Teaching about race and health
My students understand the connections between poverty and health. Why doesn't Washington? (Or Harrisburg?)
Today's piece, the fourth in our ongoing race and health series, is by Janet Golden, a historian of medicine and public health. She writes about the teaching of race and health, and connections between past and present.
- Michael Yudell
As a medical historian, I find the subject of race and health to be both the easiest and the hardest to present to my students. It's easy because there is so much data to analyze, from W.E.B. DuBois' Philadelphia Negro (1899) to more recent work from the National Institute on Minority Health and Health Disparities. This agency, which is part of the National Institutes of Health, has been around in one form or another since 1990, and today has the mission of leading "scientific research to improve minority health and eliminate health disparities." That is the challenge.
Economic disparities and racism are the foundation of a significant portion of health disparities. They are linked to factors like living in neighborhoods filled with environmental hazards such illegal lead smelters and in homes with lead-based paint, not to mention the cockroaches that have been linked to asthma. Poverty is tied to the lack of access to good food, good jobs, good education, and good health services. Neighborhoods matter. Health is not an individual issue; it is a collective concern.
The infant mortality rate, an index of national well being used around the world, shows how far we have come since 1900, when the death rate for infants was 100 out of every 1000 live births. And a look at the infant mortality rate today shows we have a long way to go. As pediatrician and historian Jeffrey Brosco has demonstrated, "deaths among African-American infants have remained double the national average" for more than a century.
That's the crux of our nation's problem and of the problem in my classroom. We aren't talking about something that can't be substantially remedied; we are talking about a situation that reflects the ongoing problem of race and inequality.
The classroom is where we study the steps forward and backward that helped to diminish health disparities from what they were a century ago. It is where we look at the multiple reasons why we have failed to close the gap. It is where we explore classic studies of health, poverty, and the environment undertaken by agencies such as the United States Children's Bureau. It is where we dig into peer-reviewed scientific studies that show the complexities of racial disparities in health. And the classroom is where we study the links among civil rights activism, health reforms, and public policy.
My students get it. They are able to see the connections and the possibilities for improvements and to think about the cultural and economic changes that lead to better health outcomes and to greater potential for all Americans. The questions they ask challenge and inspire me.
Sadly, I'm teaching the wrong group. I'd like to be addressing some of our elected officials. Why? Because, with calls for cuts to federal departments it looks like we are going to be taking a big step backwards.
Health disparities are getting attention, thanks to the work of the National Institute on Minority Health and Health Disparities and other funders. That is good news. Yet income disparities are growing. That is bad news. Cuts in funding have consequences now and in the future.
Where are things likely to end up? That's a questionthat my students often ask and that I can't answer. (I tell them, I do history, not future!) But it is a conversation we need to be having, and not just in the classroom.
Janet Golden, a Rutgers University history professor, specializes in the histories of medicine, childhood and women.
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