Bassett calls race a critical factor in public health

By Dan Goldberg 
Politico New York, Sept. 1, 2015

Last week, New York City's health commissioner gathered her staff in their Long Island City headquarters.

It was part of a regular brown-bag series Bassett offers for the staff. Usually she brings in outside speakers, but last Monday she decided to give the talk herself. She decided to explain how racial inequality fits into her vision of public health.

Health disparities, she said, are not the result of income inequality alone. An understanding of public health requires an understanding of how persistent racism has impacted the health and well-being of people of color in specific geographic areas.

"Neighborhoods that are disadvantaged need [to] correct a historic injustice," Bassett told POLITICO New York. "The framing matters."

Bassett believes her department should view public health issues, in part, through the lens of racial injustice, on the premise that health inequalities won't be solved simply by offering new services, and can't always be addressed with new regulations.

For example, for years health department officials have warned that sugary drinks contribute to obesity and heart disease, and blacks in New York City have higher rates of both when compared to whites. To tackle that problem, Bassett said, it's imperative to understand how and why sugary drinks are more often marketed to black and Latino youth, and to counter such messages by having teens talk to peers in their neighborhoods about healthy eating.

"When I joined the health department [as commissioner], everyone talked about income inequality — no one would talk about race," she said. "The first step toward solving anything is bringing it into the public discourse."

She explained to her staff how she feels racism and public health fit together, and how physicians and public health officials have a role to play in the #blacklivesmatter debate, which has been part of the national discourse since the deaths of Michael Brown in Ferguson, Missouri, and Eric Garner on Staten Island after encounters with police officers.

"With the death of Eric Garner, everyone asked the question, how are we tackling racism," said Bassett, who wrote a commentary in The New England Journal of Medicine explaining how she felt physicians should engage with the movement.

“There is great injustice in the daily violence experienced by young black men," she wrote. "But the tragedy of lives cut short is not accounted for entirely, or even mostly, by violence.”

Her presentation to staff last week included slides that showed how life expectancy in East Harlem is nine years less than it is in Murray Hill, and how the maternal mortality rate for black women is 11 times higher than for white women. 

Bassett's more expansive view of public health counts racism as a social determinant. It means universal pre-K and affordable housing are as much public health issues as immunization rates. It also means gun violence and police violence are just as much a public health concern as cigarettes and sugary drinks. 

It's an opinion Bassett has voiced for decades but one that remains controversial throughout much of the country.

(Surgeon general Vivek Murthy had his confirmation held up for months because he tweeted that guns were a public health issue.)

Bassett did not criticize the New York Police Department, opting instead to focus on police violence as a broader national issue, but it is hard to separate her broader criticisms from current conditions on the ground. Broken windows policing, championed by police commissioner Bill Bratton, is now decried by many leaders in the African American community, who accuse the department of systematically harassing young black men. Garner's death didn't just spark a debate over racism in America. It led to a spate protests over how police officers treated black men and women. 

Mayor Bill de Blasio has tried — often unsuccessfully — to sympathize with both the protesters who want police reform and the police officers trying to do their jobs.

Bassett avoided explicitly addressing the politics, but said it is crucial to know the numbers, praising The Guardian's "The Counted" series, which tracks people killed by U.S. law enforcement officers in 2015. 

Viewing racism as both a social justice issue and a public health issue has been a cause of Bassett's since the mid-1980s, when she challenged liberals to do more than simply acknowledge socioeconomic factors.

"Racism disproportionately concentrates blacks into the lower strata of the working class and further causes blacks in all class strata to be racially oppressed," she wrote in 1986.

But even as she talks about how deeply ingrained race is as a factor in the system, Bassett also makes it clear that she doesn't view the problems as unsolveable. 

One of her slides showed how infant mortality rates for black babies declined after the Jim Crow era ended in the south, and how they quickly aligned with those in the north. 

Jim Crow was a far more overt form of racism than anything New York City sees today, but the larger point Bassett tried to impress upon her staff is that racial factors do play an outsize role in health outcomes.

That is why Bassett, in a break from her predecessors, focuses so much attention on neighborhood initiatives.

Her theory, supported by census data, is that because New York City is such a segregated city, geographically targeting department resources is critical in achieving health equity. 

"We can use our data to both learn more and highlight the issues, and contribute to critical research that lends to a better understanding in which race contributes to poor health outcomes," she said.

PNHP note: Dr. Bassett is a member of the board of PNHP's New York Metro chapter.