Advocating in a New Reality Theme of Igniting Hope 2022

Based on News Release by Ellen Goldbaum

From the COVID-19 pandemic to the racist massacre at the Jefferson Avenue Tops Friendly Markets and the shocking deaths of Jonathan D. Daniels, MD, associate director of admissions at the Jacobs School, and his daughters, speakers acknowledged the collective traumas that the community has endured.

Pastor George Nicholas of the Lincoln Memorial United Methodist Church and chair of the board of UB’s Community Health Equity Research Institute began his remarks by calling out the names of the 10 victims that Buffalo lost on May 14. He then named Daniels and his daughters, Jordan and Jensen. After asking for a moment of silence, he said, “Follow this moment of silence with a lifetime of noise.”

President Satish K. Tripathi noted that UB held its commencement ceremonies just days after the massacre. “I asked our students to join me in a moment of silence. But in the next breath, I told them, ‘You must not remain silent. You must use your knowledge and expertise to address hate and racism.’”

Allison Brashear, MD, MBA, vice president for health sciences and dean of the Jacobs School, said, “While these losses are raw, they’ve already become a catalyst for change.”

She talked about the need to diversify the ranks of all health care providers, as well as medical school faculty, staff and students.

She said, “You have my commitment that we will continue to work to address this issue.”

Just how deeply health care inequities are rooted in society and in biases that have no connection to reality was clearly demonstrated in the lecture given by keynote speaker Ruth S. Shim, MD, MPH, associate dean of diverse and inclusive education and Luke & Grace Kim Professor in Cultural Psychiatry at the University of California, Davis.

Shim described a 19th-century physician named Samuel Cartwright, who invented a disease called drapetomania that he said was the disease of enslaved people who want their freedom. Another disease he invented was one that he said was evidence of “the intrinsic laziness of Black people.” The so-called treatment for these conditions was whipping.

Shim noted that these made-up diseases, which even Cartwright’s contemporaries didn’t believe in, persist in stereotypes prevalent today.

“A lot of physicians thought he was pretty much a quack,” she said, adding that those who disagreed with him weren’t loud enough and those ideas are still with us. “There is a danger even when these ideas are fringe. They take root anyway.”  

Health disparities can result from the notion that a particular minority population is somehow biologically inferior or that they are people who don’t take care of their health.

It is sometimes said that underrepresented populations “make poor choices” about their health, but, Shim said, people make choices based on those options that are available to them. She said that the social determinants of health and mental health “are shaped by the distribution of money, power and resources.” 

Shim used the crack cocaine and opioid epidemics to demonstrate how society interprets similar social problems in very disparate ways, based on race.

She discussed the “very racialized and gendered impressions of who uses crack cocaine,” showing media images of Black women addicted to crack cocaine that clearly demonized them for their addiction. By contrast, the opioid problem was depicted as a public health problem described in sympathetic stories about those addicted to opioids.

She discussed the tremendous sentencing disparities of 100:1 between those arrested with a single gram of crack cocaine vs. those arrested with 100 grams of powdered cocaine, even though the larger amount is clearly for distribution and not for personal use. She said that society passes laws to reflect its racialized beliefs.

“There’s a narrative about personal choice, but what drives outcomes is structural racism,” she said.

She recommended that health care providers adopt a broader perspective about their patients. “Don’t just gather their medical history but understand how these systems impact the patient,” she said.

Medical histories themselves can reflect and promote implicit bias.

Shim acknowledged that health care providers are always taught to include race in their patient descriptions, adding that while providers don’t always say ‘Mr. Smith is a 45-year-old white man,’ they always include race if Mr. Smith happens to be a person of color.

“Racism is a huge driver of negative health outcomes, so we need to acknowledge that,” Shim said, but added that the race statement often activates more, not less, implicit bias. She advocates for including that kind of information in a patient’s social history along with other social determinants of health. 

The relationship between a community growing its own food and its political power was the theme of the keynote speech by Rev. Heber Brown III, founder of the Black Church Food Security Network in Baltimore, which advances food security and food sovereignty by co-creating Black food ecosystems anchored by Black congregations in partnership with Black farmers.

