Why your doctor should care about social justice | Mary Bassett

76,599 views ・ 2016-03-17

TED


Please double-click on the English subtitles below to play the video.

00:12
When I moved to Harare in 1985,
0
12800
3296
00:16
social justice was at the core of Zimbabwe's national health policy.
1
16120
4776
00:20
The new government emerged from a long war of independence
2
20920
3696
00:24
and immediately proclaimed a socialist agenda:
3
24640
2816
00:27
health care services, primary education
4
27480
3376
00:30
became essentially free.
5
30880
1856
00:32
A massive expansion of rural health centers
6
32760
3856
00:36
placed roughly 80 percent of the population
7
36640
2696
00:39
less than a two-hour walk from these facilities,
8
39360
3176
00:42
a truly remarkable accomplishment.
9
42560
2776
00:45
In 1980, the year of independence,
10
45360
2656
00:48
25 percent of Zimbabwean children were fully immunized.
11
48040
4176
00:52
By 1990, a mere decade later,
12
52240
3296
00:55
this proportion stood at 80 percent.
13
55560
2720
00:58
I felt tremendously privileged to be part of this transformation,
14
58920
5176
01:04
a revolution.
15
64120
1456
01:05
The excitement, the camaraderie, was palpable.
16
65600
3840
01:10
Working side by side with brilliant Zimbabweans --
17
70120
3336
01:13
scientists, doctors, activists --
18
73480
2936
01:16
I felt connected not only to an African independence movement,
19
76440
4976
01:21
but to a global progressive public health movement.
20
81440
4480
01:26
But there were daunting challenges.
21
86680
3336
01:30
Zimbabwe reported its first AIDS case in 1985, the year I arrived.
22
90040
5576
01:35
I had taken care of a few patients with AIDS in the early 1980s,
23
95640
3776
01:39
when I did my medical training at Harlem Hospital, but --
24
99440
3520
01:44
we had no idea what lay in store for Africa.
25
104880
3880
01:49
Infection rate stood at about two percent in my early days there.
26
109600
3736
01:53
These would soar
27
113360
1816
01:55
to one out of every four adults
28
115200
3376
01:58
by the time I left Harare 17 years later.
29
118600
3440
02:02
By the mid-1990s,
30
122560
1656
02:04
I'd told hundreds of people in the prime of life
31
124240
4136
02:08
that they were HIV-positive.
32
128400
2216
02:10
I saw colleagues and friends die,
33
130640
3096
02:13
my students, hospital patients, die.
34
133760
4000
02:18
In response, my colleagues and I set up a clinic.
35
138720
3416
02:22
We did condom demonstrations.
36
142160
2536
02:24
We launched school education and workplace interventions.
37
144720
5416
02:30
We did research. We counseled the partners of infected men
38
150160
4576
02:34
about how to protect themselves.
39
154760
1616
02:36
We worked hard, and at the time, I believed that I was doing my best.
40
156400
5536
02:41
I was providing excellent treatment,
41
161960
2096
02:44
such as it was.
42
164080
1200
02:45
But I was not talking about structural change.
43
165840
4160
02:51
Former UN Secretary Kofi Annan has spoken candidly
44
171240
4136
02:55
about his personal failure
45
175400
2056
02:57
leading to the Rwandan genocide.
46
177480
1856
02:59
In 1994, he was head of the UN peacekeeping department.
47
179360
4056
03:03
At a 10-year memorial for the genocide,
48
183440
2536
03:06
he reflected, "I believed at the time I was doing my best,
49
186000
4056
03:10
but I realized after the genocide
50
190080
1896
03:12
that there was more I could and should have done
51
192000
3960
03:16
to sound the alarm and rally support."
52
196760
4480
03:22
The AIDS epidemic caught the health community unprepared,
53
202400
4040
03:27
and today, when the World Health Organization estimates
54
207160
3336
03:30
that 39 million people have lost their lives to this disease,
55
210520
5336
03:35
I'm not alone in feeling remorse and regret
56
215880
4096
03:40
at not having done more earlier.
57
220000
2480
03:43
But while living in Zimbabwe,
58
223960
2056
03:46
I didn't see my role as an advocacy or a political one.
59
226040
4696
03:50
I was there for my technical skills,
60
230760
1936
03:52
both my clinical and my research epidemiology skills.
61
232720
4456
03:57
And in my mind, my job was to take care of patients
62
237200
4976
04:02
and to do research to better understand the population patterns of transmission,
63
242200
5136
04:07
and I hoped that we'd slow the spread of the virus.
64
247360
3720
04:11
I was aware that socially marginalized populations were at disproportionate risk
65
251520
5176
04:16
of getting and dying of AIDS.
66
256720
2016
04:18
And on the sugar plantations,
67
258760
2056
04:20
which really more closely resembled feudal fiefdoms
68
260840
3776
04:24
than any modern enterprise,
69
264640
1976
04:26
60 percent of pregnant women
70
266640
2656
04:29
tested HIV-positive.
71
269320
2040
04:32
I worked to show how getting infected was not a moral failure
72
272279
3897
04:36
but instead related to a culture of male superiority,
73
276200
3776
04:40
