Civil Rights Take Center Stage
By Carla Garnett
On the Front Page...
A little girl, call her Audre, has her first experience with medical care at the age of 3 or 4. During an eye exam, her eyes are probed coldly by an apathetic physician. Without explanation, she is exposed to medical instruments and procedures that are uncomfortable and painful. Before she leaves the office, a frightened and miserable Audre overhears the doctor and his associates discussing her "peculiar eyes" and otherwise ridiculing her, "From the looks of her, she's probably simple, too." Would her first impressions of medical care be lasting? Further, what impact would the experience have on Audre as she seeks medical care throughout the rest of her life?
The above recollection was written in Sister Outsider, the autobiography of African-American poet Audre Lorde, but the sentiments could be held by any one of the millions of Blacks reared during the pre-civil rights era, according to former NLM visiting scholar Dr. David McBride, who heads the African/African-American studies department at Penn State University. For about 30 minutes on Feb. 11, he discussed similar Black culture medical encounter issues dating back to the 1960's in his Black history lecture, "The African-American Medical Experience: Perspectives and Prospects." His presentation was part of Black History Month activities sponsored by the National Library of Medicine.
"America has one of the largest and most scientifically advanced health care systems in the world," he remarked, "yet throughout its development, this medical care system has been unable to eliminate serious gaps in the health status of America's largest racial minority, African Americans."
As proof, McBride said that in 1985 it was estimated that about 60,000 excess deaths occurred among Blacks compared to whites. By 1990, the figure had risen to at least 80,000. These discrepancies continue today, he said, due to higher rates of cancer, heart disease, stroke, diabetes, homicide and HIV that Blacks experience. The author of several books on health inequities among minorities, McBride has devoted much of his professional life to researching why so many Black Americans have been falling through cracks in the U.S. health care system and how improvements can be made for future generations. In 1987-1988, he served as a visiting scholar in NLM's Division of History, where he conducted research on infectious disease history and the HIV/AIDS crisis among the urban poor.
By far the most comprehensive and influential federal health policy involving Blacks has been Medicaid and Medicare, he pointed out. "Compared to Medicaid and Medicare," he said, "only the Civil Rights Act of 1964 has had greater impact on the health and welfare of Black Americans." Part of what he called the economic access paradigm, such federal financial programs enabled the poor and other disadvantaged populations to pay for medical services. Since the policy's passage, physician care and hospital utilization by low-income Blacks have increased markedly, he explained.
Ironically, however, as access to health care improved, glaring gaps between the health of African Americans and whites were thrown into sharper focus. Rates of diagnosed diabetes and hypertension in the African American community, particularly among Black males, skyrocketed.
"The ability to pay did not lessen the social stigma attached to being Black," McBride said, referring to the sense of victimization and discrimination described in young Audre's experience. "Reimbursement policies could not address the ways in which the attitudes and practices inside medical institutions affected the quality of the provider-patient interaction. There's a difference between getting to health care that is effective and compassionate as opposed to receiving medical treatment that is inappropriate, mistreatment or medical care in which the doctor controls the terms of the treatment and the patient sits in passive silence and complies."
Lauding the government's recently announced $400 million effort to end disparities in health care by 2010, McBride said two critical tactics could go a long way toward filling in gaps in medical care: development of more and better preventive medicine models and increased involvement on the part of community and private industry leaders.
Also speaking at NLM's program was Elena Temple, press secretary for Congressman Albert Wynn (D-Md.). Temple substituted for her boss, who had to remain on Capitol Hill for a special vote in the commerce committee. She discussed the importance of all Americans but particularly Blacks exercising their right to vote. The struggle by African Americans for equal voting rights was too long and too hard for their descendants now to take the right for granted or to shirk their civic responsibility altogether, she said. Temple also refuted an insidious, but completely untrue rumor that the 1965 Voting Rights Act and the 15th amendment to the Constitution will expire in 2007, leaving Blacks without the right to vote. Although the rumor is being passed in several media most ubiquitously via online arenas and email chains Temple assured the audience that the important battles ahead do not involve preserving access to the voting booth, but making use of the access already provided and guaranteed.
"Assess your values, assess your actions," she concluded. "Our enemy in the new millennium is apathy."
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