How racism makes us sick | David R. Williams

譯者: Linda Sheu 審譯者: Yanyan Hong

An article in the Yale Alumni Magazine

耶魯大學的校友雜誌中，

told the story of Clyde Murphy,

敘述了克萊德．漠菲的故事，

a black man who was a member of the Class of 1970.

他是在 1970 年畢業的一個黑人。

Clyde was a success story.

克萊德是一個成功的案例。

After Yale and a law degree from Columbia,

從耶魯大學畢業後， 他順利取得哥倫比亞大學法律學位，

Clyde spent the next 30 years

接下來三十年，

as one of America's top civil rights lawyers.

他成為了一名美國頂尖的民權律師。

He was also a great husband and father.

同時，他也是一位很好的丈夫與父親。

But despite his success,

雖然克萊德的私人生活以及事業

personally and professionally,

都算是相當完美成功，

Clyde's story had a sad ending.

但他的生活最後卻以悲劇告終。

In 2010,

在 2010 年，

at the age of 62,

克萊德 62 歲，

Clyde died from a blood clot in his lung.

死於肺血栓塞。

Clyde's experience was not unique.

克萊德的案例並不獨特。

Many of his black classmates from Yale

許多跟他一起 從耶魯大學畢業的黑人，

also died young.

都很早過世。

In fact, the magazine article indicated

雜誌中曾有文章指出，

that 41 years after graduation from Yale,

從耶魯大學畢業 41 年後，

the black members of the Class of 1970

1970 年畢業的黑人其死亡率

had a death rate that was three times higher

比同期班上其他同學的平均死亡率

than that of the average class member.

還要高三倍。

It's stunning.

太驚人了。

America has recently awakened

美國最近

to a steady drumbeat

持續發生令人警醒的事情，

of unarmed black men being shot by the police.

許多未武裝的黑人被警察射殺。

What is even a bigger story

更嚴重的是，

is that every seven minutes,

每七分鐘

a black person dies prematurely in the United States.

就有一個黑人比預期中提早死亡。

That is over 200 black people

每一天都有超過 200 多個黑人，

die every single day

因為其與白人之間的 健康條件不平等而死亡。

who would not die if the health of blacks and whites were equal.

For the last 25 years,

過去 25 年來，

I have been on a mission

我一直肩負使命

to understand why does race

努力去了解為什麼一個人的種族

matter so profoundly for health.

會如此影響他的健康。

When I started my career,

當我剛開始我的工作時，

many believed that it was simply about racial differences

許多人認為那只是因為不同種族

in income and education.

有著收入與教育程度之差別。

I discovered that while economic status matters for health,

我發現雖然經濟處境 會影響一個人的健康，

there is more to the story.

但是事實遠不止於此。

So for example, if we look at life expectancy at age 25,

比如說，我們來看看 年輕人的預期壽命，

at age 25 there's a five-year gap between blacks and whites.

25 歲的白人預期 可以比同年齡的黑人多活五年。

And the gap by education for both whites and blacks

受教育程度不同所造成的 死亡年齡差距

is even larger than the racial gap.

比種族鴻溝造成的更大。

At the same time, at every level of education,

同時，每一個教育階段的白人，

whites live longer than blacks.

都比黑人活得久。

So whites who are high school dropouts

高中輟學的白人

live 3.4 years longer than their black counterparts,

比高中輟學的黑人 還要多活 3.4 年，

and the gap is even larger

來比較大學畢業生的話，

among college graduates.

差距則更大。

Most surprising of all,

最讓我驚訝的是，

whites who have graduated from high school

只有高中畢業的白人

live longer than blacks with a college degree

比起有大學以上學歷的黑人

or more education.

活得更久。

So why does race matter so profoundly for health?

到底為什麼一個人的種族 會如此影響他的健康？

What else is it beyond education and income

除了教育程度與收入之外

that might matter?

還有什麼原因呢？

In the early 1990s,

1990 年代早期，

I was asked to review a new book

有人請我複審一本

on the health of black America.

