September 18, 2020
Dear Interested Readers,
Pondering the Message of Caste in the Context of These Times
One of the benefits of retirement is the time to participate in book groups and other gatherings of older folks who are still interested in a wider world. The pandemic and the summer season put a brake on my Monday morning book group, but recently I learned that the biweekly Sunday evening discussion group that my wife and I have enjoyed for several years, and that the pandemic also canceled, is reforming in three small outdoor groups for as long as the weather allows, and then will probably be on Zoom. The plan is to move from our previous discussions that varied from session to session with a prolonged study of Caste: The Origins of Our Discontents by Isabel Wilkerson which was published in early August. The book has been on the New York Times best sellers list for six weeks. I guess it doesn’t hurt to be a choice of Oprah’s Book Club.
Isabel Wilkerson is the author of the highly regarded book, The Warmth of Other Suns (2010), and a former New York Times writer who won the Pulitzer Prize in 1994 for writing a “profile of a fourth-grader from Chicago’s South Side and for two stories reporting on the Midwestern flood of 1993.” The Warmth of Other Suns describes “the great migration” of African Americans from the South to northern urban areas where there was the hope of opportunity and relief from the oppressive Jim Crow environment of the South. In Caste, Wilkerson discusses “race and racism” and points out that race is a much newer term than “caste.” Wilkerson argues that we must understand how our caste system affects us all and has been the infrastructure of American life since slaves were brought to Virginia in 1619. Our caste system is a powerful reality in describing the opportunities available to individuals. Intuitively, we all know our place, and the caste system holds us in that place. I would add that the pandemic has reminded us once again that who we are and the social factors that exist in our lives both have a powerful effect on our individual outcomes.
I would highly recommend listening to the interview that Wilkerson had with Terry Gross on August 4, or reading the transcript of their conversation. Early in her introduction of Wilkerson Gross says:
…she’s written a new book called “Caste” that explains why she thinks America can be described as having a caste system and how if we use that expression, it deepens our understanding of what Black people have been up against in America. She compares America with the caste system in India and writes about how the Nazi leadership borrowed from American racist laws and the American eugenics movement.
The idea that Nazi thinking and actions were in anyway derivative of observations of life in America might be perceived as outrageous and inflammatory, but Wilkerson is a good historian, and documents her assertion. There is no escaping the historical records of the laws and public policies that restricted contact between the races, and limited the economic opportunities of Black Americans. Wilkerson reminds us of the sins of complacency and silence in the face of injustice even if as an individual we were never racist, and never sought to exclude or disadvantage a person from a different place in our caste structure.
Early in the conversation Gross asked Wilkerson why she decided to talk about caste and asked for a description of the differences between race and caste. Wilkerson’s answer was thought provoking:
Well, I found that the word racism, which is often applied to discussions of interactions among and between African Americans and other groups in this country – I found that term to be insufficient to capture the rigid social hierarchy and the repression that they were born into and that, in fact, everyone in that regime had to live under. And so I turned to the word caste, which is a word that had been used by anthropologists and social scientists who went in to study the Jim Crow era in the 1930s in particular. And they emerged from their ethnography, they emerged from their time there with the term caste as the language to use to describe what they found when they went there.
And so I came to that word as had they. That is the term that is more precise. It is more comprehensive, and it gets at the underlying infrastructure that often we cannot see but that is there undergirding much of the inequality and injustices and disparities that we live with in this country.
Wilkerson had been working on this book for a while, and it was probably finished before the pandemic emerged in March, and before it became obvious that the pandemic would be another revelation of the disparities in health and access to care that disadvantage Black Americans. Her book becomes even more important in the context of all of the demonstrations that have followed the murder of George Floyd in Minneapolis and the shooting of Jacob Blake in Kenosha.
Wilkerson persists in the discussion of the relationship between race and caste. She makes the point that many of us don’t harbor the hatred of racism, but we all participate in the “caste system” that limits the possibilities for so many Black Americans. It is now well documented by public health statistics that the color of our skin, our positions in society, our personal wealth, and where we must live as a manifestation of economics and race, all have a major impact on our health outcomes and life expectancies. We now quip that health varies more by ZIP code than genetic code. Our caste system is a powerful driver of where we live. Where we live determines much of the circumstances of our health risks and for Black Americans the realities that flow from the caste system that we rarely discuss and that is an underpinning of life that affects us all has as one of its manifestations the shorter life expectancy and increased burden of chronic disease, and yes, the different experience that Black Americans have with the police. I have bolded a few phrases in Wilkerson’s continuing explanation:
Well, it’s a difference in some ways between what one would consider caste versus race to begin with. I think of caste as the bones and race as the skin. And that allows us to see that race is a tool of the underlying structure that we live with, that race is merely the signal and cue to where one fits in the caste system. And caste system is actually an artificial hierarchy. It’s a graded ranking of human value in a society that determines the standing and respect, the benefit of the doubt and access to resources, assumptions of competence and even of beauty through no fault or action of one’s own. You’re just born to it. And so caste focuses in on the infrastructure of our divisions and the rankings, whereas race is the metric that’s used to determine one’s place in that or one’s assignment in that caste system.
