Sunday, July 14, 2013

Health disparities: What the Florida rulings teach us.

That addressing health disparities in the US is an important priority is evident in the large numbers of grant calls that are put out by the Department of Health and Human Services (DHHS).

These calls are issued in the backdrop of large scale data that document a wide range of disparities in health outcomes. 

Specifically in the context of race, there are large disparities between Blacks and Whites in mortality and morbidity, as well as in disease-specific outcomes. 

These health disparities in many instances persist even after controlling for social class. In other words, within the same social class, African Americans typically experience poorer health outcomes compared to Whites.

Based on the notion that these health disparities are unacceptable, number of health campaigns are carried out that are directed at addressing these disparities. They focus on information dissemination, attitude change, and behavioural factors. The targets of these interventions are African Americans. The goal, to induce behaviour change through knowledge, attitude change, and motivation.

These are welcome and much needed efforts at addressing the poorer health outcomes that are experienced by Blacks in the US. The work I have done and continue to do with African Americans and health disparities broadly falls within this domain.

However, there are much deeper structural inequities that are played out in the very organisational structure of US society that often go unnoticed in the calls for addressing health disparities that are rooted in these very structures. These structural inequities are so fundamental, so normal to the framework of American society that most efforts at addressing health disparities unknowingly end up perpetuating them, often focusing on individual behaviour change, building self efficacy, creating positive role models etc., and at the same time being oblivious to the deeply pervasive structures of racism in US society. 

What goes hidden in the mainstream narrative of health disparities is the racism that is inbuilt into the processes, institutions, and logics of mainstream American society. Everyday conversations, expectations, values and principles governing everyday life are built on the superiority of a White mainstream that dictates the rules of representation, participation, and engagement.

This structural inequity in the organising of American society is well evident in the recent court ruling in Florida that found the killer of Trayvon Martin, George Zimmerman not guilty on the grounds that the shooting was an act of self-defense. 

Trayvon, who had stepped out to buy iced tea and a bag of skittles, was followed and chased by George Zimmerman. 

The shooting was an outcome of the fight that had ensued between Zimmerman and Martin. 

Zimmerman, who was leading a neighborhood watch team, has since offered the explanation that Martin looked threatening because he was wearing a hoodie and walking in an area where there have earlier been burglaries. 

The accounts of the exact order of events remains contested and that eventually became the basis for the judgment. 

Yet, what does remain clear is that Trayvon was profiled and chased, and ultimately shot by Zimmerman.

Coming back then to the fundamental structural inequities that constitute US society, what we learn from the  above example is the culture of profiling of African American youth that is inherent in the assumptions of US society. 

That African Americans are perceived as criminals is an organising frame that makes up the US; its public policies, police surveillance, justice system, and jails are organised around this racist logic of systematically criminalising African Americans, and profiting from this process of criminalisation. 

This deep-rooted racism of American society is intrinsic to the large disparities in health outcomes that are experienced by Blacks compared to Whites. 

The acknowledgment of this racism would push those of us doing health disparities work toward transformative politics that takes as its starting point the need to fundamentally rework American society, its expectations, and its history of racism.

Deep interrogation of health disparities work would systematically guide social scientists toward examining the power exerted by the gun industry, and the intrinsic relationship of this industry to racism.

In this sense then, the social sciences that are constituted within the broader framework of health disparities would need to be fundamentally transformed, working toward addressing the underlying racism of American society, culture, legal system, educational system, housing, employment, gun regulation and so on.

To get here, we have to collectively fight the whitewashing that is built into the funding agencies and federal structures that determine what we do and how we do what we do.

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