關於黑人健康的書。

I was struck that almost every single one

我發現書中的 25 個章節裡，

of its 25 chapters

幾乎每一個章節

said that racism

都提到種族歧視

was a factor that was hurting the health of blacks.

是傷害黑人的健康的重要因素。

All of these researchers

這些研究者

were stating that racism was a factor adversely impacting blacks,

都指出種族歧視是負面影響 黑人生活的一個因素。

but they provided no evidence.

但他們沒有提出證據。

For me, that was not good enough.

對我來說，那是遠遠不夠的。

A few months later,

幾個月之後，

I was speaking at a conference in Washington, DC,

我在華盛頓發表演講，

and I said that one of the priorities for research

我提出我研究中的當務之急

was to document the ways in which racism affected health.

就是記錄種族歧視如何影響健康。

A white gentleman stood in the audience

一個白人男士站起來說，

and said that while he agreed with me that racism was important,

雖然他對我表示贊同， 認為種族歧視很重要，

we could never measure racism.

但是我們永遠無法衡量它。

"We measure self-esteem," I said.

我回答道，我們可以衡量自尊心。

"There's no reason

如果我們認真對待這件事，

why we can't measure racism if we put our minds to it."

那就沒有理由說 我們無法衡量種族歧視。

And so I put my mind to it

所以我全力以赴，

and developed three scales.

並發展出一個三步驟衡量法。

The first one captured major experiences of discrimination,

第一是對被歧視的經歷進行評估，

like being unfairly fired or being unfairly stopped by the police.

比如說，不公平地被辭職， 或是被警察攔著。

But discrimination also occurs in more minor and subtle experiences,

但是歧視通常發生在 更細小且不易察覺的層面上，

and so my second scale, called the Everyday Discrimination Scale,

所以我的第二步驟叫做 每日歧視比例尺。

captures nine items

它包含九項條目，

that captures experiences

比如體驗到

like you're treated with less courtesy than others,

你所受到的禮遇不如他人，

you receive poorer service than others in restaurants or stores,

在餐館受到其次的待遇，

or people act as if they're afraid of you.

或著是人們看到你會感到害怕。

This scale captures

這個尺很明顯地表示出

ways in which the dignity and the respect

一般社會人士瞧不起的人，

of people who society does not value

他們的尊嚴與自尊心會

is chipped away on a daily basis.

每一天一點一點地被侵蝕。

Research has found

我的研究指出，

that higher levels of discrimination

隨著歧視的惡化

are associated with an elevated risk of a broad range of diseases

更多的疾病會產生，

from blood pressure to abdominal obesity

從高血壓到肥胖症，

to breast cancer to heart disease

從乳癌到心臟病，

and even premature mortality.

甚至提早死亡。

Strikingly, some of the effects are observed at a very young age.

讓人驚訝的是，很多負面的作用 在年輕人身上就能發現。

For example, a study of black teens

比如說，一個研究 黑人青少年的研究指出，

found that those who reported higher levels of discrimination as teenagers

在青少年期受到越多 歧視的孩子們，在二十歲那年

had higher levels of stress hormones,

相對的有越多的壓力荷爾蒙，

of blood pressure

更高的血壓，

and of weight at age 20.

更重的體重。

However,

但是，

the stress of discrimination

受到歧視會有更大的壓力

is only one aspect.

只是許多問題的其中一個。

Discrimination and racism

不公平待遇與種族歧視

also matters in other profound ways for health.

還有更多不同影響健康的方法。

For example, there's discrimination in medical care.

比如說，醫療制度的不公平待遇。

In 1999, the National Academy of Medicine

在 1999 年，全國醫療協會

asked me to serve on a committee

請我在一個委員會中幫忙，

that found, concluded based on the scientific evidence,

過程中，我們藉由科學證明，

that blacks and other minorities

黑人與其他少數民族

receive poorer quality care than whites.

