February 17, 2023

Dear Interested Readers,

 

Contemplating the Social Determinants of Health During Black History Month

 

It’s February, and that means it is “Black History Month.” As I thought about how important it is for all Americans to recognize the huge contributions that Black Americans have made to the building of this country, its defense, and its culture, I began to wonder about how February became Black History Month. This question seemed even more important in the context of the pushback by Florida Governor Ron DeSantis and others on the far right against teaching Black history and Critical Race Theory (CRT) in our schools and colleges. We are in the midst of multiple culture wars, and the outlook for near-term progress in the efforts to improve the social determinants of health hangs in the balance between competing political forces.

 

I was surprised to learn that the focus on Black history in February began almost a hundred years ago in 1926. That was when Dr. Carter G. Woodson, a Harvard graduate, and founder of the Association for the Study of Negro Life and History, had the idea of emphasizing Black history for the week in February that coincided with the birthdays of Abraham Lincoln and Frederick Douglass. Lincoln was born on February 12, 1809. Frederick Douglass was born into slavery and there is no certain date for his birth. He thought that he was born either in 1817 or 1818 in February.  Given all the uncertainty about the year, there seems to be even more uncertainty about the day. Apparently, Douglass chose February 14th as his birthday.  

 

In 1969, Black students at Kent State advocated that there should be a whole month of focus on the history and contributions of Black Americans; so, Woodson’s Black History Week began its journey toward Black History Month. Governor DeSantis, a big critic of teaching Black history as part of CRT might be surprised to learn that it was a different kind of Republican, President Gerald Ford, who moved Black History Month onto the national agenda in 1976. Since 1976 the designation has been continued year after year by every president. 

 

Nicole Hannah-Jones is the brilliant Pulitzer Prize-winning journalist behind the very controversial call for all of us to take a “deep dive” into Black History through her work at the New York Times on “The 1619 Project” which was published on August 14, 2019. August 2019, was the four hundredth anniversary of the landing in Virginia of the White Lion, the slave ship that brought the first slaves to America. The first essay in the project was written by Hannah-Jones. She begins her essay with a focus on her father who was a veteran who always flew the American flag in front of their small home in a Black neighborhood of Waterloo, Iowa. Her father was born in Greenwood, Mississippi, but his mother brought her sons North in the hope of a better life that was only partially possible since “red-lining” and racism were also present in Iowa.  As a young person, Hannah-Jones was confused about her father’s passion for flying the flag of a country that treated him poorly even when he had been a soldier in their army:

 

I had been taught, in school, through cultural osmosis, that the flag wasn’t really ours, that our history as a people began with enslavement and that we had contributed little to this great nation. It seemed that the closest thing black Americans could have to cultural pride was to be found in our vague connection to Africa, a place we had never been. That my dad felt so much honor in being an American felt like a marker of his degradation, his acceptance of our subordination.

 

The essay is long, and Hannah-Jones makes point after point underlying how Black Americans have yearned for equality and support the founding principles of equality even though they have never experienced real equality and never been given access to many of the government supports that build generational wealth that white Americans have expected. Not only have Black Americans never experienced full equity, they have more often than not been viewed as a societal problem. She writes:

 

For centuries, white Americans have been trying to solve the “Negro problem.” They have dedicated thousands of pages to this endeavor. It is common, still, to point to rates of black poverty, out-of-wedlock births, crime and college attendance, as if these conditions in a country built on a racial caste system are not utterly predictable. But crucially, you cannot view those statistics while ignoring another: that black people were enslaved here longer than we have been free.

 

You probably know that the original presentation of “The 1619 Project” has been followed by an expanded book edition, a podcast series, and now a six-part series on Hulu that debuted in late January. My wife and I have viewed the series. It brings to the screen most of the data and emotional impact of the original series. There are teaching supplements for use in school systems where it is still possible to discuss racism or critical race theory. The internet is loaded with criticism of “The 1619 Project.” Some of the criticism comes from respected right-leaning academics. You won’t have any trouble finding these opinions. I will leave the discovery process to you. 

 

What I would bring to your attention are three more of the essays in the original publication back in 2019. They are part of an amazing journalistic effort. The three essays that I have chosen speak directly to the social determinants of health or the healthcare disparities that we all know exist, even as we fail year after year to adequately address them.  Despite the common knowledge that minorities suffer problems with exposure to disease and pollutants, access and quality of care, inherent biases of healthcare workers, and disproportionate barriers in state and federal programs, inequalities in all aspects of healthcare still persist more than fifty years after Dr. Martin Luther King, Jr. proclaimed:

 

“Of all the forms of inequality, injustice in healthcare is the most shocking and inhumane.”

