By Brenda Gazzar
Code Wack Podcast, August 16, 2021
Featuring Dr. Linda Rae Murray, MD, MPH, former Chief Medical Officer – Primary Care for the Cook County Bureau of Health Services & “full-time troublemaker,” discussing the artificial separation between social, structural, and personal racism.
Welcome to Code WACK!, your podcast on America’s broken healthcare system and how Medicare for All could help. I’m your host, Brenda Gazzar.
How has American medicine played a role in propagating racism? How does racism put Black people and Native Americans at a higher risk for illness and death? To find out, we spoke to Dr. Linda Rae Murray, a physician who spent 40 years in clinical practice helping the medically underserved. She retired in 2014 from her post as the chief medical officer for the Cook County Department of Public Health of the Cook County Health & Hospital System in Illinois. She’s been a voice for social justice and health as a basic human right for more than fifty years.
Welcome to Code WACK!, Dr. Murray.
Murray: My pleasure.
Q: So I’d love to hear a little bit about you. When you graduated from medical school in 1977, what was the landscape like for female African American physicians?
Murray: Well, I don’t think there’s anything unusual about that time period. In 1977, we were entering a period of retrenchment in the United States. Conservatism and Reaganism was coming to the fore but the situation for Black physicians of all genders has never been good, so it wasn’t good then. This is a period as I started my residency training where the public sector was under attack. Public hospitals were being defunded. We lost a number of hospitals around the country and we lost a number of public hospitals in St. Louis, Philadelphia and other places.
Q: One of the biggest problems in American healthcare has been racism. It’s well documented, but still many Americans don’t acknowledge it. Can you give us some examples of social and structural racism in health care?
Murray: Well, the medical care system, and health care in general is a part of our culture and society and so structural racism is the underpinning of what goes on in America and so I am always concerned about how that racism seeps into the structure of a country. So I don’t care what you start with, you can start with where services are available. When I was a resident, only the United States and South Africa were the only ones that didn’t try to provide universal coverage for its population. Today it’s only us in terms of rich countries.
And so when you talk about structural racism in medicine, American medicine plays a special role in propagating through up until really the 1950s the notion that (Black people) were biologically inferior — that was a major strong strain of American medicine, and how the structure is set up with everything we do, what kind of jobs you have or don’t have, what kind of exposures you have, an inability to access diagnostic services and curative services. These are all things that are obvious in medical care settings, but the real harm that structural racism does goes far beyond the medical setting, far beyond the hospital or the exam room. It goes into all aspects of American life.
Q: Hmmm. Thank you. This idea that people of color are biologically inferior, how does and how did that manifest itself?
Murray: So I want to be careful here about our language again. Western racism in the modern era, in the past couple of 100 years, is based on a hierarchy and so all of those hierarchies put Africans at the bottom of racial hierarchy so when we say people of color, that’s an important political concept but in terms of racial hierarchy, Africans are at the bottom — and so I don’t care whether you’re talking about the Bell Curve, which argues that that’s why Blacks have poor education outcomes, or whether you’re talking about old-fashioned “eugenics movement,” this is a notion that has run through our history so from a medical point of view in terms of American medicine, this notion that these negative traits and positive traits, they are inherited and that far outweighs whatever else happens to people.
So that concept we still have today whether you’re talking about outcomes at the Olympics or sportscasters that argue that, you know, Blacks are somehow differently made as beings. And, you know, so a Black basketball player will be skilled, a white basketball player would be smart. You see these kinds of differences that exist all along. I am concerned as we look at modern genetics. We’ve done some studies as recently as 2016 that showed an extraordinarily surprising number of medical students and residents believe certain myths about African Americans, about Blacks. For example, the notion that our skin is thicker. Nowhere in medical schools is that taught but that notion was there among, like I said, a surprising number of physicians and medical students. That’s also the nature of structural problems. They are baked into the society, and most people are unaware that they’re even there. They just are considered part of the normal universe and so those things are still with us and they’re still a major concern.
Q: Right. And so how are these myths most detrimental to Black patients?
Murray: Well, they’re most detrimental for Black people because we die younger and from diseases that can be prevented, I mean that’s the very nature, that’s the very definition of health inequity, and here I want to bring back other people who are not white, in terms of that hierarchy. So, for example, Native Americans, our Indigenous groups in North America, have mortality rates and often health outcomes that are equal to or worse than Blacks depending on which disease entity you look at so there’s no question that racism kills people, to put it bluntly.
It doesn’t just mean it kills people when police shoot you. It kills people with everyday things, whether you don’t get your blood pressure treated, whether you don’t have access to cancer screening, whether you’re just stressed out by the fact that you’re unemployed, and you don’t have good nutrition and all of these activities of life, all of these things in our society imprint themselves on our bodies, and when you have societies that are unequal, where oppression is going on, where people are under stress, then those show up. So it’s not an accident for example with COVID, people who had to go to work, who did not have the privilege of working remotely, are the people who got COVID more frequently, and if you didn’t have spacious living quarters with nutrition, good transportation, all of the things that we know put you at higher risk, then you got COVID and you’re more likely to get sick from it and be hospitalized and die.
Q: Okay, thank you so much. Social and structural racism in health care obviously differ from personal racism. How do you think the three work together to negatively impact Black Americans’ experience with health care?
Murray: I think we try to make too much of an artificial separation between these things and let me just say that, personally mediated racism at the personal level changes. So, you know, 100 years ago, the use of the N word might be considered normal and not even in certain parts of the country, just a normal descriptor. Today, what the young people call microaggressions, which I think is a euphemism, it’s still racism, the level of which these things are expressed in polite society changes. So again, things that might be said about women when I was a young woman would not be acceptable to say today in a public setting, that doesn’t mean they’re still not said. It doesn’t mean those ideas still aren’t there. We as individuals live in a societal setting. And so, all of those levels of which racism operates reinforce each other, they’re not separate, and so it doesn’t do any good to have people be polite, if in fact you are not allowing Black people to vote. It doesn’t matter if you’re polite, if educational opportunities are different, or where you can live are different. So those structural conditions haven’t changed, I think, in any measurable way so we still are being impacted.
It’s almost like climate change, you know, you might have people talking more intelligently about climate change today but as we’ve just seen from our recent report, the climate is still getting warmer and we’re still changing at a more and more rapid rate so we have to address not only structural racism, we also have to address class biases, and gender biases in our society and unless we do them all together and really, really reject the basis on which our country operates, which is an individualistic profit-driven perspective, then we’re going to be killing lots of people. These things also kill lots of white Americans. They are just unaware of it or choose to ignore it. It’s not an accident that the life expectancy for example for white Americans has been dropping, and it’s part of those same structural problems that are going on.
Thank you Dr Linda Rae Murray.
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