- Julianne Malveaux, Ph.D

My edited column is below:

IF YOU DON’T LIKE DISPARITIES, TRY EQUALITY

Last week I attended a “think tank” conversation with leaders of the Rodham Institute, a newly established center at George Washington University that is dedicated to reducing health disparities in Washington, DC.  This is an important effort, because Washington, DC is such a divided city.  “East of the River”, Wards 7 and 8, are the poorest areas in the district, with some of the most challenging problems, and with an obesity rate of over 40 percent, more than the national average, and more than the extremely poor state of Mississippi.  There are food deserts “east of the river” where it is easier to get potato chips than an apple or banana.  While there are rudimentary hospitals and health centers, most referrals to a specialist will likely require a Ward 7 or 8 resident to take an expensive taxi ride across the river.  This city is rife with health disparities.

Washington, DC isn’t the only city with these issues.  Whether you are in San Francisco, Baltimore, New York, Chicago, Atlanta, or Dallas, there are areas that can be described as predominately black and predominately poor.  To be sure, there are well-off people in these predominately black areas.  They live there by choice, and have the resources and luxury of mobility that gives them access to some of the best hospitals in the city.  But the poor don’t, and when health centers consolidate or close, they experience barriers to health care.

Health disparities are a function of assets, access and attitudes.  Those with greater assets have more access to healthy food, better health care, and more information.  Those without assets do not, and often make a decision to forego medical treatment in terms of something more basic – food.  Some of these folks can’t or don’t know to go to cost-savings suburban stores like Costco, where bulk healthy food is readily available.  Some, stuck in habit, prefer greasy food to baked options.  Many do not make the connection between eating choices and heart disease.  Assets and access are linked.

Then there is the issue of attitudes.  Too many physicians don’t take poor (and African American) patients seriously.  The Institutes of Medicine released a study in 2002 that showed that African American and Latino men were less likely than others to get painkillers for a broken bone.  A subsequent study showed that African American children were likely to get differential treatment in emergency rooms.  Too many poor people use emergency rooms for primary health care because they lack health insurance or access to good health care.

The attitude gap is also internal.  Too many poor (and Black) people don’t take good care of themselves, which explains some health disparities.  Frequent exercise and good eating habits go a long way toward healthy living, as do regular checkups.  Some folks don’t know how to do the right thing.  Some folks don’t have access to the right thing.  And some people just won’t do the right thing.

One of the ways the attitude gap could be bridged is by admitting more African Americans to medical school.  However, one of the speakers at the Rodham Institute conference indicated that not one African American man was admitted to this year’s class at Howard University’s medical school!  The speaker was absolutely wrong, but unfortunately credible, since not one of the 150 people present questioned the statement. In fact of the 120 students admitted to Howard Medical School, 30 percent (or 36) are African American men.

Former Secretary of State Hilary Rodham Clinton closed out the conference, graciously laying out her vision for the institute and answering questions.  She said that health disparities are a function of inequality, and that’s the point that sticks.  Too often we look at the results of inequality without looking at the causes.  Health disparities, the achievement gap, unemployment differentials are all a function of inequality.  Dealing with these gaps on a piecemeal basis doesn’t get us close to the solutions.

At the same time, how do we close the income and wealth gaps that are at the root of so many other gaps?  In the current conservative environment, talk of income or wealth transfers is just that. . .talk.  Conversations about reparations are even more meaningless in this environment, especially when the entire Congressional Black Caucus won’t sign the Conyers bill on simply studying the impact of slavery on contemporary American life.

The Rodham Institute has laudable goals, a wonderful founding director in Dr. Jehan El-Bayoumi (full disclosure – my doctor), and a great community focus.  In working to eliminate health disparities, perhaps this group will get us a bit closer to closing economic disparities as well.

When George Orwell wrote the novel 1984, he envisioned a character, a real or imagined “Big Brother” who was a know-all, see-all, omnipotent and elusive presence that intruded into lives because he could.  Those who knew about “him” were told that they did not exist, but in many ways, Big Brother may not have existed either. The omnipotence had taken on a life of its own.

