Mary Bassett: How Does Racism Affect Your Health?

Dec 13, 2019
Originally published on December 16, 2019 11:06 am

Part 2 of the TED Radio Hour episode Accessing Better Health.

About Mary Bassett's TED Talk

How does race affect the medical attention you receive, your baby's chances of living, and your life expectancy? Mary Bassett says structural racism can impact every aspect of health.

About Mary Bassett

Mary T. Bassett is the Director of the FXB Center for Health and Human Rights at Harvard University, as well as the FXB Professor of the Practice of Health and Human Rights at the Harvard School of Public Health.

Prior to her directorship at the FXB Center, Dr. Bassett served for four years as commissioner of Health for New York City. Previously, she was the Program Director for the African Health Initiative and the Child Well-being Program at the Doris Duke Charitable Foundation.

She received her B.A. in History and Science from Harvard University and her M.D. from Columbia University. She has a master's degree in Public Health from the University of Washington, where she was a Robert Wood Johnson Clinical Scholar. Dr. Bassett began her career on the medical faculty at the University of Zimbabwe for 17 years.

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GUY RAZ, HOST:

It's the TED Radio Hour from NPR. I'm Guy Raz. And on the show today - ideas about Accessing Better Health.

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RAZ: Do you think that access to being healthy in the developing world and even in the U.S. is almost a privilege rather than a right?

MARY BASSETT: I'm afraid so. I mean, you should know that I feel and the data support that being healthy is not only a matter of having access to individual health care services. It's having access to a life that protects your health.

RAZ: This is Mary Bassett. She's a physician. From 2014 to 2018, she was New York City's health commissioner.

BASSETT: I used to be told in New York City at City Hall - they'd say, there's nothing that she doesn't think is related to health (laughter).

RAZ: Mmm hmm.

BASSETT: And, you know, I think that's kind of true. There's hardly anything that I don't - I think doesn't have a bearing on our ability to be healthy.

RAZ: For years, Mary's worked on issues around social justice, and she says she began to approach health care through this lens around 30 years ago in Zimbabwe. Mary Bassett picks up her story from the TED stage.

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BASSETT: When I moved to Harare in 1985, social justice was at the core of Zimbabwe's national health policy. The new government emerged from a long war of independence and immediately proclaimed a socialist agenda. Healthcare services, primary education became essentially free. The excitement, the camaraderie was palpable. I felt connected not only to an African independence movement but to a global progressive public health movement. But we had no idea what lay in store for Africa.

Zimbabwe reported its first AIDS case in 1985, the year I arrived. By the mid-1990s, I told hundreds of people in the prime of life that they were HIV-positive. I saw colleagues and friends die, my students, hospital patients die. In response, my colleagues and I set up a clinic. We did research. We counseled the partners of infected men about how to protect themselves. We worked hard.

And at the time, I believed that I was doing my best. I was providing excellent treatment, such as it was. I worked to show how getting infected was not a moral failure but instead related to a culture of male superiority, to forced migrant labor and to colonialism. Whites were largely unscathed. But I was not talking about structural change.

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RAZ: I mean, you came there for your technical skills as a medical professional, and you did what you should have done, which was to work to educate people. But as you say, your tools that were at your disposal were pitifully weak, that actually, there was a much bigger problem and challenge that you didn't feel comfortable talking about. What was that?

BASSETT: Well, one of the things is how we're trained as medical doctors, that we think of the patient once they walk through the door, and we limit our interactions with them to that encounter. And in that sense, I think I was doing my job. But I would argue that the role of medical doctors is broader than that, that we have to think about the world from which patients come when they enter our universe and seek health care.

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BASSETT: So in Zimbabwe, for example, the economy was founded on migrant labor. So routinely, men migrated from their homes in the rural areas in a bid to earn money for their families. But in - the result was that separations of men from their wives was a way of life, and that created a risk, which we now know was a risk for HIV infection. So structural things, not just access to medical care, create high-risk situations for poor health.