比白人還要受到更差的醫療服務。

This was true for all kinds of medical treatment,

各式各樣的醫療服務都相對更差，

from the most simple

從最基本的

to the most technologically sophisticated.

到最複雜的。

One explanation for this pattern

其中一個原因

was a phenomenon that's called "implicit bias"

是一個叫做「隱性偏見」的現象，

or "unconscious discrimination."

又稱「淺意識歧視。」

Research for decades by social psychologists

十多年來，社會學家的研究指出

indicates that if you hold a negative stereotype

如果你對某些人種

about a group in your subconscious mind

有負面的刻板印象，

and you meet someone from that group,

當你遇到一個那個種族的人，

you will discriminate against that person.

你會對那個人有歧視。

You will treat them differently.

你會不公平的對待他。

It's an unconscious process. It's an automatic process.

整個過程是淺意識的。 是自動化的。

It is a subtle process, but it's normal

是個微妙但也正常的的過程，

and it occurs even among the most well-intentioned individuals.

連最善意的人也可能會犯的錯誤。

But the deeper that I delved

我越是更深層地

into the health impact of racism,

研究種族歧視，

the more insidious the effects became.

我越發現它的隱患。

There is institutional discrimination,

我發現連最基本的

which refers to discrimination

社會制度都有

that exists in the processes of social institutions.

嚴重的歧視存在。

Residential segregation by race,

社區因為不同種族而隔離，

which has led to blacks and whites living in very different neighborhood contexts,

造成白人與黑人 住在非常不同的社區，

is a classic example of institutional racism.

是最典型的社會制度種族歧視。

One of America's best-kept secrets

美國最大的一個秘密，

is how residential segregation

就是社區的隔離

is the secret source

是造成種族不平等的秘密來源。

that creates racial inequality in the United States.

In America, where you live

在美國，你住哪

determines your access to opportunities

會影響一個人的

in education, in employment,

教育與工作機會，

in housing and even in access to medical care.

連醫療制度與找房子都會受到影響。

One study of the 171 largest cities in the United States

有一個研究指出 美國前 171 的大城市當中，

concluded that there is not even one city

沒有一個城市是

where whites live under equal conditions to blacks,

白人與黑人的居住環境是平等的，

and that the worst urban contexts in which whites reside

而且當中住在最爛的環境的白人

is considerably better than the average context of black communities.

都還是比一般的黑人住的還要好。

Another study found

另外一個研究指出，

that if you could eliminate statistically

如果我們能夠在統計上排除

residential segregation,

社區隔離，

you would completely erase black-white differences in income,

我們就能夠排除黑白種族在

收入、教育、

education and unemployment,

失業率、單親媽媽等等的差別，

and reduce black-white differences in single motherhood

by two thirds,

拉近三分之二的差距，

all of that driven by segregation.

這些都是因為隔離造成的。

I have also learned

我同時瞭解到

how the negative stereotypes

我們對黑人的

and images of blacks in our culture

負面的刻板印象，

literally create and sustain

確實地造成

both institutional and individual discrimination.

制度與個人的偏見。

A group of researchers have put together a database

一群科學家收集了一批數據，

that contains the books,

裡面有大學畢業的普通美國人

magazines and articles

一輩子下來會閱讀的書本、 雜誌與報刊，

that an average college-educated American would read over their lifetime.

收集起來研究他們的內容，

It allows us to look within this database

我們藉此找出

and see how Americans have seen words paired together

美國人在長大的過程中

as they grow up in their society.

讀到某些詞彙時，聯想到什麼。

So when the word "black" appears in American culture,

當美國人看到「黑人」這個字時，

他們通常同時看到的字是什麼？

what co-occurs with it?

"Poor,"

「窮苦」、

"violent,"

「暴力」、

"religious,"

「有虔誠信仰」、

"lazy,"

「懶惰」、

"cheerful,"

「開心」、

"dangerous."