 

Many of the ills in our society, including healthcare disparities, can be traced to America’s particularly aggressive form of capitalism with its brutal laissez-faire attitude, resistance to regulation, hostility toward organized labor, and aversion to fair taxation. Capitalism has not been experienced this way in many other advanced societies which outperform us in healthcare metrics. Matthew Desmond, now a professor and head of an institute for the study of poverty at Princeton and the author of the 2016 book, Evicted: Poverty and Profit in the American City which won the Pulitzer Prize in 2017, wrote a powerful essay entitled, “In order to understand the brutality of American capitalism, you have to start on the plantation.” In his article Desmond outlines how so much of America’s wealth was built on the back of black labor before the Civil War, through the Jim Crow era, after the passage of the Civil Rights Act of 1965, and up till now. In the Hulu series, Nicole Hanna-Jones adapted Desmond’s essay to make all of the points he made with examples from our time. The series uses the work environment and attempts to unionize Amazon as an example of how we have not changed. In  the essay, Desmond writes: 

 

Those searching for reasons the American economy is uniquely severe and unbridled have found answers in many places (religion, politics, culture). But recently, historians have pointed persuasively to the gnatty fields of Georgia and Alabama, to the cotton houses and slave auction blocks, as the birthplace of America’s low-road approach to capitalism.

Slavery was undeniably a font of phenomenal wealth. By the eve of the Civil War, the Mississippi Valley was home to more millionaires per capita than anywhere else in the United States.

 

Desmond connects many of the onerous activities that control workers in American workplaces today to techniques that were developed on plantations before the Civil War and continued in the Jim Crow South with sharecropping. 

 

Today modern technology has facilitated unremitting workplace supervision, particularly in the service sector. Companies have developed software that records workers’ keystrokes and mouse clicks, along with randomly capturing screenshots multiple times a day. Modern-day workers are subjected to a wide variety of surveillance strategies, from drug tests and closed-circuit video monitoring to tracking apps and even devices that sense heat and motion. A 2006 survey found that more than a third of companies with work forces of 1,000 or more had staff members who read through employees’ outbound emails. The technology that accompanies this workplace supervision can make it feel futuristic. But it’s only the technology that’s new. The core impulse behind that technology pervaded plantations, which sought innermost control over the bodies of their enslaved work force.

 

Desmond hits hard in his last paragraph. In the length and breadth of his article, the sins of today’s American Capitalism are the continuation of attitudes and methods that evolved from slavery. Poverty, poor housing, environmental pollution, mental health issues, and diseases of despair that trouble us now are the descendants of the atrocities of slavery.

 

If today America promotes a particular kind of low-road capitalism — a union-busting capitalism of poverty wages, gig jobs and normalized insecurity; a winner-take-all capitalism of stunning disparities not only permitting but awarding financial rule-bending; a racist capitalism that ignores the fact that slavery didn’t just deny black freedom but built white fortunes, originating the black-white wealth gap that annually grows wider — one reason is that American capitalism was founded on the lowest road there is.

 

I am sure that the governor of Florida, many members of Congress, and the majority of MAGA voters would call Desmond “woke.” Until there is a real awakening to the origins of many of our disparities and the damage they do to our collective health, problems will exist and fester.

 

The first of two articles directly about healthcare was written by Linda Villarosa and is entitled “Myths about physical racial differences were used to justify slavery — and are still believed by doctors today.” Villarosa covered much of the same material in a book she published last year: Under the Skin: The Hidden Toll of Racism on American Lives and on the Health of Our Nation. I discussed her work in a letter to you last June. The last paragraph of her article is a powerful statement.

 

The centuries-old belief in racial differences in physiology has continued to mask the brutal effects of discrimination and structural inequities, instead placing blame on individuals and their communities for statistically poor health outcomes. Rather than conceptualizing race as a risk factor that predicts disease or disability because of a fixed susceptibility conceived on shaky grounds centuries ago, we would do better to understand race as a proxy for bias, disadvantage and ill treatment. The poor health outcomes of black people, the targets of discrimination over hundreds of years and numerous generations, may be a harbinger for the future health of an increasingly diverse and unequal America.