I did not need to read very far into her book to see that many of us who would be mortified if we were accused of being racist are silent in the face of the caste system. Wilkerson argues effectively that caste ensures the persistence of White privilege, and the persistence of Black disadvantage. Our caste system was developed in the old South and reengineered in the era of Jim Crow, but it was exported to the North and it is present everywhere, and at times more obvious in the urban centers of the North. Most of the laws that reinforced it are gone, but the unpleasant stench lingers in the learned attitudes of individuals, and the smoldering embers that are the persistence of Jim Crow can erupt into flames in a recurrent fashion, as the public demonstrations after the killings of George Floyd, Briana Taylor, and other heinous recent events demonstrate most vividly. Caste tells you what you can expect as an individual as you move through the world. Violations of the expectations of caste, like the election of a Black president, can generate strong feelings and perhaps subconscious concern that their advantage is in jeopardy in those whom caste favors. Wilkerson continued in her conversation with Terry Gross by saying:
… it can create easily activated resentment at anything that does not track with how one perceives oneself. In other words, the perception that someone who has been deemed lower or that one perceives to be lower than them – any advancement by someone in that group can be seen as a greater threat than it otherwise would be. There would be a greater investment in maintaining the caste system as it is and maintaining the hierarchy as we have known it to be.
Is that an explanation for the anger and posturing that we see on the far right? Does it describe the feelings that Donald Trump so skillfully tapped into on his boisterous march to the presidency. Does a white reaction to Obama’s violation of caste explain some of the circumstance that helped to elect Donald Trump in 2016? Is there a persistent part of the population that still harbors those feelings, and does the president continue to seek advantage by reminding his base that the advantages that they enjoy through the caste system are vulnerable to change? Are you and I part of the problem because we have allowed the caste system to persist?
Gross pressed Wilkerson to explain her exceptional career and accomplishments in the context of the persistence of caste. Wilkerson responded with several of the stories she related in the book. At one point as a celebrated writer for the New York Times she was writing about Chicago. One of the people she wanted to interview for her article, the CEO of an upscale retail business on Michigan Avenue, gave her an appointment for an interview, but when she showed up at the appointed time he could not believe that she was who she was because she was black. He refused to talk to her because he had an appointment with a writer for the New York Times. She could not convince him that she was the New York Times writer that he was expecting. She finally left and wrote the article without his input. The interview ends with a discussion that points out that no one who is alive now built the system. None of us have ever enslaved anyone, but the system persists, and you can see the manifestations in statistics about public health, employment, housing, education, and yes in how the police respond in encounters with Black Americans. Wilkerson’s final statement uses owning an old house as a metaphor:
No one had anything to do with the creation of the caste system that we’ve inherited. But now that we are in it and we recognize it and we are here however we got here, whether we were brought over and – where we came over in ships either of our own choice or not, whether we have recently arrived, we are now in the structure in the old house that now belongs to us. And it’s our responsibility now to deal with whatever is within it. Whatever’s wrong with it is now our responsibility, those of us alive here today.
In Summary from the interview:
- Caste is an artificial hierarchy that helps determine standing and respect, assumptions of beauty and competence, and even who gets benefit of the doubt and access to resources.
- Caste focuses on the infrastructure of our divisions and the rankings, whereas race is the metric that’s used to determine one’s place in that [structure.]
- Caste has been around for thousands of years: “[Caste] predates the idea of race, which is … only 400 or 500 years old, dating back to the transatlantic slave trade.”
- People of color who are not Black are…[in an ambiguous position between Black and White.]
- …the U.S. used immigration as a legal way to maintain the caste system…Curating the population means deciding who gets to be a part of it and where…
I have read about half of the book. It has already provided me with several concepts that add depth to our understanding of what must change if we are ever going to have health equity. The pandemic has destroyed any sense that there is equity in care in America. Large numbers of Black Americans, as well as other ethnic minorities, live in environments and under circumstances that make maintaining health and avoiding disease much more difficult than it is for the majority of white Americans. If you are white do you just accept the advantage you have as a birthright and defend it against any erosion, or do you recognize it for the historical mistake and misconception that it is, and become active in the efforts to eradicate the caste system? You’re not a racist, but tolerating a social structure that uses race as a way of assigning people a position in society is an acceptance of an ongoing problem that will ultimately undermine the possibilities for everyone.
Healthcare is a defined segment of society. It would be a good place to begin a focused effort to do away with our caste system which creates healthcare inequities. I was startled and delighted last week at a board meeting of the Boston University Medical Group. I serve as a “community member” of the board. The BU Medical Group provides the professional staff for the Boston Medical Center, the DSH hospital of the city of Boston. During the spring almost all of our beds were occupied by patients suffering from COVID-19 infection. During this latest board meeting we were reviewing the COVID experience and the plans that were being made to insure that we were ready for a second wave.
