Robert E. Fullilove (second from left), with civil rights workers during Freedom Summer in 1964. Bottom right: Fullilove in the classroom, 2019.
COME TO FOR FAR TOO LONG, OUR COUNTRY HAS BEEN PLAGUED BY HEALTH INEQUITY. IT’S TIME FOR THAT TO CHANGE. BY ROBERT E. FULLILOVE, EdD
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his year marks the 400th anniversary of a critical moment in our country’s history, one that continues to shape public health to this very day. It was 1619 when the first Africans arrived at the colony of Jamestown, in what is now Virginia. They may have been indentured servants—neither enslaved nor truly free—but their landing paved the way for millions more who would be sold or born into bondage during the 246 years in which race-based slavery was widespread in the United States. In 2019, the nation continues to be haunted by the legacy of that arrival. Ultimately, three articles of the Constitution would systematize slavery, establishing deep-seated inequalities that continue to play out in our economy, in our political leadership, in our housing system, and in the health of our citizens. Jim Crow laws may be more than 50 years behind us, but racial inequalities still make a life-or-death difference in our health. In the United States, people of color bear a disproportionate burden of illness and death as compared to the white population.
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COLUM B I A P U BLI C H E A LT H
The U.S. Department of Health and Human Services reports that the death rate is generally higher for African Americans than for whites for heart disease, stroke, cancer, asthma, influenza, pneumonia, and diabetes, among other conditions. African Americans are three times more likely than whites to die of a pregnancy-related complication and nine times as likely to die from HIV. American Indian and Alaska Native populations, who share a history of persecution, have a higher prevalence of obesity, diabetes, and cardiovascular disease. These disparities are often attributed to poverty. But even when controlling for poverty, the statistics are sobering: Blacks have worse outcomes than whites at every level of income and education. Research conducted at the Columbia Mailman School shows that African Americans who experienced racial discrimination were twice as likely to use illicit drugs or to take pain pills without a medical reason. Interestingly, the relationship was present only among blacks with income above 150 percent of the poverty line—more evidence that income is not an insulator from slavery’s long-term effects. It can be difficult for some members of our public health community to talk about racial inequality because it opens up a conversation they feel ill-equipped to have. But it is important that we do so. There is some evidence that the effects of racism translate literally from generation to generation: In one study by researchers at the University of California in San Francisco, black women who reported chronic worry about racial discrimination had roughly twice the rate of preterm birth of women who did not constantly worry about it.
2019–2020 EDITION