「危險。」

When "white" occurs,

當 「白人」 出現時，

the frequently co-occurring words

經常發生的詞彙是

are "wealthy,"

「富有」、

"progressive,"

「先進」、

"conventional,"

「常見」、

"stubborn,"

「固執」、

"successful,"

「成功」、

"educated."

「有受教育。」

So when a police officer

因此當一個警察

overreacts when he sees an unarmed black male

看到一個未武裝的黑人，

and perceives him to be violent and dangerous,

卻緊張地以為他是危險人物，

we are not necessarily dealing with an inherently bad cop.

我們面對的不見得是 一個不好的警察。

We may be simply viewing

他只不過是一個顯現出

a normal American

受到這個社會

who is reflecting what he has been exposed to

長期薰陶而長大的

as a result of being raised

普通美國人而已。

in this society.

From my own experience,

我的經驗告訴我，

I believe that your race

你的種族

does not have to be a determinant of your destiny.

並不一定要註定你的終身。

I migrated to the United States

我在 1970 年代末，

from the Caribbean island of Saint Lucia

從加勒比海小島聖露西亞

in the late 1970s

移民到美國

in pursuit of higher education,

來念大學，

and in the last 40 years,

接下來 40 年，

I have done well.

我混得不錯。

I have had a supportive family,

我有個支持我的家庭，

I have worked hard,

我努力地工作，

I have done well.

我得到了許多。

But it took more for me to be successful.

但是那還不夠讓我成功。

I received a minority fellowship from the University of Michigan.

密西根大學給了我 少數民族的獎學金。

Yes. I am an affirmative action baby.

是的。我是一個平權措施的寶寶。

Without affirmative action,

沒有平權措施，

I would not be here.

我不可能有今天。

But in the last 40 years,

但是以往 40 年來，

black America has been less successful than I have.

美國的黑人沒有我成功。

In 1978, black households in the United States

在 1978 年， 白人家庭每賺一塊錢，

earned 59 cents for every dollar of income whites earned.

黑人家庭只賺 59 分。

In 2015,

在 2015 年，

black families still earn 59 cents

當白人家庭賺一塊錢美金，

for every dollar of income that white families receive,

黑人家庭仍然只賺 59 分，

and the racial gaps in wealth are even more stunning.

而且種族差別造成的 貧富懸殊更加嚴重。

For every dollar of wealth that whites have,

白人擁有的每一塊錢，

black families have six pennies and Latinos have seven pennies.

黑人家庭只有 6 分， 中南美的家庭只有 7 分錢。

The fact is,

實話說，

racism

種族歧視

is producing a truly rigged system

造成了一個不公平的系統，

that is systematically disadvantaging some racial groups in the United States.

一個徹底損害某些美國人種的系統。

To paraphrase Plato,

改述一下柏拉圖曾經說的，

there is nothing so unfair

世界上沒有比平等對待 不平等的人民，

as the equal treatment of unequal people.

還要更不平等的事情了。

And that's why I am committed

因此我這麼投入地

to working to dismantle racism.

想要拆除種族歧視。

I deeply appreciate the fact

我深刻領悟到我能夠有今天，

that I am standing on the shoulders

是因為有許多前人犧牲自我，

of those who have sacrificed even their lives to open the doors

替我們打造了一條通路

that I have walked through.

好讓我們通過。

I want to ensure that those doors remain open

我希望這條通路繼續維持暢通，

讓更多人通過。

and that everyone can walk through those doors.

Robert Kennedy said,

羅伯特甘迺迪說：

"Each time a man" -- or woman, I would add --

「每當一個男人」 ──我還要加上或是女人──

"stands up for an ideal

「為了理想而奮鬥，

or acts to improve the lot of others

或者是為了大眾的利益

or strikes out against injustice,

而與不公平打鬥，

he sends forth a tiny ripple of hope,

小小的希望之波浪 就會慢慢地前進，

and those ripples can build a current

小小的波浪聚集 在一起變成大急流。

that can sweep down the mightiest walls of oppression and resistance."

