key: cord-0683968-4qllcxiw
authors: Brooks, Oliver T.
title: President’s Message: Unfinished Business
date: 2020-09-02
journal: J Natl Med Assoc
DOI: 10.1016/j.jnma.2020.08.002
sha: c2efe3b4c6da75d155016d4516838779b3034152
doc_id: 683968
cord_uid: 4qllcxiw

nan

Author affiliation: Chief Medical Officer, Watts HealthCare Corporation, Los Angeles, CA, USA T here is an ebb and flow to life. There is a time and place for all things under heaven. There is nothing so powerful as a movement whose time has come. At this juncture we find ourselves at a nexus in America. This is quite a non-specific statement, that could be referencing a sundry of current conditions: racial tensions, a viral pandemic, police brutality, political polarization, or economic uncertainty. To which condition do I refer as the nexus, the inflection point? Yes, you know: all of the above. The key is that they all link together, weaving a fabric with strength, holes, stains, color, but most importantly, substance. It exists. Our role as scientists, healers, and advocates is to repair and cleanse this cloth such that it provides cover, warmth and support for all, especially our African-American community. The holes and stains are most obvious in certain areas of this fabric; that is where we place our efforts.

Over the past 12 months I have addressed a myriad of sections of this cloth. In November in the JNMA I wrote: "Research reveals that African Americans are more likely than other racial and ethnic groups to experience health inequities. Given the disproportionate impact on chronic diseases in communities of color, Congress must find ways to make healthcare coverage universal, accessible, and of high quality for all." 1 Little did I know that I was referencing a fact that would by its truth lead to thousands of excess deaths due to a virus that at the time we had never heard of: SARS-CoV-2, causing COVID-19. The nexus of underlying conditions and pandemics was breached.

At present there are federal security forces being sent to Portland, Oregon without the request of, and in fact in defiance of the wishes of the local government. The concern is protests related to racist practices of police and an undercurrent of 400 years of systemic racism. In an entry in one my articles I professed the following: "In summary, public health scholars should champion efforts to implement surveillance of police brutality and press funders to support research to understand the experiences of people faced with police brutality. We must ask whether our own research, teaching, and service are intentionally antiracist and challenge the institutions we work in to ask the same. To reduce racial health inequities, public health scholars must rigorously explore the relationship between police brutality and health, and advocate for policies that address racist oppression. 2 " At the time about two months ago I did not predict that this would be a political flashpoint in a major American city.

As a consequence of the ravages of the COVID-19 pandemic, the unemployment rate in the US at the time of this writing is 11.1%, exactly 3 times the rate 12 months prior. 3 However, the Black unemployment rate is 15.4%. Both of these numbers are extraordinarily high, the highest in decades. As employment is directly linked to insurance coverage in the US, the only country with a major economy without universal healthcare coverage, and with African-Americans historically uninsured at a rate 50% higher than Whites, the nexus is on our necks: unemployed, uninsured, with higher rates of underlying conditions that lead to adverse outcomes from COVID-19.

So as I survey the landscape, and as I transition from active President of the oldest and largest organization representing African-America's physicians and the guardians of the health of African-Americans, to the role of hindsight viewer I see progress: there is frank discussion on the state of race relations, with the removal of confederate statues and flags, legislation compelling the CDC to release race and ethnic data on COVID-19 cases, hospitalizations and deaths, budgets in various cities redirecting police budget funds to other services to provide non-armed interventions, and anti-racist entities such as Black Lives Matter becoming all but mainstream.

However, what I truly see is Unfinished Business. Blacks make up only 4% of practicing physicians, the same percent as 40 years ago. Black women die related to maternity 3 times the rate of White women during or after childbirth. 4 Studies have shown that "black people are three times more likely to be killed by police in the United States than white people. More unarmed black people were killed by police than unarmed white people last year," despite the fact that only 14% of the population are black ª 2020 Published by Elsevier Inc. on behalf of the National Medical Association.

https://doi.org/10.1016/j.jnma.2020.08.002 people. 5 Studies are showing that those with certain comorbidities (chronic lung disease, moderate to severe asthma, serious heart conditions, those immunocompromised including cancer treatment, severe obesity and particularly if not well controlled diabetes, renal failure, or liver disease), are at higher risk for severe illness 6 from COVID-19. Those comorbidities have African-American fingerprints all over them.

This leaves us at the nexus. The NMA has found its footing in 2020. The NMA has been referenced by national news outlets, Vice-President Pence, CDC Administrator Robert Redfield, House Speaker Nancy Pelosi, civil rights leader Jesse Jackson, Sr, and Surgeon General Jerome Adams. There is indeed nothing more powerful than a movement whose time has come. It is incumbent on the NMA to define the movement: I will be clear that the movement is one that we have championed for decades: Health Equity. As President of the NMA I have spent endless hours focusing on trumpeting this message, and that only through advocacy for ourselves will we achieve this. We do not yet have Health Equity but the moment is here to achieve it. We cannot let this moment, this movement pass. John Lewis suffered a fractured skull defending what he knew was the ultimate truth. We must show this same level of commitment and fortitude. We must cross the bridge and let nothing, no one stop us. Our time has come.

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