Brown told attendees that Black agricultural systems began not with the institution of slavery in the past few hundred years, but in 3,000 BC in West Africa.

“It was known throughout the world that the knowledge was there in West Africa, that these places had the wisdom. This was known. And European enslavers knew it too,” he said.

He discussed how after the Civil War, each Black family got 40 acres of land and then President Andrew Johnson repealed it. “This was Black land theft,” Brown said, adding that in 1920 there were 925,000 Black-owned farms in the U.S., and in 1975 there were 45,000; today just 1 percent of rural land is owned by Black people.

Brown quoted Black food activists from the turn of the century who knew that food is power and that people cannot be free if they cannot feed themselves. He quipped that the U.S. Department of Education “owes the Black Panthers a check” because it was the Black Panthers that started the free breakfast program for kids in the 1960s. “They knew that kids can’t learn if their stomachs are empty,” he said.

To address food security and food justice issues in Baltimore, Brown’s project, the Black Church Food Security Network, uses Black churches in the city to reclaim the power that he says results when a community grows its own food. They focus on growing crops and building greenhouses on land owned by Black churches because municipalities and politicians are “less likely” to claim that land for development.

Similar projects can be launched in Western New York. Brown said smiling, “I hear you have apples up here. I want to get a truck coming north with the bounty of the south and get another truck going south with the bounty of the north.”

What his organization and others throughout the U.S. are doing is called asset-based community development. “Don’t start with what’s wrong,” he concluded, “start with what’s strong.”

Henry-Louis Taylor Jr., PhD, professor of urban and regional planning in the School of Architecture and Planning and director of the Center for Urban Studies, had the pleasure of introducing his daughter, Keeanga-Yamahtta Taylor, PhD, author, activist, Leon Forrest Professor of African American Studies at Northwestern University, scholar and MacArthur “genius” grant awardee.

Taylor began by discussing the historic precedent of Judge Ketanji Jackson, the first Black woman to be appointed to the U.S. Supreme Court. “But, all too often, exuberant claims that we have made it crowd out a more complicated reality,” she said, adding that the rise of a few has not altered the reality for the many.

She said that recent events, such as legislation making Juneteenth a holiday and the passage of the federal anti-lynching bill, are hailed as evidence of progress even while they “have almost no meaning in contemporary American life.”

She described the prevailing attitude that if Black people live in poorly resourced neighborhoods, the narrative holds that it’s because they don’t care about neighborhoods; if they have poor schools, it’s because they don’t care about education. The narrative “blames individuals” and states that it’s something intrinsic to these people that prevents their success.

She introduced the idea of racial capitalism, which creates conditions for deprivation, explaining that depressed living standards for Black communities are a structural part of the economy. She said there are whole industries that are based on undervaluing Black labor.

And amid what has been called the Great Resignation, where 33 million Americans left low-wage jobs as a result of poor working conditions and mounting debt, she said we are now seeing an increase in labor organizing and labor success.

Taylor said that the protests that followed the murder of George Floyd in 2020 provided a glimpse into the potential of an anti-racism movement. But at the same time, she said the very existence of the 10-year-old Black Lives Matter movement says so much about racism today: “Surely a society in which we all have made it would not need such an elemental and plaintive declaration imploring that the lives of Black people have value and meaning.”

In addition to the keynote speeches, breakout sessions focused on mental health; housing and economic development; food and nutrition; and senior services.

Along with the Jacobs School, other UB units that participated include the schools of Social Work, Public Health and Health Professions, Architecture and Planning, Pharmacy and Pharmaceutical Sciences, Dental Medicine, Nursing and others. Dozens of representatives from health care providers, colleges and universities and nonprofit organizations also participated.

Igniting Hope is co-sponsored by the Buffalo Center for Health Equity and UB’s Community Health Equity Research Institute, directed by Timothy F. Murphy, MD, SUNY Distinguished Professor of medicine and senior associate dean for clinical and translational research in the Jacobs School.

The conference was funded in part by the National Center for Advancing Translational Science of the National Institutes of Health.