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BASSETT: Medical anthropologists, such as Paul Farmer, who worked on AIDS in Haiti, call this structural violence - structural because inequities are embedded in the political and economic organization of our social world, often in ways that are invisible to those with privilege and power. And violence because its impact - premature deaths, suffering, illness - is violent.

We do little for our patients if we fail to recognize these social injustices. Sounding the alarm is the first step towards doing public health right, and it's how we may rally support to break through and create real change together. So these days, I'm speaking up about a lot of things, even when it makes listeners uncomfortable, even when it makes me uncomfortable.

RAZ: As you make clear in your talk, this experience that you had earlier in your career had a profound effect on the way you think about access and about who gets care and who doesn't get care. So you get to New York, and what do you see?

BASSETT: Well, New York City is one of the wealthiest cities in the United States and probably in the world, but it also has many poor people. Nearly half of the population lives in official poverty. And it's also one of the most highly segregated cities in the United States. And the patterns of health that we see in New York City mirror the residential segregation so that some neighborhoods in New York have life expectancies that are over 25 years shorter than other neighborhoods in New York City. That's how big the life expectancy gap is. And it often is a racial gap, meaning that the black-white difference in life expectancy is the largest that New York City data show. And that's why we have to talk about racism.

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BASSETT: In New York City, premature mortality - that's death before the age of 65 - is 50% higher for black men than white ones. A black woman in 2012 faced more than 10 times the risk of dying related to childbirth as a white woman. A black baby still faces nearly three times the risk of death in its first year of life as compared to a white baby. New York City's is not exceptional. These statistics are paralleled by statistics found across the United States. And a lot of this is about racial disparities and institutionalized racism, things that we're not supposed to have in this country anymore, certainly not in the practice of medicine or public health. But we have them, and we pay for them in lives cut short.

RAZ: So, I mean, as those statistics make clear, not only institutional racism, but day-to-day exposure to racism will have a pretty profound effect on someone's health.

BASSETT: Yes. There are institutional factors. There are personal factors. And they all move in the same direction so that a person who's classified as black in the United States is less likely to have access to high-quality health care, is more likely to be subjected to unequal treatment by their physician and is more likely to live in a neighborhood where they have other obstacles to their health, like finding good food or living in a neighborhood where you feel safe going out to exercise or having good public transport that enables you to leave your neighborhood and seek services that may not be available there. So all those things make a difference.

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BASSETT: As the #BlackLivesMatter movement unfolded, I felt frustrated and angry that the medical community's been reluctant to even use the word racism in our research and our work. The medical community has largely stood by passively as ongoing discrimination continues to affect the disease profile and mortality. And I worry that the trend towards personalized and precision medicine, looking for biological or genetic targets to better tailor treatment, may inadvertently cause us to lose sight of the big picture that it is the daily context where a person lives, grows, works, loves that most importantly determines population health and, for too many of us, poor health. Our role as health professionals is not just to treat our patients but to sound the alarm and advocate for change. Rightfully or not, our societal position gives our voices great credibility, and we shouldn't waste that.

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RAZ: So with any problem, the first step, obviously, is to address it and to talk about it, even if it's provocative.

BASSETT: Yeah.

RAZ: And as you mention in your talk, I mean, some people are uncomfortable with the word racism, but you felt that it was important to continue to talk about this and to shine a light on it. Then what? How do we begin to think about fixing this?

BASSETT: Well, the first step is to take an - a racial equity lens and apply it to all the work that we do.

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BASSETT: That's what we mean when we talk about structural, right? It's not just one institution. It's not just the hospital system. It doesn't just include doctors doing their job, seeing their patients. It's much bigger than that. It extends outside of the health sector - whether we have housing, jobs, education, transport, recreation.

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BASSETT: It's not just institutions across institutions. It's the culture, everything.

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BASSETT: We have to look at the context that makes it harder for people to have healthy lives.

RAZ: Yeah.

BASSETT: And that's how you start fighting racism. That's what I think (laughter).

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RAZ: Mary Bassett is a physician and the director of the FXB Center for Health and Human Rights at Harvard University. You can see her entire talk at ted.com.

(SOUNDBITE OF MUSIC) Transcript provided by NPR, Copyright NPR.