In the world of public health, Camara Phyllis Jones, MD, MPH, PhD, is known as a powerful warrior in the fight against race-based inequality in health and health care. A researcher on the social determinants of health and equity at the Centers for Disease Control and Prevention (CDC), Jones shared the lessons she has learned over a professional lifetime of identifying and battling the impacts of racism on health with the students and faculty of Meharry Medical College, at a recent seminar.
As a speaker in the 2012 National Scholars’ Current Issues in Health Policy Seminar Series at the Robert Wood Johnson Foundation (RWJF) Center for Health Policy at Meharry, Jones challenged her audience to look closely at the impact racism continues to have on health.
“We have to recognize that racism is one of the root causes of [health] disparities,” Jones explained in her presentation: Achieving Health Equity: Addressing Racism as a Threat to the Health and Well-being of our Nation. “We need to be willing to name racism and ask: How is racism operating and be willing to intervene. We cannot pretend that it is a thing of the past. It continues to have a profound impact on our experiences and opportunities.”
Different Faces-Different Options
Jones, whose father graduated from Meharry in 1954, captivated the large seminar audience with vivid imagery of how inequality influences health status.
Using cartoon figures to illustrate the path of people falling off a cliff [experiencing a health crisis], Jones said, “all of us would want an ambulance waiting for us at the bottom of the cliff to speed us on to care. But what else can we put in place for people who may approach the edge of this cliff besides just stationing lots of ambulances at the bottom?”
“What if we add a net, a fence or even move the population away from the edge of the cliff? These health interventions would represent medical care, secondary prevention, primary prevention and addressing the social determinants of health. We also need to ask why are there differences in resources available to people approaching the cliff and why are different populations found at different parts of the cliff?” Jones explained that addressing these questions is about addressing the social determinants of equity, which are different from the social determinants of health and include racism and other systems of oppression.
Understanding the Role of Discrimination
Jones has long addressed the role racism plays in health and health care. In fact, she made it a priority early in her career as a family practice physician at Montefiore Hospital in Bronx, N. Y. “It was there that I started challenging attending physicians about the routine practice of including a patient’s race in the chief complaint [the summary message about a patient that one doctor gives to another],” she said.
“I wondered why it was important to know that it was at 45-year-old black woman experiencing crushing sub-sternal chest pain, as opposed to a 45-year-old white woman experiencing crushing sub-sternal chest pain. It became clear to me that it was because the data were always presented by race, that physicians came to think of race as a biological risk factor.”
Jones explained that racism is “a system of structuring opportunity and assigning value based on the social interpretation of how we look, which is what we call race.” Once again turning to imagery, she asked her audience to see the behavior of a gardener planting seeds as analogous to three different levels of racism: institutionalized, personally-mediated and internalized.
“A gardener has two flower boxes, one which she knows to contain rich, fertile soil and the other which she knows to contain poor, rocky soil. She also has seed for the same kind of flowers, except some seed will produce pink flowers and some seed will produce red flowers. The gardener prefers red over pink, so she puts the red seed in the rich, fertile soil and the pink seed in the poor, rocky soil. What happens? The red flowers sprout strong and tall, while the pink flowers struggle to grow at all,” Jones explained.
“The initial separation of the red and pink seed into the two types of soil, along with the flower boxes, which keep the soils separate, and the gardener’s inaction in the face of need, represent institutionalized racism. Personally-mediated racism is illustrated when the gardener plucks the pink flowers in disdain, and internalized racism is illustrated when the pink flowers seek red pollen from the bees because even they perceive red to be better than pink,” Jones said.
‘“A very important question is, who is the gardener?” Jones asked. “The gardener is the one with the power to decide and control resources, which are the elements of self-determination. The gardener includes the government, the media, even communities to the extent that they can claim self-determination. It’s dangerous when the gardener is aligned with one group, and when the gardener is unconcerned with equity.”
While it may seem that racism only affects people who are discriminated against, Jones pointed out that the negative fallout touches all parts of society. “Racism is sapping the strength of our whole society through the waste of human resources,” Jones said. “It is sad for our nation, and soul-crushing for the people who never even know, much less have the opportunity to develop, their full potential.”
The path to a more equitable health system and society, Jones concluded, can only be achieved in a society that “values all individuals and populations equally, recognizes and rectifies historical injustices and provides resources according to need.”
Though disparities persist, Jones added that she hopes that she will, “I will be able to go beyond documenting the impacts of racism on health to motivating and equipping people with tools to address its effects. I expect that in my generation, we will be able to engage in a national conversation on racism (as opposed to a national conversation on race). I expect that in my children’s generation, we will launch a national campaign against racism in which we try to identify and dismantle the mechanisms of racism which operate in our structures, policies, practices and values. It will be very hard work—but it’s going to happen and our whole nation will be better for it.”
The mission of the Robert Wood Johnson Foundation Center for Health Policy at Meharry Medical College is to provide leadership in health policy education, conduct research and support reform on a national, state and local level, while continually supporting the historic mission of Meharry Medical College: to improve the health and health care of minority and underserved communities. Center students conduct research that examines, illuminates, and disseminates information on disparities in health that disproportionately impact minority and underserved communities and the related health policies that may mitigate or perpetuate these disparities.