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National Medical Association

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Title: National Medical Association


1
National Medical Association
Racism in Medicine Health Parity for African
Americans
Authored by Rodney G. Hood, M.D. Immediate Past
President
2
(No Transcript)
3
A Historical Perspective of Racial and Ethnic
Health Disparities
  • The Impact of Racism on the
  • Health Status of African Americans

4
Carnage of Racism
5
The Beginning
  • The Evolution of Man

6
Palaeonto-logical Evolution Evidence
  • Lucy

7
Origin of All Languages
Africa
8
Genetic Evolution Evidence
  • In 1987 geneticists at UC Berkeley (Cann/Wilson)
    analyzed partial mitochondrial DNA (mtDNA)
    sequence (less than 7) of different people
    worldwide and found more genetic mutations among
    indigenous Africans than any other people.
  • Max Ingman, et. al., at the University of Uppsala
    in Sweden recently described global mtDNA
    diversity in humans based on analyses of the
    complete mtDNA sequence of 53 humans of diverse
    origins. Nature Mitochondrial Genome Variation
    and the Origin of Modern Man, Dec. 7, 2000.

9
The Migration of Man
10
The African Eve
  • The UC Berkeley geneticists postulated that the
    entire population of the modern world was
    descended from a relatively small group of people
    that left Africa 100,000 years ago.
  • This group postulated the African Eve theory
    (Newsweek), that every human being alive today
    carries the mtDNA of just one African woman
    (Lucys cousin) or a small number of female
    African ancestors who lived more than 10,000
    generations ago.

11
Imhotep the Physician
  • This great African physician was deified in
    approximately 2850 B.C.
  • Imhotep was the first person known as a doctor
    throughout the world and acknowledged as the god
    of medicine 5000 years ago.
  • Some 2500 years before a Greek laid claim to this
    same title.

12
Historic African Surgery
Edinburgh Medical Journal, 1884
  • Cesarean Section performed by a Banyoro surgeon
    in Uganda in 1879 with the use of aseptic
    technique, sutures and hot cautery irons.

Illustration from Dr. RW Felkins description of
the Cesarean Section.
13
Human Genome Project
14
A Portrait in Diversity
15
Human World Clans The Seven Daughters of
Eve Whose Your Mama?
Lucy
16
LAYLA Rodneys Mama
17
Conclusion of Evidence
  • Thus, we have Fossil, Linguistic and Genetic
    evidence that persuasively point to the
    conclusion that every person alive today is
    descended from modern humans (Homo Sapiens) that
    existed only in Africa until approximately
    100,000 years ago.
  • The origins of humanity, civilization,
    intelligence and modern medicine (Imhotep) have
    evolved from Africa.

18
The Evolution of Racism in Medicine
  • Racism has roots in medicine
  • over 2500 years

19
Race and Ancient Scientific Precursors
The Great Chain of Being
20
Pseudoscience of Racism
21
Early Forefathers of Racial Bias
22
The Roman-Greek Contributions to Racism
in Medicine
  • The teachings of Galen (c. 130-201), a famous
    second century Roman physician of Greek origin,
    were accepted as sacrosanct by teachers of
    Western medicine for 1500 years.
  • Galen promoted the racist concepts of Black
    physical and psychological inferiority in his
    teachings and writings.
  • Bernal M.Black Athena/ The Fabrication of
    Ancient Greece 1785-1985, Rutger Univ. Press,
    1987.

23
European Contribution Racism in Medicine
  • Many European physician-scientists during the
    16th, 17th, 18th and 19th centuries contributed
    racist teachings into the medical corpus of
    knowledge.
  • A few notables
  • Paracelsus A famous Swiss physician and
    philosopher.
  • Anton van Leeuwenhoek Father of Microscopy.
  • Marcello Malphighi Father of Histology

24

25
(No Transcript)
26
Hottentot Venus Lady
  • Exploitation of Saartjie Baartman by Baron
    Georges Cuvier

27
The Round Up Period
28
The Slave Ship
29
Living Africans Thrown Overboard The Slave
Ship Zong in 1781
30
Transatlantic Slave Period
31
The Assault on Black Humanity Continues
32
American Health Professional Contribution
to Racism in Medicine
33
Benjamin Rush, M.D.
34
The Beginning of Womens Health
Father of Gynecology J. Marion Sims,
M.D.
35
Medically Prescribed Punishment
36
First Black Health Reconstruction Period
37
Organized Medicines
Race-Based Policies
  • Three periods of AMA official rejection of Black
    physicians
  • 1. June 1869 the Medical Society of the
    District of Columbia.
  • 2. May 1870 at the 21st AMA National
    Convention in Washington, D.D.
  • 3. In 1872 the AMA Convention again rejected a
    similar biracial delegation.

