Potent quotables
And that’s when it hit me. The people in institutional power, mostly older white men, didn’t really expect me to do anything in my new role. They wanted a figurehead; they didn’t expect me to change anything.
Looking back, I can see there were stunning omissions and flaws in my education.
It’s hard to be healthy when you have no place to be outside in nature, when you can’t access nutritious food, and when you are subject to pollution and other harmful environmental factors beyond your control. Today, studies show that your zip code is a much bigger determinant of health outcomes than your DNA. Your zip code determines where you go to school, and your access to decent food, health care, and secure, affordable housing. It affects the kind of jobs and transportation that are available to you, all of which are major determinants in health outcomes. It has affected whether the COVID-19 vaccine will be available to you, with Black and Latinx communities experiencing a disproportionate lack of access when vaccines were first rolled out, which some have described as “vaccine redlining.”
Exposure to racism—and the cumulative trauma caused by lack of access to stable housing, education, resources, and opportunity—has a measurable, deleterious effect on health.
Instead, this phenomenon is better described as “institutional untrustworthiness,” whereby institutions have shown themselves to be untrustworthy to our communities thanks to a litany of abuses and mistreatment enacted against Black Americans by the health-care system. You might have thought that the concept of institutional untrustworthiness as well as the stories of Henrietta Lacks, Anarcha, Betsy, Lucy, and the men of the Tuskegee Study might have warranted inclusion in our education. But they were nowhere in sight.
The answer is: I don’t know for certain. I’ll never know if racism was a factor or not. This is part of the problem. It’s much easier to explain blatant acts like burning crosses and racial slurs than it is to explain unconscious bias in medical settings.
In the same way, I came to see that the woman who couldn’t take time off work to get her blood pressure medication wasn’t only suffering from high blood pressure, she was suffering from lack of workplace protections. The young man who lost his life to gun violence clearly needed better educational and employment opportunities. The elderly gentleman who had his diabetes medication stolen at the homeless shelter would need safe, permanent housing before his health could ever begin to improve in meaningful ways. To have people use the ER as their primary source of care spoke volumes to me about the many ways our dysfunctional and chronically underfunded health-care system was failing to meet the needs of our communities. If our government had invested the resources into robust and accessible social services, public health, primary prevention, and single-payer, universal health care in this country, many of our patients wouldn’t need to be in the ER in the first place.
Since the start of the pandemic, it’s estimated that one in five US health-care workers have quit their jobs, adding to concerns about burnout and its impact on our health-care system and, ultimately, our patients.
And while I saw the problem too and had hoped that I could contribute to positive change through my leadership and presence at the institution, it was driving Kamini directly into advocacy and activism—in opposition to the hospital administration.
Knowing everything I know about health care and the way we are treated as Black people, I had come to the conclusion that I simply couldn’t get sick. It was just too dangerous for me to be anything apart from healthy.
In a well-resourced country such as ours, the death of any birthing person from preventable conditions should be nothing short of a national scandal. And yet Black birthing people still die in the hundreds every single year.
The issue with doing the unpaid labor of diversity, equity, inclusion, and anti-racism is that it leaves you overwhelmed and with less time to do your other work.
In other words, right from onset, the testing criteria was biased against low-income New Yorkers—the working people who ended up contracting the virus even though they hadn’t traveled. This is what happens when you don’t see health care through an equity lens. The people you think about least are usually the ones most at risk.