In the November 17th “Healthcare Musings” letter the second paragraph was biographical.

I first began to worry about race as a small child. My family was progressive on issues of race in comparison to other families in the South between the late forties and mid sixties, but like most white Southerners we usually held our own council and did not say anything at all. We had many warm relationships with people of other races, but we were silent on the big issues. I was present when my university was integrated, but I looked the other way. I felt uncomfortable when injustice was obvious. I minded my own business. I smiled when appropriate. I never called out injustice, and I got out of town as soon as I could. Coming North to Boston, I discovered that I was in the midst of just as much discrimination, and almost as much injustice as I had seen at home. Again, I minded my own business. I went to work on my studies. I shed my Southern accent, and adopted the posture of a “liberal.”

From there I went on to describe observations and thoughts that I had while visiting my father at the rehab facility where he was getting care in North Carolina. The sight of Confederate flags flying in the yards of small rural homes triggered many memories. The letter was an attempt to connect veiled racism, economic inequality, and injustice to the healthcare disparities and much of the poverty that we tolerate as a society. The gaps in opportunity, income and health status between white America and black America still exist 54 years after Martin Luther King, Jr’s “I Have A Dream Speech,” 64 years after Brown v. The Board of Education of Topeka Kansas that deemed “separate but equal” to be unconstitutional, and 53 years after the Civil Rights Act of 1964 that theoretically ended the Jim Crow era of exploitation, organized terror, and de facto slavery that was common in the states of the old Confederacy. I tried to make the case that the Triple Aim would never be achieved unless we more effectively addressed the web of connected issues that still challenge us today and include racism, economic inequality, and injustice. The conclusion was that the current state, if it persists, will ultimately harm us all. I ended the piece by quoting from Bryan Stevenson’s Just Mercy.

We are all implicated when we allow other people to be mistreated. An absence of compassion can corrupt the decency of a community, a state, a nation. Fear and anger can make us vindictive and abusive, unjust and unfair, until we all suffer from the absence of mercy and we condemn ourselves as much as we victimize others.

After the letter was published I received an email from an Interested Reader who I first met a couple of years ago when I visited a large health system in the Southwest.  She was an obvious leader with a significant administrative responsibility. She wrote:

Good Morning,

Thanks for your honesty and transparency in your letter.  I long for the day, the time and the energy that you have so that I too can help in my own little way promote equality of benefits and opportunity across all Americans. This was personally touching to me and I’m thankful for folks like you Gene who continue to help shed light and make a difference.

My response was a redundant recitation:

One of the advantages of retirement is the time to read and write. Over the last few months as I have been reading about health care disparities it has become increasingly clear that inequality is often a function of racism. As you know, I grew up in the Jim Crow, segregated South. My parents did not think of themselves as racist, but except when things were obviously and unavoidably wrong my family was content to “go along” or be silently complicit. We were a very typical family. Like all other white families of our social circle, we did not directly oppress anyone, we just did nothing to change what was happening, and we were silent beneficiaries of the status quo. There is no question that over the last few years this country’s heritage of more overt attitudes of white supremacy, for which it has never apologized or really even honestly admitted, is again rearing its ugly head.

Years ago I read The Autobiography of Malcolm X and Eldridge Cleaver’s book, Soul on Ice,  and realized that they were experiencing an America that I was shielded from even needing to think about. I was profoundly affected by Dr. King’s assassination, and after his death I have come to realize how generous his philosophy is.  Despite those experiences I have remained relatively quiet thinking that my role was just to model acceptance of all people based on their humanity. I bought Dr. King’s dream that someday in America we would all be judged on the merit of our character and not by the color of our skin. Over fifty years have passed and there has been only marginal and very spotty improvement in the economic status and the opportunities for black Americans and most minorities. The data shows, that in relative terms, black Americans may be worse off now than in 1965.

Recently, as I have been thinking about the differential health experience in America by race and zip code, I now see that all along I have been part of the problem. Just voting for a black president did not end racism and all forms of inequality and injustice. I am beginning to get the point now of the Black Lives Matter movement. I can better hear the “dog whistles” in our political conversations. I am ashamed and disgusted with myself and other do-gooder white Americans who really haven’t done much to change the structural inequities that exist. We have blinded ourselves to the reality of the experience of most black Americans while consoling ourselves with the sense that things are good because there is a small minority of black Americans like yourself who are exceptionally talented and have had some success. I feel it is a numerator phenomena. You are the successful numerator of a very large denominator of people who still lack the opportunity and help they deserve.