At the meeting, the CEO of the hospital, Kate Walsh, described the BMC experience with COVID-19. At the peak of the pandemic, in Late March and through April and May, all elective procedures and most outpatient visits were cancelled and replaced with a focus on managing COVID patients. There were huge financial losses that were managed in part through pay cuts and elimination of retirement benefits. Since almost every hospital bed was occupied by a patient with the virus and there were shortages of PPE, there were huge stresses on the staff and the budget. Despite great efforts to treat every patient with the care they required, our experience demonstrated the sad reality that even with our commitment to healthcare equity in our disadvantaged population, our African American and Latinex patients fared worse than the disadvantaged white population. The medical group and hospital experienced multiple millions of dollars of financial loss that have been replaced in part by state and federal supplements, and the ironic improved performance of the system’s insurance function that did not need to pay for the elective procedures that did not occur. After presenting our recovery from all the bad news and the disturbing statistics, and reviewing the plans to do better if there is a second wave, she surprised me by saying, “We must apply as much energy to achieving health equity as we do to staying solvent.”
She went on to explain that the pandemic had demonstrated that even at the Boston Medical Center we had a compelling need to teach skills that could eliminate institutional racism as we worked to achieve health equity. As she was describing the initial plans that included activities in the hospital and the community, I used the “chat function” of Zoom to ask her if I could quote her. She said yes. I hope that other healthcare leaders across the country will follow her lead. As I metaphorically looked around the room by looking at the Zoom participants on “gallery view,” I saw a board that demonstrated substantial racial and gender diversity. Kate Walsh saw a need for much more than a diverse board if our goal was healthcare equity and real improvement of the social determinants of health. I challenge you to ask what your practice or hospital is doing to eliminate the impact of our caste system on the healthcare outcomes in your community. We must begin the work of addressing our caste system. I can’t think of a better place to start than with the inequities that we know exist in healthcare.
A Visitor With A Message. Fall Is Coming!
I noticed a big bird offshore near my swim float late last Sunday afternoon. My first thought was that it was a juvenile loon. Then I realized that its neck was too long, and its beak was too pointed to be a loon. On closer examination, I noticed that the bird’s body was almost completely submerged. It surely was not a loon. Could it be a cormorant on our lake? What came next really surprised me. The big bird hopped up on my swim float and began preening itself. I pulled out my cell phone and quickly started taking pictures with the expectation that it would soon fly away. The natural backlighting obscured the birds markings, but I decided that it was surely a cormorant who was “passing through” the neighborhood. The bird then began a ritual or some kind of dance. It would stand up tall, almost on its toes and then spread its wings and flap them about like it was trying to dry them. For the next half hour it was up and down, alternating between flapping, stretching and then resting. I kept expecting the bird to leave, but it didn’t before I had to turn my attention to other things.
I was curious about my visitor and decided to check out cormorants on the Internet. What I found was informative. In a 2017 article in Fosters.com entitled “Cormorants, common but never boring” by Susan Pike I read:
Most people recognize cormorants by their habit of wing spreading – thought (but not proven) to be what they do to dry their feathers. You’ll see them on piers, on rocks, on sandflats, standing with their wings spread out facing into the wind. Cormorants are known for their wettable feathers. They have less preening oil than other birds. When birds preen they distribute preening oil in a thin layer, coating their feathers and waterproofing them. Because they have less preening oil, cormorant feathers can get wet. This is thought to be an adaptation for diving and swimming through the water. Wettable feathers trap little air which helps them to sink and overcome the buoyancy that results from their lightweight bones (an adaptation for flight).
My guess is that the bird I saw was in transit. I saw some other visitors this week who were perhaps passing through, a pair of “flickers.” I caught one on camera last year, but they were too fast for me this time. I read that northern flickers do migrate. I guess that the birds are telling me it is fall.
I really don’t need the birds to tell me that fall is coming fast. The water temperature of the lake is in the low sixties, and there are trees turning to red and yellow everywhere I look. I saw the early fall colors of this shapely maple as my wife and I were coming out of a session with our pilates instructor (who follows all the COVID recommendations) yesterday.
I think fall is a state of mind. It is transitional. Things are moving toward winter. We are heading out for the West Coast on Tuesday in an RV so this weekend will be one of pulling boats out of the water and clearing the deck of furniture because by the time we come back there may be snow.
The weathermen in New Hampshire and Massachusetts are predicting a great weekend for romps through the woods and apple picking. It will be bright, clear, and a little chilly. Wherever you are, I hope that you will be out and about because it won’t be long until we will need to be coming indoors where social distancing will require a little more effort.
Be well! Enjoy the fall. When you are out and about, wear your mask and practice social distancing as best you can if you are near other people. Look for opportunities to be a good neighbor. Think about your own relationship to our cast system. Let me hear from you about your view of the challenges ahead that will shape our shared future. I would love to know how you are managing the uncertainties of our times,
Gene