to forced migrant labor and to colonialism.
74
280000
3536
04:43
Whites were largely unscathed.
75
283560
2800
04:46
As health professionals,
76
286960
1936
04:48
our tools were pitifully weak:
77
288920
3256
04:52
imploring people to change their individual behaviors,
78
292200
3856
04:56
use condoms, reduce number of partners.
79
296080
2856
04:58
Infection rates climbed,
80
298960
2600
05:02
and when treatment became available in the West,
81
302240
3936
05:06
treatment that remains our most potent weapon
82
306200
2416
05:08
against this virus,
83
308640
1696
05:10
it was unaffordable to the public sector across Africa.
84
310360
4376
05:14
I didn't speak out
85
314760
1240
05:16
about the unequal access to these life-saving drugs
86
316520
4656
05:21
or about the underlying economic and political systems
87
321200
3656
05:24
that were driving infection rates
88
324880
2856
05:27
in such huge swaths of the population.
89
327760
4200
05:33
I rationalized my silence
90
333400
2536
05:35
by reminding myself that I was a guest in the country,
91
335960
2936
05:38
that sounding the alarm could even get me kicked out,
92
338920
2936
05:41
keep me from doing good work,
93
341880
1656
05:43
taking care of my patients,
94
343560
1496
05:45
doing much-needed research.
95
345080
2760
05:48
So I didn't speak out
96
348520
1376
05:49
about the government's early stance on AIDS.
97
349920
3120
05:53
I didn't voice my concerns loudly enough.
98
353800
3816
05:57
Many doctors, health professionals,
99
357640
3176
06:00
may think I did nothing wrong.
100
360840
1880
06:03
Our pact with our patients,
101
363520
2016
06:05
the Hippocratic Oath and its variants,
102
365560
2736
06:08
is about the sanctity of the patient-doctor relationship.
103
368320
4960
06:13
And I did everything I could
104
373840
2840
06:17
for each and every patient of mine.
105
377360
3880
06:22
But I knew
106
382680
1696
06:24
that epidemics emerge along the fissures of our society,
107
384400
3736
06:28
reflecting not only biology,
108
388160
2016
06:30
but more importantly patterns of marginalization, exclusion,
109
390200
5616
06:35
discrimination related to race, gender, sexuality, class and more.
110
395840
5160
06:42
It was true of AIDS.
111
402040
1280
06:44
It was true just recently of Ebola.
112
404160
3360
06:48
Medical anthropologists such as Paul Farmer,
113
408880
2536
06:51
who worked on AIDS in Haiti,
114
411440
1936
06:53
call this structural violence:
115
413400
2400
06:56
structural because inequities are embedded
116
416440
4096
07:00
in the political and economic organization of our social world,
117
420560
4976
07:05
often in ways that are invisible to those with privilege and power;
118
425560
5360
07:11
and violence because its impact --
119
431400
3096
07:14
premature deaths, suffering, illness -- is violent.
120
434520
5440
07:21
We do little for our patients
121
441240
2776
07:24
if we fail to recognize
122
444040
2856
07:26
these social injustices.
123
446920
1936
07:28
Sounding the alarm is the first step towards doing public health right,
124
448880
6336
07:35
and it's how we may rally support
125
455240
3056
07:38
to break through and create real change together.
126
458320
4080
07:43
So these days, I'm not staying quiet.
127
463440
3040
07:46
I'm speaking up about a lot of things,
128
466840
3176
07:50
even when it makes listeners uncomfortable,
129
470040
3656
07:53
even when it makes me uncomfortable.
130
473720
2920
07:57
And a lot of this is about racial disparities
131
477360
3096
08:00
and institutionalized racism,
132
480480
1960
08:03
things that we're not supposed to have in this country anymore,
133
483040
3736
08:06
certainly not in the practice of medicine
134
486800
3336
08:10
or public health.
135
490160
1216
08:11
But we have them,
136
491400
1200
08:13
and we pay for them in lives cut short.
137
493280
4200
08:18
That's why sounding the alarm
138
498320
2656
08:21
about the impact of racism on health in the United States,
139
501000
4776
08:25
the ongoing institutional and interpersonal violence
140
505800
4296
08:30
that people of color face,
141
510120
1976
08:32
compounded by our tragic legacy
142
512120
4336
08:36
of 250 years of slavery,
143
516480
2920
08:40
90 years of Jim Crow
144
520000
2240
08:42
and 60 years of imperfect equality,
145
522800
3896
08:46
sounding the alarm about this
146
526720
2376
08:49
is central to doing my job right
147
529120
3336
08:52
as New York City's Health Commissioner.
148
532480
2439
08:55
In New York City, premature mortality -- that's death before the age of 65 --
149
535760
4616
09:00
is 50 percent higher for black men than white ones.
150
540400
3776
09:04
A black woman in 2012
151
544200
2816
09:07
faced more than 10 times the risk of dying related to childbirth
152
547040
4736
09:11
as a white woman.
153
551800
1320
09:13
And though we've made enormous strides
154
553880
3016
09:16
in reducing infant mortality rates,
155
556920
3056
09:20
a black baby still faces
156
560000
2536
09:22