Orwell’s book was a book ahead of its time. At a different point in time, his book could have been dismissed as psychedelic fantasy.  Today, he is just a step behind the reality in which we live.  Verizon is sharing telephone records.  The Department of Justice is monitoring journalists, and the IRS is playing games with those who seek nonprofit status.  People pulled over for a minor traffic violation will have to submit fingerprints to find out if they have broken other laws.   Big Brother is alive and well in too many layers of our lives,

Meanwhile, market researchers are segmenting populations by zip code and consumer patterns.  They can tell you what percentage of whites; African Americans or Latinos live in a certain zip code.  They can tell you what you earn, what you are worth, and how many of your neighbors have criminal records.  The zip code data drives marketers. Does it also drive law enforcement?

A recent study indicated that African Americans are between 2 and 6 percent more likely to be arrested for marijuana violations that whites are.  I guess it is easier to arrest from a corner than from a country club!  The rate of arrests for marijuana possession is 716 per 100,000 for African Americans, compared to 192 per 100,000 for whites.  The disparity is much higher in some counties.

Does this mean that African Americans are breaking more laws, or that law enforcement officers are targeting some zip codes or communities more regularly?  It is a lot easier to pick up a few citizens enjoying marijuana in a park than banging down the doors of an elite country club.  Yet data about marijuana usages suggests that there is little to distinguish the habits of African Americans from those of whites.  The only difference is the arrest rate.

Big Brother knows.

Big Brother has driven the kind of demographic that will tell you where you can find low-income, highly unemployed individuals, no matter of race.  Big Brother can tell you who can afford lawyers and who cannot.  Big Brother can drive police to investigate the least and the left out, those who are most vulnerable, while deciding to allow others to slink behind their space of class and privilege.  Big Brother can play bang for buck games that make it more profitable to arrest those with few resources in the hood instead of those with home-based protection.

Data collection seems to be a race-neutral process.  While data collection is an input, arrests are an output.  Between input and output there is the opportunity for racial bias to show up.  If white folk and black folk take an equal toke, why are black folk more likely to be arrested?  Are zip codes driving public safety officers to one place and deterring them from another?

Differences in marijuana arrests raise real questions about the many ways that data may be used to discriminate.  Instead of structural racism, intrinsic racism, and other forms of racism, we now have a data-based racism that is only logical when we ask how data is collected.  Simply put, the zip code data leads people to discriminate, if only because they are being led to single out a certain population.

Wealth accumulation is important. Even moderate amounts of wealth increase the likelihood that young people these in households are more likely to go to college, more likely to experience upward economic mobility, and more likely, in the next generation, to attain homeownership.  Our nation lost more than $16 trillion in wealth during the downturn.  Much of it has been recovered, but too many families, especially African American families, have yet to recover.  Homeownership among African Americans, especially younger African Americans have declined.

Unemployment also has something to do with the wealth gap, because those who are unemployed frequently draw down on their home value, increase credit card debt, or use other means to simply survive.  African Americans are twice as likely to be unemployed as whites are, and there are no existing public policies to both increase employment generally, and to target employment programs to those most in need.  President Obama can’t create “Black” employment programs, but targeting employment possibilities to inner city resident is an implicit target to Black America.  Targeting to recent college grads that are unemployed and have significant debt would also implicitly favor African Americans (since virtually all African American students graduate with some debt, but nearly 50 percent of whites graduate without debt).

Median wealth among single African American women with children is just $5 according to a Pew study.  Average wealth is a bit higher, at $1000.  The root of this low level of wealth is a function of unequal income, but more importantly more debt, lower savings, and lower stock ownership.  Consider the life of an African American mom.  She works hard, raises her children as best she can, may or may not have health insurance (the lack of which can push her into debt), and is likely to have little savings.  She is all too often the sole support of her children.  If she is the most stable in her family, she is frequently “hit up” for loans by parents and siblings.  This, too, contributes to her difficulty to accumulate wealth.

Wealth gaps were significant even before the recession, with African Americans less likely to own homes, hold stock, or have significant savings.  Not only were African Americans more likely to have debt, but also African American debt was more likely to come from high-interest credit card debt, while others had lower-interest bank debt.  Can the gap between African American wealth and that of others ever be closed?  It’s unlikely given that unequal wealth is a function of history.  In other words, income is a snapshot of what is happening today, but wealth is the history of you and your family.   The very wealthy pass on estates that may shape life chances for several generations.  Those who were enslaved, generally, had little to leave.  Often those who were thrifty enough to accumulate found their wealth blatantly stolen by envious whites.  The destruction of Black Wall Street had nothing to do with the fact that a black teenager allegedly jostled a white woman in an elevator, and everything to do with the thriving Black middle class in Tulsa, Oklahoma.