 

The last powerful healthcare essay from The 1619 project that I will bring to your attention is “Why doesn’t the United States have universal health care? The answer has everything to do with race.”  It was written by Jeneen Interlandi. The article is a historical review that will be of interest only to the “woke” among us. Ms. Interlandi is a powerful writer. She ends the article with a bold look into the reality of our moment in history:

 

One hundred and fifty years after the freed people of the South first petitioned the government for basic medical care, the United States remains the only high-income country in the world where such care is not guaranteed to every citizen. In the United States, racial health disparities have proved as foundational as democracy itself. “There has never been any period in American history where the health of blacks was equal to that of whites,” Evelynn Hammonds, a historian of science at Harvard University, says. “Disparity is built into the system.” Medicare, Medicaid and the Affordable Care Act have helped shrink those disparities. But no federal health policy yet has eradicated them.

 

I hope that during Black History Month you might decide to look at the original presentation of “The 1619 Project,” but I know that you probably don’t have the time to do so that an old retired doc like myself has. I have not listened to the podcasts, but I think that I will. I was given the book for my last birthday by one of my sons and have enjoyed it. It has a wonderful blend of essays, poetry, and literature that describe and give life to the journey of African Americans in their homeland for the last four hundred years. I do hope that you will watch the television version on Hulu. If you don’t have a Hulu account, click here and sign up for the free seven-day trial. You can easily see all six shows in seven days. 

 

The sixth and final segment of the Hulu presentation is entitled “Justice.” Near the end of the show, there is a clip from a statement to the press by Senator Mitch McConnell. He was asked about “reparations” which has been a touchy subject since the Civil War. I found the original clip on CNN. McConnell’s comment didn’t really surprise me, but it got me thinking. He said:

 

I don’t think reparations for something that happened 150 years ago for whom none of us currently living are responsible is a good idea. We’ve tried to deal with our original sin of slavery by fighting a civil war, by passing landmark civil rights legislation. We elected an African American president. I think we’re always a work in progress in this country but no one currently alive was responsible for that and I don’t think we should be trying to figure out how to compensate for it. First of all, it’d be pretty hard to figure out who to compensate. We’ve had waves of immigrants as well come to the country and experience dramatic discrimination of one kind or another so no, I don’t think reparations are a good idea.

 

Senator McConnell’s statement suggests that issues of race are behind us. He is seeking to absolve all of us living today from the sins of our ancestors. My ancestors owned slaves. They must have sexually abused some of them as related in The 1619 project because “23 and Me” tells me I have a trace of West African DNA and among the more than one thousand “relatives” that have been identified for me by “23 and Me” there are several African Americans. I did not commit the sins. My ancestors did as McConnell advises. What he fails to note though was that anyone like me living today has continued to benefit from the evils of slavery, Jim Crow, and the racial disparities that exist until today. I am not accountable for what my great great great grandfather might have done in 1820, but I am accountable for my stance against the persistence of those inequities just as Senator McConnell should be accountable. We need to find a way to provide justice for those who have descended with a legacy of abuse because of slavery. Until there is some form of correction for past injustices and ongoing barriers to equity there will continue to be damage and loss for all Americans.

 

The issues of our collective guilt and forward-looking responsibilities and what to do about this painful and damaging history and its present iterations is not a dead subject. Nikki Haley launched her campaign for president this week. In her first big speech, she spoke out against “woke” culture and denied that there was racism in America. She said that we should stop our “self-loathing” because America is not racist. Haley, DeSantis, and, I am sure, other candidates for president in 2024 who have not yet announced, will decry attempts to make our children aware of the “truth” about our distant history and continuing inequalities. The history I was taught through college contained many misrepresentations. My guess is that in many places in America, there has been no change.

 

The cover-up has worked pretty well for four hundred years. I doubt that there will ever be the political will to address the problems with “reparations,” but we can say, “Enough!” We could more effectively address poverty and homelessness. We could establish more effective “antiracism” policies as advocated by Ibram X. Kendi. Kenddscribes  antiracism:

 

“To be antiracist is to think nothing is behaviorally wrong or right — inferior or superior — with any of the racial groups. Whenever the antiracist sees individuals behaving positively or negatively, the antiracist sees exactly that: individuals behaving positively or negatively, not representatives of whole races. To be antiracist is to deracialize behavior, to remove the tattooed stereotype from every racialized body. Behavior is something humans do, not races do.”

 

We could establish a better system of healthcare that is built on antiracism policies. We could give everyone the dignity that they deserve. I deeply believe that if we had the will to address the sins of the past and the ongoing inequalities that persist even after we claim victory over racism, we would all be healthier, happier, and safer. 

