting “to discuss the very serious implications the proposed resolution will have for Black families who want and deserve high-quality educational options for their children.”
In conclusion, the identity politics and social justice agenda of the NEJM opinion piece authors clearly seeks to promulgate, via a highly influential medical journal, a false narrative that depicts the United States as a racist, villainous society. In order to do so, they willfully ignore the inconvenient truths which give lie to their thesis. For its part, by giving space to Hardeman et al.’s vilification of America less than a month before the presidential election, the NEJM has clearly exceeded its mandate. It ought to be embarrassed.