沖倒壓制與抵抗的高牆。」

I am optimistic today

今天我非常的樂觀，

because all across America,

因為在全美國，

I have seen ripples of hope.

我都有看到希望的小波浪。

The Boston Medical Center

波士頓醫療中心，

has added lawyers to the medical team

請了律師加入他們的醫療團，

so that physicians can improve the health of their patients

所以當醫生在治療病人的過程中，

because the lawyers are addressing the nonmedical needs their patients have.

律師可以順便處理病人 跟醫療無關的問題。

Loma Linda University has built a gateway college

羅馬林達大學在聖貝納迪諾附近

in nearby San Bernardino

蓋了一間技術學院，

so that in addition to delivering medical care,

所以當他們提供醫療服務的同時，

they can provide job skills

他們可以教導工作技能，

and job training

給弱勢團體，

to a predominantly minority, low-income community members

與低收入的人們，

so that they will have the skills they need to get a decent job.

給他們機會找到好一點的工作。

In Chapel Hill, North Carolina,

在北卡羅萊納州的教堂山附近的

the Abecedarian Project has figured out

初學者計畫，

how to ensure that they have lowered the risks for heart disease

發現如何減少 30 歲的黑人

for blacks in their mid-30s

得心臟病的機率，

by providing high-quality day care

方法是提供高品質的

from birth to age five.

0 歲到 5 歲的幼兒園。

In after-school centers across the United States,

美國的課後安親班當中，

Wintley Phipps and the US Dream Academy

溫特理．非浦思與美國夢想學院，

is breaking the cycle of incarceration

藉由高品質的輔導與細心的帶領

by providing high-quality academic enrichment and mentoring

減少了囚犯的孩子、

to the children of prisoners

與在學校落後的孩子

邁上不歸之路。

and children who have fallen behind in school.

In Huntsville, Alabama,

在阿拉巴馬州的亨茨維爾，

Oakwood University,

歐克伍德大學

a historically black institution,

是個有史以來都是黑人學生的機構，

is showing how we can improve the health of black adults

他們在學生入學時新生介紹當天，

by including a health evaluation

提供每個學生健康檢查，

as a part of freshman orientation

而且提供學生許多健康資訊，

and giving those students the tools they need

好讓他們有足夠的智慧

to make healthy choices

去選擇美好的生活習慣，

and providing them annually a health transcript

接下來每一年都複診，

so they can monitor their progress.

讓年輕人可以持續維持自己的健康。

And in Atlanta, Georgia,

在喬治亞州的亞特蘭大城，

Purpose Built Communities has dismantled the negative effects of segregation

重新建設的社區打破隔離現象，

by transforming a crime-ridden,

把充滿犯罪行為、

drug-infested public housing project

販毒的公營低收入戶住宅，

into an oasis of mixed-income housing,

變成一個綜合收入水準、

of academic performance,

教育水準，

of great community wellness

社區本身健康

and of full employment.

又充滿工作機會的社區。

And finally,

最後，

there is the Devine solution.

還有迪文方案。

Professor Patricia Devine

派翠莎．迪文教授

of the University of Wisconsin

在威康森大學

has shown us how we can attack

告訴我們如何

our hidden biases head on

打破我們潛在的偏見，

and effectively reduce them.

有效率地減少它。

Each one of us

我們每一個人

can be a ripple of hope.

都可以是希望之波浪。

This work will not always be easy,

過程不會簡單，

but former Supreme Court Justice Thurgood Marshall

前最高法院法官瑟古德．馬歇爾說：

has told us, "We must dissent.

「我們必須要持異議。

We must dissent from the indifference.

我們必須要反對漠不關心。

We must dissent from the apathy.

我們必須要反對冷淡。

We must dissent from the hatred and from the mistrust.

我們必須要反對仇恨與不信賴。

We must dissent

我們必須要持異議，

because America can do better,

因為美國可以更好，

because America has no choice but to do better."

因為美國除了更好之外 沒有其他的選擇。」

Thank you.

謝謝。

(Applause)

（掌聲）