 

The Sap Is Rising Early

 

Late February is usually when the sap begins to rise in the sugar maples that are ubiquitous in my little town. We are at least two weeks ahead of schedule this year, perhaps closer to three. Except for two days back a couple of weeks ago when the temperature fell to less than twenty below for two nights in a row, our temperatures have risen into the high thirties or low forties on the majority of afternoons. On the day after the night when the temp fell to minus twenty-one, it was over fifty! That was a seventy-degree swing in temperature in about sixteen hours.  

 

The perfect weather to kick off the maple sugaring season is exactly what we have been experiencing. Nights in the twenties and days in the forties cause the sap to rise. Despite knowing that we were unseasonably warm I did not think about the rising sap until I got an email from my friend Steve last Friday. My wife and I were two of eighty-one recipients of the message below.

 

Hi All,

You are on this list because you have expressed an interest in stopping by while we are boiling sap.  Well, it’s three weeks early but it looks like we will have enough sap for our first boil of the year on Sunday.  We will start around 1:00 and will probably go till 6:00 or until we run out of sap.  Please feel free to bring a drink/snack and swing by 28 Lamson and meet some new friends.  Also, feel free to bring others…

Thanks,

Steve

 

Steve is an interesting guy. I don’t think that he uses the phrase “social determinants of health” very often. He is a retired attorney who spent most of his career working in the electrical industry as a corporate officer in a Vermont electric company. He and his wife moved to New London to be closer to their grandchildren and both immediately became active in charitable activities. Steve is on the board of our local hospital. He is an active volunteer in our local food bank. He councils many struggling young people who ask for his help. Steve is also one of the organizers behind a credible effort to build workforce housing near the center of town. He is a board member of the local land trust. He volunteers as a basketball coach at one of the local junior high schools. He is core to our wood delivery program, and he is the president of our charitable non-profit, Kearsarge Neighborhood Partners (KNP). 

 

Steve doesn’t talk about the social determinants of health, but he is actively involved in fighting poverty, improving housing, providing cars to people who need transportation, improving food insecurity, protecting the environment, providing heating, and working to improve medical services to our community. Somehow he finds the time to tap over a hundred maple trees and turns the activity into a social event that creates a sense of community. It is dangerous to go to one of Steve’s “boiling” events because he is likely to press you to get involved or more involved in one of the many projects that he has going on that will improve our local social determinants of health. I speak from experience. Steve is like Tom Sawyer. He can get a lot of friends to help him “paint the fence.” 

 

We did drop by for the inaugural boil. At least half of the people who were on the invitation list were there while we were. It was a sunny afternoon. There were plenty of refreshments and great conversations and laughter inside the sugar shack and outside in the warm sun. 

 

After we left and we were on our way home, it suddenly occurred to me that I might have lost my gloves. At about the same time that I realized that I had lost my gloves, it occurred to me that I had missed a great opportunity to get a picture for the header of this letter. Both problems were solved when on Monday I got another email from Steve.

 

Hi All,

Just a heads up that I will be boiling from 11-2.  Stop by if you want to hang out or collect some buckets!  Just a note that someone who parked in front of our house yesterday lost a black glove that we have it here.

Thanks!

Steve

 

I had lost two gloves, but I was pretty sure that he had found at least one of them. I also decided that even if he had found only one glove, it was worth the three-mile trip across town to Steve’s house just to get a picture of his “sugar shack.” To my delight, he had not realized that he had both gloves since I had rolled them up together. So, I got my gloves, got my pictures, and enjoyed another hour chatting in the aromatic steam inside the “sugar house.” What is even better is to anticipate that later this year I will probably get another pint of Steve’s maple syrup as a gift. I should add that Steve does the tree-tapping, syrup-hauling, wood-splitting, and fire-stoking that is required to make syrup but the last steps of taking the sweet liquid from a boiled-down syrup to a filtered finished product require the touch of his wife Nancy who also supports and provides many of the finishing touches to all of Steve’s many activities and efforts for the community’s benefit. They are an effective team and have more energy than any three couples I know. 

 

Nancy is sitting in the rocking chair in the picture below. She is talking with their neighbor Becky whom Steve has talked into managing our transportation program, Kars for Kearsarge. 

 

 

The boiling pans and tending the fire below require Steve’s constant attention. The fire roars!

 

 

I just enjoy the conversation and watching other people do the work while knowing it won’t be long until I get to taste the product!

 

You may not have the opportunity to watch syrup boil this weekend, but I do hope that there will be something exciting that you might do with friends in your community on a warm late winter day this weekend.

Be well,

Gene