BY JULIANNE MALVEAUX

On May 21, I had the opportunity to testify before a Congressional Progressive Caucus, meeting on the fact that federal dollars drive inequality by paying contractors who pay too many of their workers very little.  The hearing was driven by a study from Amy Traub and her colleagues at Demos, a New York based think tank, that issued a report exposing the many ways that federal contracting often adds to the burden of the low income, especially those who earn less than $12 an hour, or less than $25,000 a year.

If these workers have even one child, they are living at or below the poverty line.  As summer looms, we know that children who are in summer programs will be better prepared when they return to school in the fall. Yet those with income limitations will find it difficult to pay fees that range from $50 to $125 a week for summer enrichment programs.  This cycle of disadvantage means that low wages yield more limited opportunities for students who, but for their parental situation, might be exposed to the kind of opportunities that would make them more competitive for college admissions. Their limited wages create a cycle of disadvantage for children.

The Obama Administration has supported a “Race to the Top” in education, yet job creation suggests that we are running a “Race to the Bottom” in terms of job creation.  We are underutilizing talent and expertise when we sideline so many Americans.  Those over 50 who have experienced downsizing have moved into lower paying retail jobs.  New college graduates have been pushed back into their parents’ homes, and into low-wage jobs because there is little else available.  Too many take unpaid internships to make them more competitive for future jobs, working at night or on weekends in the retail market because these are their scant possibilities.

Some economists suggest that we are in an economic expansion, not a recession, and the 2.5 percent GDP growth last quarter might support that.  Still, there has been little trickle down from the top to the bottom.  People take what is offered in salary because they have few choices. The federal government can help or hurt these workers depending on how they choose to protect them with minimum wage legislation, with regulation on federal contractors, with requirements to make health care and other social protections available.

Instead, according to Demos we have millions of workers who work full time, but are paid at low wages, thanks to federal contracting policy.  If government takes the lowest bid to provide services, workers will likely earn the lowest wage.  If our government specified that a living wage and benefits are part of the contract we would reduce inequality.  Today, too many contracting executives earn six or seven figure salaries, while workers earn poverty-level wages.

I am especially concerned about home health care workers, and others in the hospital services industry because these are predominately black and brown women, taking care of our sick, infirm and elders.  How can we expect these workers to offer the highest quality care, when we are not offering them the highest quality wages?  These are women who bring chips of ice to the dying, who hold a hand and say a prayer to someone who needs comfort.  They rub the feet and massage the heads of those who are in pain.  What if the low wages they are paid becomes a stressor, not allowing them to fully focus on their work for worries about their own economic survival?

Our economy has been bifurcated between those who have good jobs and bad jobs.  Good jobs have decent pay and benefits, while bad jobs have hourly pay and none of the above.  Increasingly, the Great Recession has pushed former good job workers into bad jobs, and bad jobs have become the norm for too many. We may be creating a permanent underclass by offering too little to too many, using federal funds to subsidize this inequality. When full –time workers need food stamps and federally subsidized health insurance, when full-time workers cannot afford apartments, when full time workers give full effort and remain in poverty, then we have turned the American dream into a nightmare!

Watching the President and First Lady Michelle Obama slow dance to the romantic standard reminded us that African American families have not often been positively depicted.  This attractive image of an intact Black family had come “At Last”.  Thus, the song was symbolic of what many folks, and especially African Americans, believed about the Obama Presidency.

Some of us blindly believed that with an African American president opportunity had come “At Last”.  Some believed it so fervently that the least criticism of President Obama, no matter how mild and how lovingly conveyed, could cause you to be run out of the race.  An alumnus of Morehouse College, Rev. Kevin Johnson, the selected baccalaureate speaker at his alma mater, wrote an opinion piece that was mildly critical of President Obama.   As a result, former White House and new Morehouse President John S. Wilson, Jr. changed the format of baccalaureate to a panel, not one speaker, as is customary.

