RACE AND PUBLIC HEALTH

WITH CORONAVIRUS STILL AT LARGE, we are witness to the further fortification of an edifice I thought was already invincible: the Standard Approach to medicine and public health. In the Standard Approach, poor African-American (and increasingly, Hispanic) lives are left in jeopardy so that affluent lives, usually white, can be extended. After all, when we talk about “health” in the United States, what we mean is the extension and improvement of white lives. We see this now in the grave disparities in the coronavirus death rate between patients of limited means who are treated in publicly supported hospitals and the ones with private insurance who are treated in better-staffed and better-equipped private hospitals. We see this in the more than twofold-higher death rate from coronavirus for Black Americans compared with whites. We see it in the data showing that two-thirds of coronavirus deaths in the nation’s largest concentrated outbreak—that is, New York City’s—occurred in neighborhoods where median income was below the city average.

In the Standard Approach, all illness is a matter of risk, and all risk a matter of personal choice. This formulation is a double sleight of hand. First, we’re schooled to think of illness as a discrete, well-defined, unwanted alteration of our normal state. Illness is the thing that keeps us from going to work or school, doing well in the job interview, or taking good care