Reflections on Racial Disparity

The following is a paper I wrote February 11 for my community health class; the assignment was to reflect on specific readings about racial disparity.

 

The readings for this week included:

• Hebert, P., Sisk, J., Howell, E., When Does a Difference Become a Disparity? Conceptualizing Racial and Ethnic Disparities in Health. Health Affairs; Mar/Apr 2008, Vol. 27 Issue 2, p374-382.
• Smedley, B., Stith, A, Nelson, A. (Ed.) Unequal treatment: Confronting Racial and Ethnic Disparities in Health Care (2002). Washington, D.C.: National Academies Press Committee on Understanding and Eliminating Racial and Ethnic Disparities in Health Care.

I gripped the useless steering wheel in front of me, all senses alert, taking in the crackling roar of the windshield grinding relentlessly on the pavement. I was hanging upside down by my seatbelt and realized that I was likely facing my end. A heavy sadness wrapped around my heart with the thought that I would never see Mother again. The roar continued and I waited helplessly in the darkness for the inevitable impact that I hoped would not be too painful.

And then there was a wicked silence that told me the car had finally stopped. Instantly the adrenalin of fear kicked in and I knew it was urgent to get out of the car. On TV, the next thing to happen after a car flips is an explosion. Unlike Starksy on TV, though, who usually did everything right, I released my seatbelt to escape and landed clumsily on my head in a pile of shattered glass. The door was blocked by the weight of the car and the only way out was through the side window. The only thought that drove me forward was “GET OUT NOW!” Never mind that the shattered window still had shards of glass around the frame.

An instant later I was standing several feet away from my car. With huge relief I saw that the car was not in the middle of the Interstate as I’d feared, but well off the road in a field. I looked at my poor car resting strangely upside down, the headlights shining their beacons into the darkness like a lighthouse, the incongruously cheerful strains of Claude Bolling’s Picnic Suite haunting the night from the tape deck still playing away. “I should have turned off the car,” I thought, while the unmistakable fumes of fuel warned me to stay well clear.

Now what? I was a young woman alone in the middle of a cornfield with no homes anywhere in sight. Anyone could easily take advantage of my vulnerable situation as I realized I still faced danger. But so far I was still alive. I did a quick survey: head hurt, neck in pain, back screaming pain, dark blood trickling slowly down both forearms in tiny rivulets like condensing ice water on a glass; my hasty exit through the window had left its mark. Someone was approaching. Friend or foe, I had no choice but to wait.

“Is there anyone in the car?” He was bending over, trying to peer into my dark car. “I’m alone,” I replied. “You ok?” He asked. “Uh, I think so.” “Come with me,” and he extended his hand toward me.

The hand was black.

It was only a flickering moment but it was framed in the context of generations of mistrust and abuse between “us” and “them”. My first encounter with people of Color was as a child in a restaurant in the city with Grandma and Grandpa. All of the people working in the kitchen, collecting the glass dishes from the dining room onto metal carts for washing, were dark. I’d never seen anyone like them before in my all-white community. “You don’t want to be like THOSE People,” Grandma had said. Later as I grew up, I noted that the people with smart jobs were all white. The people cleaning the hotels, picking up the garbage, and washing the dishes, were Black. I had to agree with Grandma, I wanted something better.

In my household, our church was the center of our lives. As a young child, I learned that God had restored his church and reestablished the authority to act in his name using the keys of the Priesthood. Young men were ordained with levels of the Priesthood, starting at age 12, with one caveat: the Priesthood was available only to men who were not of the lineage of Cain. My parents and church leaders tried to explain the unanswerable question: “Why?” For some reason God felt that Blacks were not worthy enough for the Priesthood. Although the church reversed its position when I was a young adult, the damage had already been done in my impressionable youth. I trusted God, and trusted the church like my parents. Even after the church started extending the Priesthood to Black members, shadows of condescension persisted. Eventually I rejected the church and formally withdrew my membership, but was still left with that stain of my upbringing.

That hand was black.

Soon after I moved to Chicago, the springs in my mattress started breaking through on both sides: top and bottom. That mattress, salvaged many years before from somebody’s garbage heap at the side of the road, had been a blessing to me at a time when I could barely afford food and rent, let alone furniture. It was time to find a new mattress, and I didn’t want just any mattress, I wanted one that was 90 inches long to fit my Gelder-sized body. The yellow pages and several phone calls I’d made had yielded only one place in all of Chicagoland that offered the possibility of obtaining a custom-made 90” mattress. They gave me the address of their store over the phone and told me to ring the doorbell at the side door when I arrived.

Ring the doorbell?

I found the address on my map and it took over an hour to drive there from my apartment. As I approached the store I noticed uneasily that the neighborhood was one of “those” that I probably should not be driving around in. I found the store and parked my car across the street and sat in my seat looking at it. Bars covered the windows. The front door was secured with a chain. Graffiti marred the side wall. I checked all of my car doors to make sure they were all safely locked and felt that I should leave. But to leave meant that I would not get my 90” mattress, and I gathered myself up, got out of the car, squared my shoulders, and walked, hardly breathing, across the street and down the alley to the side door. “Who’s there?” someone hollered when I rang the bell. “Mary Gelder,” I squeaked. “I have an appointment.” They let me in and told me someone would be with me shortly, leaving me alone in a small showroom displaying three beds. The walls were covered with posters; a picture of Jesus was in the far corner. Their Jesus was apparently different than the Jesus I grew up with. I could hear some sort of work activity in a room beyond, where I imagined they might soon be making my new 90” mattress. I wondered if I’d made a mistake. I had once managed the furniture department at Sears, and learned the value of a quality mattress. I wondered where on the scale of quality a mattress made by this shop would fall: good, better, or best? Or maybe – worst?