nearly three times the risk of death in its first year of life
157
562560
4560
09:27
as compared to a white baby.
158
567800
1880
09:31
New York City's not exceptional.
159
571200
1560
09:33
These statistics are paralleled
160
573280
3816
09:37
by statistics found across the United States.
161
577120
4200
09:42
A recent New York Times analysis
162
582240
3256
09:45
reported that there are 1.5 million missing black men across the country.
163
585520
6800
09:53
They noted that more than one
164
593640
2080
09:56
out of every six black men
165
596600
2296
09:58
who today should be between the ages of 25 and 54 years
166
598920
5296
10:04
have disappeared from daily life,
167
604240
2920
10:07
lost either to prison or premature death.
168
607840
3720
10:12
There is great injustice
169
612960
2416
10:15
in the daily and disproportionate violence faced by young black men,
170
615400
3976
10:19
the focus of recent protests under the banner #BlackLivesMatter.
171
619400
5080
10:25
But we have to remember
172
625120
1616
10:26
that enduring and disparate rates
173
626760
3416
10:30
and the occurrence and outcome of common medical conditions --
174
630200
3936
10:34
heart disease, cancer, diabetes, HIV --
175
634160
3136
10:37
diseases that may kill slowly and quietly
176
637320
4256
10:41
and take even more black lives prematurely.
177
641600
4240
10:46
As the #BlackLivesMatter movement unfolded,
178
646880
3856
10:50
I felt frustrated and angry
179
650760
3536
10:54
that the medical community
180
654320
1296
10:55
has been reluctant to even use the word "racism"
181
655640
4456
11:00
in our research and our work.
182
660120
2696
11:02
You've probably felt something every time I've said it.
183
662840
2880
11:06
Our medical students held die-ins in their white coats,
184
666520
3256
11:09
but the medical community has largely stood by passively
185
669800
4016
11:13
as ongoing discrimination continues to affect
186
673840
3416
11:17
the disease profile and mortality.
187
677280
2816
11:20
And I worry
188
680120
1776
11:21
that the trend towards personalized and precision medicine,
189
681920
4536
11:26
looking for biological or genetic targets to better tailor treatment,
190
686480
5176
11:31
may inadvertently cause us to lose sight of the big picture,
191
691680
5016
11:36
that it is the daily context,
192
696720
2496
11:39
where a person lives, grows,
193
699240
3696
11:42
works, loves,
194
702960
2456
11:45
that most importantly determines population health,
195
705440
4896
11:50
and for too many of us, poor health.
196
710360
2640
11:54
As health professionals in our daily work,
197
714360
2920
11:58
whether in the clinic or doing research,
198
718040
3696
12:01
we are witness to great injustice:
199
721760
2520
12:05
the homeless person who is unable to follow medical advice
200
725160
3776
12:08
because he has more pressing priorities;
201
728960
2416
12:11
the transgender youth who is contemplating suicide
202
731400
4736
12:16
because our society is just so harsh;
203
736160
2616
12:18
the single mother who has been made to feel that she is responsible
204
738800
5056
12:23
for the poor health of her child.
205
743880
2560
12:26
Our role as health professionals
206
746960
2416
12:29
is not just to treat our patients
207
749400
3160
12:33
but to sound the alarm
208
753000
1720
12:35
and advocate for change.
209
755360
3040
12:39
Rightfully or not,
210
759880
1696
12:41
our societal position gives our voices great credibility,
211
761600
3976
12:45
and we shouldn't waste that.
212
765600
1480
12:48
I regret not speaking up in Zimbabwe,
213
768280
3760
12:52
and I've promised myself
214
772680
2256
12:54
that as New York City's Health Commissioner,
215
774960
2616
12:57
I will use every opportunity I have
216
777600
4296
13:01
to sound the alarm
217
781920
1856
13:03
and rally support for health equity.
218
783800
2456
13:06
I will speak out against racism,
219
786280
2776
13:09
and I hope you will join me,
220
789080
2136
13:11
and I will join you when you speak out against sexism
221
791240
3336
13:14
or any other form of inequality.
222
794600
3256
13:17
It's time for us to rise up
223
797880
3416
13:21
and collectively speak up
224
801320
2696
13:24
about structural inequality.
225
804040
2560
13:27
We don't have to have all the answers
226
807640
3296
13:30
to call for change.
227
810960
1600
13:33
We just need courage.
228
813120
2320
13:36
The health of our patients,
229
816320
2240
13:39
the health of us all, depends on it.
230
819480
2680
13:43
(Applause)
231
823600
4880
About this website

This site will introduce you to YouTube videos that are useful for learning English. You will see English lessons taught by top-notch teachers from around the world. Double-click on the English subtitles displayed on each video page to play the video from there. The subtitles scroll in sync with the video playback. If you have any comments or requests, please contact us using this contact form.

https://forms.gle/WvT1wiN1qDtmnspy7