The purpose of baccalaureate is to have one speaker to focus on the spiritual dimensions of graduation.  There is no way that Rev. Johnson would deliver a political speech. Still, he was essentially disinvited from the baccalaureate because of his views.

President Obama is the President of the United States of American, not the President of Black America.  Yet, it seems that African Americans have been kicked to the curb in terms of focus and attention.  Other groups – the LGBT community, the Latino community – have been mentioned explicitly.  However, on African American issues, our President has been silent.

Now, some African American people are crooning “At Last”. Charlotte Mayor Anthony Foxx has been nominated to serve as Secretary of Transportation.  If confirmed, Mayor Foxx, an outstanding an eminently qualified candidate would join Attorney General Eric Holder as the second African American to serve in the cabinet.

Similarly, the nomination of Congressman Mel Watt to lead the Federal Housing Finance Agency is a step forward.  FHFA regulates Fannie Mae and Freddie Mac and allows Congressman Watt the opportunity to implement some of the Obama initiatives about homeowner recovery from the Great Recession.  The raging right has already come after Congressman Watt.  The Daily Caller (a political blog) has reported an unsubstantiated claim by former Presidential candidate Ralph Nader that the Congressman disrespected him in a letter.  Nader has never produced the letter.  Thus, the purpose of the claim is to besmirch FHFA nominee Congressman Mel Watt.

If Watt is confirmed, this represents a step forward for both President Obama and for African American people, and for the entire nation.   The issue is, of course, confirmation.  Will the White House Congressman, be able to garner the votes Watt needs to be confirmed?

What does the White House gain or lose if Watt is not confirmed.  The “At Last” segment of the African American community will credit the President for making the nomination, even if not confirmed.  The more critical segment of the African American community will view the ways the White House embraces this nominee, and question commitment.  Ask UN Ambassador Susan Rice what it feels like to be dropped, when Senate confirmation seemed unlikely.

During President Obama’s first term, his inattention to the African American community was understandable, though not acceptable.  He was busy straddling lines, generating compromise, and leaving a legacy of health care reform.  African Americans were patient in the hope that “as last” African Americans would get recognition in his second term.  After all, as a lame duck President, he has much to gain, and little to lose in rewarding his most loyal constituency.  At last some of us have our disappointment confirmed.  Our President’s inaugural speech mentioned every community except the African American community.

President Obama and his supporters should not be thin-skinned.  Philadelphia’s Rev. Kevin Johnson should not be “disinvited” from the Morehouse baccalaureate.  Nor should a panel dilute his message, when the tradition is to have a sole speaker.  Johnson is a Phi Beta Kappa graduate of Morehouse College, who deserves to be treated with respect.  His column pointed out realities – President Clinton appointed seven African Americans to his cabinet, President Bush, four, and President Obama, just one.  Congresswoman Marcia Fudge, who leads the Congressional Black Caucus, in a letter to President Obama, wrote, “The people you have chosen to appoint in this new term have hardly been reflective of this country’s diversity.

Are the Foxx and Watt appointments a response to criticism?  Based on their appointments, should Black folks sing “at last” or “not yet”?

Further, the Senators crafting the bill put goodies into the bill that only serve to advantage themselves or their states. Senator Lindsay Graham wants more visas for the meat packing industry. Senator Charles Schumer provided special provisions for Irish people with a high school diploma (why?), Senator Marco Rubio, the much touted possible presidential candidate in 2016, asked for more visas for the cruise ship industry, and Senators Michael Bennett wants more visas for workers in ski resorts.

Meanwhile, the legislation would eliminate the Diversity Visa Program, which allows a visa lottery for countries that have low levels (less than 50,000 people) of immigration to the United States.   Many African immigrants come here through this program (Ghana and Nigeria each had six thousand immigrants through this program in 2011; African immigrants are 36 percent of those receiving diversity visas). Thus, while Senator Schumer pushes for special provisions for Irish immigrants, there is no one on the Senate side pushing for special provisions for African and Caribbean immigrants.

Instead of the Diversity Visa Program, the Senate Bill 744 creates between 120,000 and 200,000 visas on a “merit based” system, which gives highest priority to those who have future employment opportunities. Because employers do not seek out African and Caribbean immigrants for employees (as they seek out Indian and Chinese employees), the merit-based point system is likely to provide fewer opportunities for those from Africa and the Caribbean. Senator Schumer’s special provision for the Irish carries no stipulation that these people be employed, essentially granting them a pass from the merit-based point system.