38
Nineteenth-Century Academic
Thinking on Race
  • Nathaniel Southgate Shaler (1841-1906)
  • Joseph LeConte (1823-1901)
  • Edward Drinker Cope (1840-1897)

39
National Medical Association
Birth
40
The Civil Rights Era The Second Black
Health Reconstruction Period
  • The 1964 Civil Rights Act, hospital desegregation
    court rulings, passage of Medicare and Medicaid
    and the health centers movement, all created a
    Civil Rights Era in health care for Blacks.
  • This initiated the Second Black Health
    Reconstruction Period from 1965 - 1985.

41
The Slave Health Deficit A National Crisis
  • 35 more Blacks than the general population die
    from cancer each year.
  • 40 more Blacks than the general population die
    from heart disease each year.
  • 35 of Black men suffer with hypertension
    compared to the national average of 25.
  • Diabetes Mellitus is 70 higher among Blacks.
  • Blacks suffer much higher rates of ESRD but
    Whites are twice as likely to receive a life
    saving kidney transplant.
  • The impact of HIV/AIDS, violence, substance
    abuse, unintentional injuries, infant mortality
    many other preventable conditions is greater for
    Blacks.

42
Causes for the Ethnic Health
Disparities
  • Inadequate Access
  • Socioeconomic
  • Cultural Differences
  • Genetic Differences
  • Environmental Exposures
  • Dietary Habits
  • Unhealthy Life Styles
  • Culturally Incompetent Health Care Systems
    Providers
  • Racial Bias
  • Racism

43
Modern Racism in Health Care
  • An Unspoken Risk Factor for the African
    American Health Deficit and Ethnic Health
    Disparities in the United States

44
Of All Forms of Inequity, Injustice in
Healthcare is the Most Shocking and
Inhumane. - Martin Luther King
45
Assault on the Black Intellect
  • Centuries ago scientists taught Blacks were
    inferior both physically and intellectually
  • 20th Century Scientific Accusers
  • Sir Francis Galton, Arthur Jensen, William
    Shockley, Richard Herrnstein and Charles Murray
  • 20th Century Scientific Defenders
  • Stephen Jay Gould, Alvin Poussaint and Richard
    Atkinson

46
The Evidence forModern Racism in Medicine
  • Health Care Racial Profiling

47
Racial Bias in Medicine Health Care Racial
Profiling
  • JAMA, 1994 A study in Los Angeles revealed
    Hispanic patients were twice as likely as white
    patients to receive no analgesia when presenting
    to the ER with a fresh bone fractures.
  • The Annals of Emergency Medicine, Jan. 2000
    (Emory University School of Medicine) concluded
    that Black patients with broken arms and legs
    were less likely than white patients to receive
    painkillers when presenting to an Atlanta ER.

48
Racial Bias in Medicine Health Care Racial
Profiling
  • Race, quality of care and prescribing practices
    in psychiatric emergency services, Psychiatry
    Service March, 1996.
  • Conclusion Clinicians, mostly Caucasian,
    prescribed more psychiatric medications to
    African Americans than to other patients and
    devoted significantly less time to their
    psychiatric evaluations.

49
Health Care Racial Profiling
  • The Schulman// Georgetown Cardiovascular Study
    (NEJMFeb. 1999).
  • The Lung Cancer Sloan-Kettering Study
    (NEJMOct.1999).
  • The Renal Transplant Harvard Study (NEJM Nov.
    1999).

50
Health Care Racial Profiling
  • Brigham Womens Hospital and Harvard Medical
    School Study, Quality of Care by Race Gender
    for CHF and Pneumonia, by Ayanian, et al
    (Medical Care Dec. 1999, 37(12)1260-9)
  • The Michelle van Ryn Study, Effects of Race and
    SES on Physicians Perception of Patients
    (J. Social Science and Medicine March 2000)
  • Yale University Cooperative Cardiovascular
    Project, Racial Differences in the Use of
    Cardiac Catherization after Acute Myocardial
    Infarction, by J. Chen, et al (NEJM, May
    2001, Vol.344)

51
Defining Racism
  • Camara Phyllis Jones gives a theoretical
    framework for understanding and defining racism.
  • Internalized Racism
  • Personally Mediated Racism
  • Institutionalized Racism

