Houston is the fourth largest city in this nation. It has the largest medical complex in the WORLD, not just in the USA. The Texas Medical Center (TMC) is one of the largest employers in the city. Everyday there are more than 200,000 – 250,000 people who come in and out of the TMC. Yet it still shows the impact of the exclusions of Title, VI and the Civil Rights Act of 1964 in addressing health care.
The African American citizens of Houston are not the only individuals who have felt the impact of these exclusions. Today, we talk about addressing health disparities as one of the top priorities of the current US Department of Health & Human Services agendas. Yet, no one has mentioned our failures over the years of the civil rights movement to address these exclusions and their continued impact on the health of this nation. We talk about other issues, social determinants such as poverty, access to care and so on. I am not discounting these as issues. But when will someone step forward to talk about this issue. Not only talk about it, but also do something about it. It would mean discussing the “R” word in the delivery of health care and health care research. It would mean that we would have to help our fellow persons of color and may be upset the power structure. For those of us who discuss this issue, we are referred to as “troublemakers or boat rockers.” Someone recently said to me that today, if Rosa Parks refused to sit in the back of the bus, she would be criticized for being “too aggressive.” Would we still subconsciously compromise our rights so that Negroes can still sit behind the colored sign when the white section is full and whites would have to stand. So have we lost that sense of self worth for the sake of a pseudo-form of integration?
An assessment of the quality of healthcare for African Americans in 2011 should be guided by an issue that still has not been adequately addressed. Houston is the fourth-largest city in the United States, yet this city, as well as the nation, does not have enough minority researchers and academic physicians in positions of enough power to influence the future of their own health status. Given the level of public investment in the Texas Medical Center and the US, such as NIH, their reputations as the nation’s premiere biomedical research centers, and the need to reduce and eliminate health disparities locally, statewide, and across the nation, one would expect there to be a significant number of African Americans or even scientists of color on academic tenure track positions and/or in senior management in both places or other similar institutions across the nation. That, unfortunately, is not the case, and never has been the case.
It has become increasingly apparent that who we are shapes how we look at problems. Those most impacted by racism and bigotry and who have not succumbed to the go along to get along will solve the problems facing this nation. As Albert Einstein once said “We can’t solve problems by using the same kind of thinking we used when we created them.” Better yet, how can we expect solutions from those who benefit from the problems? It is in their vested interest to continue the situation when they are unaware what the impact will have. They live for the moment and not the future. Those who were shaped by the problem, in turn, often yield unique perspectives on scientific and technical problems and challenges in bench research and clinical care, and ultimately should provide a framework for addressing health disparities in Houston, the state of Texas and the nation. African Americans as well as American born or American educated people of color, however, are noticeably underrepresented among physicians and scientists in the academic health establishments in the Texas Medical Center and other leading national institutions, and even fewer are working on the health problems facing African Americans and/or people of color, either at the bench or in the clinic.
For the past thirty plus years that I have been a citizen of Houston, its African American leaders or even other leaders of color have been silent on this subject. The same can be said nationally, other than the flare up when reports like that which recently came out of NIH, it is a return to normalcy and the lack of truly addressing the issue. It would be unfair to say that academic health care institutions in Houston and around the nation do not recognize and prioritize the issues of cultural diversity and health disparities. However, the recognition of such has done nothing to increase the number of minority health professionals on their staffs, or more importantly, to place them in leadership roles in positions that count. Unfortunately, this is not just a Houston problem, but a national one. The question I have is not what should be done about the situation, but when will the leadership in the African-American communities as well as other communities of color make this a priority to do something about the problem instead of vocalizing about it. It is only then that we will make progress in addressing health issues that disproportionately affect the health of the African-American citizens of Houston as well as others of color across this nation. To me, that is the key solution to solving the health problems that face our communities of color as well as the poor. With a change in the diversity of those in real leadership roles will come a change in our health status.
I was asked a few years ago to write an editorial on the future health of African American in Houston. Unfortunately, this editorial is one of those evergreen pieces. In the news world, it is an article you can continue to bring out and dust off because very little has changed since it was originally written.