Nobody was coming, so I walked around the room, killing the time by looking at the posters they had on the walls. Each poster featured a Black person accompanied by a brief account of his or her contribution to the Black community. Martin Luther King was among them, but he was the only one I recognized. “Why is it that I’ve never even heard of these apparently great people,” I wondered to myself. The individuals who were prominent enough in Black culture to be so revered by the store proprietor had never even crossed the threshold of my awareness. Was it that I had not paid attention in school, or was my education sorely biased?

That black hand was still extended toward me. He was waiting.

“You should read this,” the nurse told me. I was working at a nursing home in my neighborhood, and had just helped one of the patients to bed, securing her diaper and removing her dentures. I took the newspaper clipping from the nurse and glanced at it. “First Black Woman Graduates” read the headline; a photo showed a young Black woman standing in front of the wrought-iron fence bordering the campus. It was a well-yellowed article about the woman before me, now in her nineties. This woman had refused to be deprived of a college education, had made up her mind despite her race and gender to graduate, had faced the university board and somehow convinced them to admit her. She put up with whatever frictions and prejudices of the student body and faculty that had surely confronted her, and finally graduated, the first Black woman ever to do so from that university. I looked at her lying in the bed before me, a woman ultimately discarded by society into the nursing home where I worked, her eyes now vacant and confused. I wondered if she had made a difference in the world, and whether her insistence on having a college education had paid off for her. I wondered how many doors had later been opened to other women, Black and White, because of her persistence and determination to crack through that racial barrier. I felt something shift in my own opinion towards the Black struggle, and realized that this woman’s courage and persistence was, that night, making a difference to me.

Why was it so hard for me to take that Black hand, to accept his humble offer of help at my moment of critical vulnerability? And why was I so disturbed when I read the suggestion by Hebert, Sisk, and Howell for a thought experiment to consider how a subject’s health “would be different if he were to relive his life to date as a different race?” How would my own health be different had I been born Black? The question shocked me enough to worry about it through the night, unable to sleep. What is it about being Black that bothered me so much at the suggestion?

It is not a question of looks or ability, nor is it an implication that I might be less of a person. It is not even a question of rightness or wrongness, although earlier in my life I did have to confront that senseless perception of race. Rather, the jolt of thinking of myself as Black brings with it a sense of deep loss of opportunity. I have to acknowledge that my life has been easier because I’ve lived in a safe, White neighborhood. Unlike the Black nursing home patient I met, some of the doors I’ve faced have been already open, ready for me to walk through. Being on the “Yes” end of things has made it easier for me to be healthy. “Yes, you can take this class.” “Yes, you can rent this apartment.” “Yes, you can have this job.” “Yes, you can be my friend.” Some of the barriers that would confront me as a Black person are deeply rooted injustices engrained in traditions, religions, role models, music and arts, political systems, and social media. Any success that I’ve enjoyed may be somewhat attributable to the fact that I’m not Black. As pointed out by Hebert/Sisk/Howell, “a person may make different choices if living a counterfactual race in a different social context.” The decisions I’ve made throughout life have stemmed from my response to a fundamental perception of my own social place. I am not relegated to the back seat, and nor were my parents, or my grandparents. In my formative years, I recognized that I belong to a race shared by our nation’s presidents, astronauts, and movie stars. As a White person, I’ve felt that I can, if only I will. Had I been Black, my perceptions, and subsequently my decisions, may have taken different paths altogether. And as a Black person, my interactions with peers, employers, and others in authority over me may have been completely different. The color of my world would likely have been in sharp contrast to what I’ve actually experienced. And that bothers me.

Accounting for the factors of disparity may be much more difficult than the Hebert/Sisk/Howell challenge implies. How can the limitations in education on the one side possibly be quantified along with the bias in education on the other? They cannot. Hebert, Sisk, and Howell demonstrated clearly the difficulties of quantifying disparities by showing that the same data may be used to show bias as well as anti-bias, depending on the artistic use of controls. There is a challenge, then, in identifying that sweet spot in the analysis, a spot that truly reveals the underlying disparity. We know that disparity lies somewhere between two extremes, but pinpointing the extent of the disparity is clearly subject to debate. If we can’t understand the extent of the disparity through analysis, can we hope to heal our racial divide? How can a healthy and fair balance between our races be secured after so many generations of abuse?

Smedley, et al provided an important list of recommendations for mechanisms and controls designed to reduce bias and stereotyping, increase consistency, and improve communication and awareness. Every step represents one means to an important, all-pervading end: trust. Establishing trust on the part of the health provider, and likewise on the part of the individual must be at the heart of any effort to eliminate disparities. If a balance may truly be found, if there is any hope of healing our culture of racism, of tearing down the iron walls around our universities and our hospitals, we must surely develop trust. Considering the historical grip of prejudice pervading our culture, this is easier said than done. But such a balance may have been found, for a moment, for two of us, that night as we stood near my car.

I wasn’t sure I could trust the individual extending his hand, but I hoped that I could. “I’m bleeding,” I said, and showed him that my hands were sticky from the blood dripping from my arms. I didn’t have AIDS or any other dread disease, but I knew he wouldn’t know that and was probably wondering. He likely felt as vulnerable as I did, and I had to give him an opportunity to protect himself if he wanted to. From me.

“Come,” he said simply. He took my bloody hand gently into his, and guided my slow, painful steps carefully across the Interstate to safety. It was a gesture of trust, of acceptance, an acknowledgement of shared risk. As his hand connected with mine, once again I felt something shift in my attitude toward the Black struggle and I found myself ready to accept his healing gift, his touch of humanity.

 

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