We Are All Tuskegee

Dec 10, 2014, 9:00 AM, Posted by Collins O. Airhihenbuwa

Collins O. Airhihenbuwa, PhD, MPH, is professor and head of the Department of Biobehavioral Health at Penn State University. The first RWJF Scholars Forum: Disparities, Resilience, and Building a Culture of Health was held last week. The conversation continues here on the RWJF Human Capital Blog.

As we address disparities and inequities, the challenge is to think about solutions and not simply defining the problem. Most would agree that health is the most important part of who we are. It is the first thing we think about in the morning when we greet one another by asking, “How are you this morning?” It is the last thing we think about at night when we wish someone a restful night.

What may be different is what health means to us and our families. This is why place and context are important. How we think about health and what we choose to do about it is very much influenced by where we reside. Our place and related cultural differences about health are less about right or wrong and more about ways of relating and meeting expectations our families and communities may have of us, whether expressed or perceived. More than that is the way we relate to what our place means in terms of how it is defined and subsequently how that definition shapes how we define it for ourselves. In other words the ‘gate’ through which we talk about our place and ourselves is very important in having a conversation about who we are and what that means for our health.

There is an African expression that was popularized by Chinua Achebe that says no one should enter their home through someone else’s gate. This means that we cannot allow our own values and the identity of our place to be defined only by what someone else considers to be the definition of us and our place. This leaves the question of what is ‘my gate’ and how do I know when I see it. I have always believed that the gate/solution that has been presented to me is the gate/solution outside my own culture and community. The idea of a gate is understood as a metaphor that was so vividly captured by Chimamanda Adichie in one of her most commonly referenced TED talks entitled ‘the danger of a single story.’

To illustrate, let us consider the ways in which we think about the city of Tuskegee. If one asks students and scholars of public health and ethics about Tuskegee, what often comes to mind is the Unites States Public Health Service syphilis study that was conducted there. In fact, we commonly refer to it as the Tuskegee study, so much so that syphilis has become the single story of Tuskegee. While we do not want to forget the medical atrocity that was committed in Tuskegee, other stories better capture Tuskegee: its innovation in the work of George Washington Carver; movable health and medicine in the work of Robert Russa Morton; pioneers in collective responsibility in public and environmental health in Negro Health Week that was launched by Booker T. Washington; and patriotism in the face of cultural devaluation as exemplified in the heroism of the Tuskegee airmen.

In this example, it is important that the syphilis study is not forgotten and should continue to be an important ethical guide post to prevent medical atrocities. However, that should be understood to be only one story of Tuskegee. It is equally important that public and population health should recognize the seminal work of George Washington Carver’s community engaged health solution, which is a precursor to what we today call community based participatory research.

Tuskegee also was home to the foundation of Negro Health Week. Identifying it with Tuskegee may very well motivate otherwise indifferent populations to become more engaged in this annual celebration for the health of the nation.

It is fascinating that Tuskegee, more than any other single place, has become a compelling story of African American experience and identity, and the identities of persons of color. Tuskegee has given so much to society but remains known for the atrocities visited on it and not the innovative health solutions, patriotism against all odds, and resilience that its very existence embodies.

Indeed, Tuskegee is the true American story that should anchor many of our conversations about solutions to health disparities. Focusing on place and community allow us to echo what has become an important refrain in public health: that place matters. In fact the theme of this year’s annual conference of the American Public Health Association was “Healthograpy”—simply defined as ‘Place Matters.’ Tuskegee can be a gate through which our shared and collective identities have been framed as a single story.

We should refocus on a conversation about the multiple stories that make up the identities of those who are considered disadvantaged. There is a Native American expression that says the longest journey one will ever take is the journey between your head and your heart. In fact, Nelson Mandela expressed it differently when he said, if you talk to someone in the language they understand, it goes to their head, but if you talk to them in their own language, it goes to their heart.

We have talked about health disparity solutions in various languages but only to our heads. It is time to connect these talks to our hearts. Let the journey begin.

This commentary originally appeared on the RWJF Human Capital Blog. The views and opinions expressed here are those of the authors.