As I have followed the thread of current events and have been reading black writers like Bryan Stevenson and Ta-Nehisi Coates, I have realized that I have been a passive acceptor of persistent racial injustice that should have gone away years ago. I have begun to hope that I might become part of a new growing population of formerly silent white privileged Americans who realize that we have been part of the persistent problem. I think that there are others who like me, incorrectly think that just because we salute the accomplishments of Dr. King and voted for Barack Obama, we have done our job. What reading Stevenson and Coates convinces me of is that we all will eventually suffer from the inequity that we tolerate in our midst. Stevenson says that the opposite of poverty is not wealth; it is justice. Poverty will persist as long as injustice, in all its various forms, persists.

My grandmother always told me, “Gene, mind out! You can’t do wrong and get by!” What I now  realize is that when it comes to issues of race, looking the other way is wrong. What is much harder is to know what you can do that might really make a difference. If I look at where I think I can make a difference, it is by continuing to raise the subject, especially as it relates to the injustice of the inequities that exist in healthcare. I believe that if we eliminate the injustices that add to the social determinants of poor health and remove the structural barriers to good care, specifically for black Americans and other minorities, we will simultaneously improve the lot of all Americans of all races.

If I was an educator I would be working on educational inequality. If I were a lawyer, I would be seeking to make a difference for minorities in the criminal justice system. If I was a banker I would try to see how I might help stimulate black entrepreneurial opportunities or home ownership. I think that we all must do more than just demand that politicians put an end to what have should have gone away over 150 years ago. We can also demand that those politicians do not make the problems worse, as they will do if they pass the unjust tax legislation that is working its way through Congress. I believe that to make racism in all forms end, we must admit that we still have a huge problem with inequality along lines determined by race. I do not think we will ever achieve the Triple Aim unless we more effectively resolve our issues of race. It is hard to admit, but in 2117 when historians look back on America in 2017, they will likely say that  we were fooling ourselves. We could not see that we were still a society deeply divided by racism and collectively suffering from the consequences of racial injustice.

Her response confirmed much of what I had perceived about her as well as being a personal story of a lifetime of unfair burdens. She gives specifics about her personal experience and the past and current realities that black families bare. Her description did not sound like a complaint. It  was gracious and emanated from a deep personal belief in the power of love and hope.


Please feel free to use my comment.  I’m as equally touched by your reply.  It makes me feel extra thankful of my upbringing, which unlike yours was very different economically, but I was blessed abundantly with the wealth of love and shielded at home from the inequalities that existed around me.  My father was orphaned as a baby.  He grew up as a discarded black man in the south who suffered great injustices.  Ironically, despite his lack of upbringing and challenges, he went to college and obtained his doctorate in theology.   My father has been a Minister for nearly 60 years now and he and my mother taught us that racial lines, barriers or limitations did not exist and despite everything, love wins in the end.  I only know how to love everyone equally.   My first real experience with hatred and racism was actually experienced as a mother [In a northern state]  and not in the South where I grew up.  I do however see daily in healthcare the inequalities and huge disparities of services and access to care for the poor and underprivileged.  I have an employee who just lost her sister earlier this year to liver disease that could have more than likely been managed differently and her life spared had she had access to better care, better medication and better insurance.  I sure hope we wake up before it’s written that we were foolish people.  I have a lot of hope in this next generation.  My two young adults are now already more connected to the social and economic injustices and far less tolerant of the foolishness than my generation.  

I am inspired by her and the growing diversity that I see as I have opportunities to visit hospitals, practices, neighborhood health centers, and social service programs in various communities. I see people like this hopeful and loving woman. Every day their contributions give meaning to President Obama’s message of audacious hope, but I fear they are swimming against a raging current that is an increasing threat and could sweep us all away.

Where do you stand? Who knows what you think? In areas like the debate about social justice and healthcare equity most of the leaders are self appointed and hone their skill by activities that give voice to their concerns.