Many hi-tech companies use the H-1B visa program on the grounds that there is a shortage of skilled workers in the United States. There is evidence that this claim is specious and that employers prefer foreign workers who they can pay less and control more. The new legislation will prevent employers from holding workers hostage because their continuing employment is necessary in order to keep their visa. The new legislation gives H-1B sixty days to find a new job. But why do we have H-1B visas at all. With unemployment over 7 percent, and black unemployment over 13 percent, surely there are unemployed people who could work effectively in technology companies. Howard University economist Bill Sprigs has written that there are proportionately more African American students majoring in computer science than white. Many of these graduates cannot find jobs. Meanwhile, African and Caribbean immigrants get just a small percentage of H-1B visas.

The Immigration Modernization bill will spend $4.5 billion in an attempt to secure the southern border, which will “secure” our country from Mexican immigrants, but ignores the northern border, which makes our country more open to Canadian immigration. Of course, Canadian immigrants are more likely to be white, and thus less feared, than Mexican immigrants. The Congressional Black Caucus is one of many groups that suggest that this $4.5 billion could be more effectively spent, perhaps on STEM education.

The immigration bill is by no means final. The House of Representatives still has to vote on it, and many of them will add amendments and exceptions to take care of their “pet” causes. Meanwhile, President Obama has been urging Democrats to accept the immigration bill as it is, because too many amendments may jeopardize the bill. For example, Senator Patrick Leahy (D-VT) would like to propose an amendment that would allow gay Americans to sponsor their partners for green cards. The Judiciary Committee is likely to pass this amendment, but the whole Senate might not pass it.

President Obama has had a bad year, so far. He didn’t get his way on gun control, and he’s been kicked around by an obstructionist House of Representatives. He needs immigration reform to fulfill promises he made to the Latino community during his campaign. But the unwieldy 844-page piece of legislation contains lots of provisions that don’t pass the smell test. It makes it more difficult for African and Caribbean immigrants to become citizens of the United States.

The African American community must take a closer look at this legislation. If Senator Schumer can give 10,000 Irish immigrants the open door, how many Africans and Caribbeans will he make exceptions for? At the very minimum, Congress should restore the Diversity Visa program.   The bill is called the Border Security, Economic Opportunity and Immigration Modernization Act. Exactly who will have more economic opportunity? And is immigration really being modernized when it locks foreign-born black people out of the process?

Why does this happen?  The late sociologist John Ogbu hypothesized that the gap was the result of young African Americans thinking that learning was “acting white”.  His theory was batted around as if it were fact, even when Duke economist William Darity refuted the Ogbu theory.  Why?  Because it fits somebody’s stereotype to describe African American youngsters as culturally alienated from the mainstream, so much that they eschew the very institution that could be a bridge for them into the middle class.

Give the history of African Americans and education; it is hard to swallow these stereotypes.  Several states had laws on the books to prevent African Americans from learning to read and write in the pre-civil war period.  Both white and black people risked flogging, cash fines and other penalties for “teaching a slave to read”.  Millions of African Americans sacrificed for the right to be literate, and ensured that their children would also have opportunities by baking cakes, frying chicken, and raising a few dollars to get to college by whatever means necessary.  At the beginning of the 20^th century, the only colleges open to African Americans were historically black colleges and universities, and we went despite the obstacles.  Our presence rejected the notion that learning was “acting white”. In fact, we were acting learned and literate.

Still, it is in the interest of some to continue that stereotype.  You’ve heard that adage that if you don’t want an African American to know something, just hide it in a book.  That kind of ignorance is the very reason that African American people were able, during the Civil War, to spy on Confederates who thought they were only illiterate enslaved people.  That is why Mary Ellen Pleasant was able to eavesdrop on conversations on stock and turn them into wealth.  Those who write about the achievement gap ought not underestimate African Americans.

Where does the achievement gap come from, then?  It comes from the opportunity gap.  The average African American household earns $31,000 a year, compared to $51,000 for whites.  $51,000 can buy a lot more opportunity than $31,000 can.  If income determines housing clusters, neighborhoods with a $51,000 mean income have better schools and more involved parents than the $31,000 neighborhood does.

