“Here is what I would like you to know,” writes Ta-Nehisi Coates to his son in his New York Times bestselling book Between the World and Me. “In America, it is tradition to destroy the black body — it is heritage.” Drawing on recent events, Coates shines a bright light on the very tangible obstacles African-Americans face in our country. Unfortunately, this is a reality that has largely been swept under the rug by the rest of America, including its health care providers. It is time that health care providers, and in particular primary care providers, confront this reality.
Recently, I had the privilege of working with family medicine physician Dr. Tina Trost who is already taking steps to approach this topic with her patients. Dr. Trost works in St. Louis, Missouri, and makes a point to always discuss the topic of police safety with her adolescent patients during well-child checks. When I asked her about why she felt the need to add this, she responded:
“I grew up near Ferguson, Missouri and now live in the Shaw neighborhood — both of which had young black men shot by police in the summer of 2014. I felt those stories in my gut because I knew that the next time, it could be one of my patients. It’s too easy to imagine what I would feel if I turned on the news and heard the name of one of my patients, caught doing something they shouldn’t, or maybe just in the wrong place at the wrong time. My job is to keep my patients safe and healthy. We talk about ‘anticipatory guidance’ for kids — that means vaccines, fruits and veggies, exercise, seat belts and making smart decisions. In my training, I learned to ask kids not to smoke, not to drink and to use condoms. Now, I also ask them to remember that if their skin is dark, they are more likely to get trouble from police. I start in middle school and continue right up until they are ready to leave for college. I usually say ‘You and I both know that because your skin is darker than mine, you are more likely to get in trouble with the police if you are in the wrong situation. So if you have a joint in your pocket, and your white best friend has a joint in his pocket, who is going to jail?’”
This indeed is the world some of our patients live in. The evidence that has surfaced in the past year regarding police bias and brutality against African-Americans has painted a bleak picture of racism in our country. The Department of Justice’s reports on Ferguson’s, and more recently Baltimore’s, police departments reveal chilling details of how African-America residents are disproportionately targeted by the police and the courts. They found systemic problems ranging from the words “black male” being automatically included in the BPD’s arrest reports, to the statistic that, “88 percent of times in which Ferguson police used force, it was against blacks and all 14 cases of police dog bites involved blacks.” What’s more, this relationship between African-Americans and the police doesn’t seem to be limited to certain areas or cities either. Recent events in Milwaukee led to an in-depth report by the New York Times on the deep racial inequalities in the city, revealing that nearly one in eight African-American men in Milwaukee county had served time behind bars. Now, with similar events springing up in Oklahoma and North Carolina, America’s history of discrimination seems destined to repeat itself until the lessons of racial inequality and brutality have been deeply felt and dealt with by all of its citizens.
At this point, the problem with the police can no longer be seen as purely societal; as health care providers, we need to address it as a problem of public health. Existing literature has long shown that African-Americans have shorter life expectancies than their white counterparts, which has been a part of the conversation on how racism, marginalization and socioeconomic disparities affect health. For example, there already exists a body of literature showing that discrimination can increase the risk of stress, depression, the common cold, hypertension, cardiovascular disease, breast cancer and mortality. But, do the police also play into these numbers? In response to public outcry against “stop and frisk,” a 2012 experiment published in the American Journal of Public Health demonstrated that even the anticipation of experiencing racism, not necessarily the act itself, was enough to trigger a stress response in participants. We cannot escape the fact that as long as the police enforce and perpetuate the same racial biases that are seen in discriminatory housing practices, the court systems and the media, they are contributing to the health status of African-Americans. As advocates for our patients’ health, we as physicians are obligated to confront this reality with our patients in the clinic.
In the climate of police brutality and racial inequality, the conversation, such as the one that Dr. Trost puts forward, can be the first step for primary care providers to affect this issue. It will serve a twofold purpose: to acknowledge the reality of our African-American patients that encroaches on their immediate safety and well-being and to create greater understanding among physicians. In essence, primary care physicians can be the start a of a dynamic dialogue. Physicians may be quick to want to take action on so pressing an issue, but we must acknowledge that even we are not free from our own biases. In fact, a 2012 study published in the American Journal of Public Health found that about two-thirds of primary care physicians studied in Baltimore harbored biases against their African-American patients, leading them to spend less time with them and involve them less in medical decisions. If we, as providers and advocates, want to make real and lasting change, the first steps will have to be understanding. Then, and only then, can we hope to work towards a better future for our patients.