This is a post I've been holding myself back from writing. But I've just watched I Am Not Your Negro and am on the plane to the US, and it's time I just banged it out. So, here'a the question...
Why is America so racist?
It's a question that plagues me. I've enjoyed my time in the country (even though they collectively cannot make a cup of tea to save their lives). It is, in fact, the fertile soil in which my curiosity about the wilful blindness of health care systems has taken root and given rise to my company, Bridging Health & Community. But I've always harboured a deep, deep unease about the flagrance with which the US holds on to racism, despite lots of rhetoric that it wants to change.
Why is that?
At the end of I Am Not Your Negro its protagonist, James Baldwin, contends that the real question for America is why it needed "niggers" in the first place (the implication being it was more than just an economic choice). He makes the point that black people didn't create them, white people did. So, to move past its racism, America needs to ask itself why. And to stare that question - or, preferably, the answer - long and hard in the face.
It is, of course, disingenuous for a Brit to be taking any kind of moral high ground on the issue of slavery and the ongoing echo that its dehumanising has led to. But I'm a British Asian. My parents are from India. My Britishness is less entangled in the country's shameful past, even if the British Empire benefited from the slave trade and my family benefited from Britain having an empire.
I'm flying to the US for a symposium being held by my company. We've been working on it for 15 months and race has surfaced a number of times. Two stand out.
The first was when I went to learn more about The California Endowment's Building Healthy Communities initiative. Their hypothesis is that many communities endure poor health outcomes because they don't have a voice to change their circumstances. This voicelessness is worse for low-income communities, their levels of education being part of what stops them knowing how or when to raise their voices. I interviewed two of the Endowment's leaders for two hours. We covered everything, from the theory, through the practice, to the changes and their measurement. At the end of our allotted time, I thanked them for their candour and got ready to leave.
You didn't ask about race, one of them said.
I never thought to. I'm not some naive metropolitan douche who's convinced himself we're all seen as equal and treated so. I've endured more than enough racism in my time, including (if not, especially) at medical school. I know that race matters, that some people are racist, and that many institutions have racism embedded into their very ways of working. But I never thought to look at health as something at the mercy of racism.
The second was when I interviewed J. Phil Thompson, an MIT political scientist whom one of our Board members told us to consider for the symposium. Why, I thought, am I being asked to consider a political scientist for a health conference? But I went ahead with it (if you've chosen your Board well you learn to listen to them). So, I asked him, "So, Phil, why do you care about health care?" His answer blew me away...
"Why do you care about health care, you're just a doctor?"
Wait, what? Surely being a doctor was all the qualification I needed to care about health care. But apparently not. We're just technocrats in the system, pawns in a much bigger game. That game is about equality, about equity, and when those things are absent for reasons of race, it's about racism.
Plain and simple.
Unfortunately, the story of American health care is the story of racism. It's deeply puzzling to me, as a Brit, as a non-white, as a second generation immigrant, as someone living in a country with a health care system that is accessible to all irrespective of the ability to pay. And yet it is what it is.
And it is a deeply troubling fact.
So, why have I been holding myself back from writing this post? I guess it's two-fold (although the two things intertwine).
First, I don't want to be yet another non-white person banging on about race (although, based on the film, perhaps more banging is precisely what's needed).
And, second, I want my work to build a credible field of practice. I don't want to build the field that links health systems and communities as a response to social injustice. I want to build it on the basis that it's an emerging and essential field of science, as crucial to health as cardiology or nephrology. In my view, the field is needed as a response to how radically unsustainable health care systems have become, whatever the social context.
But perhaps I should concede a little. Perhaps I should accept that the fertility of the soil in which I have sown the seeds of my company is the flip side of America's inability to ask itself why it needed "niggers".
That's not an easy thought to entertain.
Pritpal S Tamber
I’m the Co-Founder & CEO of Bridging Health & Community (BH&C) and the Founder of the Creating Health Collaborative. Before all this, I was the Physician Editor of TEDMED, Medical Director of Map of Medicine, and Editorial Director for Medicine at BioMed Central, the company that pioneered open access publishing. I have an MBChB (the UK equivalent to an MD) from the University of Birmingham, UK. This is my personal blog. If you're interested in BH&C or the Collaborative, check out the updates on their website or receive them by email.