Closing income gaps closes opportunity gaps, according to a Ford Foundation-sponsored book written by Dr. Linda Darling-Hammond, an Obama education advisor.  She says poverty and segregation means that some students attend schools that have fewer resources than others.  Indeed, inner city high schools are less likely to offer Advanced Placement (AP) or International Baccalaureate (IB) classes. Sometimes when these courses are available in suburban high schools, African American students are discouraged from taking them.

Dr. Ivory Toldson, a professor at Howard University and a contributor to the Root also refutes the notion that African American students think learning is “acting white”.  Most African American students, he says, are interested in attending college but may not because of cost factors.  He also says that academic support should be provided to all students, and that the way to close achievement gaps is to “reduce racial disparities in income and to increase equity and inclusion in education.”

For a great deal of students the issue is not “acting white” but being connected to educational options and outcomes. One of the more important factors in student achievement is parental involvement, yet many parents find themselves “too busy” or too uninformed to interact with teachers. One study says that parents don’t necessarily have to help with homework, but simply to reinforce that homework should be done, and to be inquisitive about it. Unfortunately, many parents, frustrated with the school system, write it off. Further, too many of our community organizations don’t sufficiently emphasize education, or if they do, don’t get into the “down and dirty” of it, preferring to raise much-needed scholarship funds than to take a young person by the hand and guide them through next steps to education.

The majority of African American students are still first-generation college students.  They aren’t always sure what next steps are, and they often need help maneuvering through a system with which their parents have no familiarity.  Too many smart students don’t have the parental and societal support they need to achieve.  The United States falls way behind the rest of the world when we don’t value students who have the potential to be high achievers, regardless of race or ethnicity.  We further disservice ourselves as a nation when we fail to value those who have the intelligences to change our world.

Too many African American people are treated in emergency rooms, as criminals, not people in need of health services.  After learning of the Anna Brown case, a sisterfriend shared that she had such an extreme anxiety attack that her 10-year-old son called 911.  When she got to the emergency room (with health insurance, thank you), she was queried about her use of drugs and alcohol, not her health condition.  It was only after her blood was tested that she was treated, so she spent four agonizing hours on a hospital bed with raspy breath, a frightened son, and no medical care.

They aren’t the only ones.  African America and Latino men, with broken bones, are less likely to get pain medication than others.  Even children of color are less likely to receive painkillers than white children, because some physicians think they are faking the level of their pain.  When we look at health disparities and wonder why African Americans are more likely to have diabetes, high blood pressure, kidney failures, breast cancer, AIDS and then some, one might point to the many ways that doctors, especially those in emergency rooms, signal that black pain is not worth treating.  The result is that someone who is really hurting chooses to forego medical care instead of dealing with medical condescension and arrogance.

To be sure, and to our society’s shame, emergency rooms often become the health providers of last resort.  Those without a regular physician are stuck going to an emergency room when all else fails.  A cold becomes the flu becomes pneumonia and only when a patient is struggling for breath does she seek treatment in an emergency room.  I can understand a doctor’s frustration because the patient did not deal with her challenges earlier.  But emergency room doctors, well paid, need to do their work without judgmental attitudes getting in their way.

Anna Brown deserved to be treated as a human being.  She deserved to be treated as someone who was struggling with pain.  Instead, she was treated as a criminal because she insisted on care.  Thus, she was accused of trespassing, instead of being treated as someone who was hurting.

While many would describe our society as post-racial that is a specious and inaccurate description of the world in which we live.  Racism muddies the water that we all swim in, and physicians are not exempted.  Those who swim in muddy water reflect the muddy attitudes that are prevalent in our society.  Many doctors consider themselves “culturally sensitive” but they have come to conclusions about poor folks, black folks, and others that they treat.  It is easier to write off a woman like Anna Brown than it is to find out what is really wrong with her.

The Hippocratic oath that physicians swear to says first, do no harm.”  From the facts that have been published about Anna Brown though, this homeless 29-year-old mother of two children was harmed by a medical indifference that landed her in a jail cell instead of a hospital bed.  The tragedy is that Anna Brown is not the only one who has been treated this way.