52
National Medical AssociationConsensus
Panel
  • Racism in Medicine Health Parity
  • for African Americans

53
NMA Consensus Panel Racism in Medicine
Health Parity for African Americans
  • Rodney G. Hood, MD - Chair
  • President NMA
  • W. Michael Byrd, MD, MPH
  • Harvard School of Public Health
  • L. Natalie Carroll, MD
  • Chair BOT, NMA
  • Linda A. Clayton, MD, MPH
  • Harvard School of Public Health
  • Gary C. Dennis, MD
  • Chair Neurosurgery Department
  • Howard Univ. Medical School
  • Michael A. LeNoir, MD
  • NMA Trustee
  • Kweisi Mfume
  • President CEO, NAACP
  • Lucille C. Norville Perez, MD
  • President-elect NMA
  • The Honorable Louis Stokes
  • Squires, Sanders and Dempsy
  • Augustus White, III, MD, PhD
  • Professor Orthopedic Surgery
  • Harvard Medical School
  • Richard A. Williams, MD
  • Clinical Professor of Medicine
  • UCLA School of Medicine

54
Desperate Diseases Must Have Desperate
Remedies. -Shakespeare
55
Health Care Solutions 5 Principles to Address
Disparities
  • Health Disparities Quality Problem.
  • Data Collection is Inadequate.
  • Stratified Clinical Performance Measures.
  • Population-wide Monitoring.
  • Race/Ethnicity Payment Strategies.
  • Kevin Fiscella, et al.,Inequality in
    Quality, (JAMA 2000 May 17 283(19)2579-84)

56
Health Policy and Research Institute
  • Health Institute Centers
  • African American Health Center Think Tank
  • Health Policy and Advocacy Center
  • Research, Surveillance and Educational Center
  • Community/Public Media Information Center
  • Mobilization and Participation Action Center

57
NMA Recommendations to Create Health Parity
  • Racial bias and racism to be considered as a risk
    factor toward poor health for African Americans.
  • Healthy People 2010 must address the impact of
    racial bias and racism in medicine to achieve
    health parity for all Americans.
  • Emphasize healthy lifestyles and alternative
    health modalities such as prayer, meditation, and
    otherholistic approaches.
  • Culturally competent and diverse health care
    workforce
  • Congressional Hearings on Racism in Medicine
  • Congressional/Presidential Advisory Committee
  • Comprehensive Universal Health Insurance Program

58
Health Parity Recommendations
  • Education
  • Support UC President Atkinsons recommendation to
    eliminate the SAT I scores as undergraduate
    admission criteria. Further support a moratorium
    or de-emphasis on the MCAT and other similar
    standardized test proposed to measure aptitude.
  • Cultural competency education to incorporate the
    ethical issue of racial bias and racism in
    medicine.
  • American public should be educated around the
    positive benefits that come with the elimination
    of all health disparities.
  • Health education must emphasize responsibility
    for good health practices with healthy lifestyles
    and the unique considerations imposed by their
    cultural experiences.
  • Initiate innovative programs to increase the
    number of underrepresented minorities in health
    sciences and combat anti-affirmative action.

59
Understanding Racism through Jazz
60
A Question to Explore
  • Is there a correlation between the
    centuries-old racist theories taught by the
    western medical profession and the current
    studies that reveal persistent race-associated
    differential health status and outcomes based
    upon the degree of melanin in the population?

61
Health Disparities the Vision for the Future
62
The Hope and The Future
  • We will, We can, and We must stop the insanity of
    racism!
  • Insanity is when we keep doing the same thing
    and expecting a different result.
  • by Albert Einstein
  • presented by Ariannah Hood

63
Linguistic Evolution Evidence
  • Afro-Asiatic languages in Ethiopia North Africa
    have the oldest linguistic roots and are heard
    today in East Africa close to the sites where the
    oldest fossils have been found.
  • J.Reader Biography of the Continent Africa,
    1997, pg. 109-110

64
He Who Has Health, Has Hope and He Who Has
Hope Has Everything. - Arabian Proverb
65
African American Health Crisis
  • The 1998 Age-Adjusted Death Rates
  • Black Americans suffered overall mortality rates
    53 percent higher than for Whites.
  • Stroke death rates for Blacks were 78 percent
    higher than Whites.
  • Heart disease death rates were 50 percent higher
    for Blacks.
  • Cancer death rates were 33 percent higher for
    Blacks.
  • And - HIV death rates for Blacks were almost 700
    percent higher than for Whites.
  • Health, United States, 2000, DHHS, Center for
    Disease Control and Prevention, National Center
    for Health Statistics, July 2000 (Table 30).
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