During her keynote speech at the opening plenary of the National Conference of Constituency Leaders, Camara Jones, M.D., M.P.H., Ph.D., helps the audience visualize racism through a handful of allegories, which she also offered during a 2014 TEDx talk at Emory University in Atlanta. She hoped people would use these stories to make changes and teach others.
How do health disparities arise?
During the first day of the National Conference of Constituency Leaders here on April 27, Camara Jones, M.D., M.P.H., Ph.D., answered this question, saying these disparities are due to differences in
- the quality of care received in the health care system;
- access to health care, including preventive and curative services; and
- life opportunities, exposures and stresses that result in differences in underlying health status.
Jones discussed these issues during her keynote speech at a plenary focused on achieving health equity while combating racism. She is the immediate past president of the American Public Health Association and a senior fellow at the Satcher Health Leadership Institute and the Cardiovascular Research Institute, both at the Morehouse School of Medicine in Atlanta.
Her work as a family physician and epidemiologist has focused on how racism has affected the health and well-being of the United States.
- Camara Jones, M.D., M.P.H., Ph.D., opened the first day of the National Conference of Constituency Leaders on April 27 with a plenary on achieving health equity.
- Jones encouraged family physicians to actively address the social determinants of equity outside of their day jobs.
- She said racism must be addressed if the United States is to achieve greater health equity.
Jones said health intervention has three dimensions: offering health services, addressing the social determinants of health and addressing the social determinants of equity.
"Having universal access to high-quality health care is how a civilized society can value all of its people equally," she said, drawing a round of applause.
At the very least, Jones said, the United States has to move into the second dimension: addressing the social determinants of health. She used the analogy of different communities with different demographics situated varying distances from the edge of a health care cliff.
"If we are about moving the population away from the edge of the cliff without recognizing we are actually dealing with a three-dimensional cliff (including the social determinants of equity), we are at risk of moving some of the population but not all of the population and actually making health disparities worse."
Jones said family physicians need to actively work to address equity outside of their day jobs, especially in the current political climate. "We have to avoid curling up and thinking things are just going to roll over us," she said. "We need to stand up and join with one another like Velcro. And however many civic duties you were involved in, you need to add one more."
Jones defined racism as a system that structures opportunity and assigns value based on the social interpretation of how one looks -- that is, on one's so-called race -- which
- unfairly disadvantages some individuals and communities;
- unfairly advantages other individuals and communities; and
- saps the strength of the whole society through the waste of human resources.
Camara Jones, M.D., M.P.H., Ph.D., (left) draws a crowd and plenty of follow-up questions after her keynote speech April 27 at the National Conference of Constituency Leaders.
Jones explained three levels of racism: institutionalized, personally mediated and internalized.
Institutionalized racism involves differential levels of access to goods, services and opportunities based on race. This type of racism occurs in housing, education, employment and income, she said, and it affects peoples' access to medical facilities and clean environments.
Personally mediated racism involves assumptions about the abilities, motives and intents of others based on race, and the different actions taken based on those assumptions. Examples of this type of racism include brutality by police, undue vigilance by shopkeepers, indifference by waiters, devaluation by teachers and disrespect by physicians.
"Physician disrespect can be as subtle as a physician not giving a patient the full range of treatment options," Jones said, "because we don't think that patient can afford or comply with or understand the treatment."
Finally, internalized racism is acceptance by members of stigmatized races of negative messages about their own abilities and intrinsic worth. Examples of this include self-devaluation, resignation, helplessness, hopelessness and accepting limitations to full humanity.
"This is a feeling of, 'Maybe I'm really not as good as ...,'" Jones said. "'Maybe I shouldn't try to graduate from high school or apply to that college or try to become a doctor or try to live in that neighborhood.' That limitation can affect your health."
Jones said racism must be addressed to set things right and tilt the country back to greater health equity.
She defined health equity as assurance of the conditions necessary to achieve optimal health for all people.
To achieve health equity, Jones said the United States needs to
- value all individuals and populations equally,
- recognize and rectify historical injustices, and
- provide resources according to need.
"Health disparities will be eliminated when health equity is achieved," she concluded.
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