Why your doctor should care about social justice | Mary Bassett

Why your doctor should care about social justice | Mary Bassett


When I moved to Harare in 1985, social justice was at the core
of Zimbabwe’s national health policy. The new government emerged
from a long war of independence and immediately proclaimed
a socialist agenda: health care services, primary education became essentially free. A massive expansion
of rural health centers placed roughly 80 percent
of the population less than a two-hour walk
from these facilities, a truly remarkable accomplishment. In 1980, the year of independence, 25 percent of Zimbabwean children
were fully immunized. By 1990, a mere decade later, this proportion stood at 80 percent. I felt tremendously privileged
to be part of this transformation, a revolution. The excitement,
the camaraderie, was palpable. Working side by side
with brilliant Zimbabweans — scientists, doctors, activists — I felt connected not only
to an African independence movement, but to a global progressive
public health movement. But there were daunting challenges. Zimbabwe reported its first AIDS case
in 1985, the year I arrived. I had taken care of a few patients
with AIDS in the early 1980s, when I did my medical training
at Harlem Hospital, but — we had no idea
what lay in store for Africa. Infection rate stood at about
two percent in my early days there. These would soar to one out of every four adults by the time I left Harare 17 years later. By the mid-1990s, I’d told hundreds of people
in the prime of life that they were HIV-positive. I saw colleagues and friends die, my students, hospital patients, die. In response, my colleagues and I
set up a clinic. We did condom demonstrations. We launched school education
and workplace interventions. We did research. We counseled
the partners of infected men about how to protect themselves. We worked hard, and at the time,
I believed that I was doing my best. I was providing excellent treatment, such as it was. But I was not talking
about structural change. Former UN Secretary Kofi Annan
has spoken candidly about his personal failure leading to the Rwandan genocide. In 1994, he was head
of the UN peacekeeping department. At a 10-year memorial for the genocide, he reflected, “I believed at the time
I was doing my best, but I realized after the genocide that there was more
I could and should have done to sound the alarm and rally support.” The AIDS epidemic caught
the health community unprepared, and today, when the World
Health Organization estimates that 39 million people
have lost their lives to this disease, I’m not alone in feeling
remorse and regret at not having done more earlier. But while living in Zimbabwe, I didn’t see my role
as an advocacy or a political one. I was there for my technical skills, both my clinical and my research
epidemiology skills. And in my mind, my job
was to take care of patients and to do research to better understand
the population patterns of transmission, and I hoped that we’d slow
the spread of the virus. I was aware that socially marginalized
populations were at disproportionate risk of getting and dying of AIDS. And on the sugar plantations, which really more closely
resembled feudal fiefdoms than any modern enterprise, 60 percent of pregnant women tested HIV-positive. I worked to show how getting infected
was not a moral failure but instead related
to a culture of male superiority, to forced migrant labor
and to colonialism. Whites were largely unscathed. As health professionals, our tools were pitifully weak: imploring people to change
their individual behaviors, use condoms, reduce number of partners. Infection rates climbed, and when treatment
became available in the West, treatment that remains
our most potent weapon against this virus, it was unaffordable
to the public sector across Africa. I didn’t speak out about the unequal access
to these life-saving drugs or about the underlying
economic and political systems that were driving infection rates in such huge swaths of the population. I rationalized my silence by reminding myself
that I was a guest in the country, that sounding the alarm
could even get me kicked out, keep me from doing good work, taking care of my patients, doing much-needed research. So I didn’t speak out about the government’s
early stance on AIDS. I didn’t voice my concerns loudly enough. Many doctors, health professionals, may think I did nothing wrong. Our pact with our patients, the Hippocratic Oath and its variants, is about the sanctity
of the patient-doctor relationship. And I did everything I could for each and every patient of mine. But I knew that epidemics emerge
along the fissures of our society, reflecting not only biology, but more importantly
patterns of marginalization, exclusion, discrimination related to race,
gender, sexuality, class and more. It was true of AIDS. It was true just recently of Ebola. Medical anthropologists
such as Paul Farmer, who worked on AIDS in Haiti, call this structural violence: structural because inequities are embedded in the political and economic
organization of our social world, often in ways that are invisible
to those with privilege and power; and violence because its impact — premature deaths,
suffering, illness — is violent. We do little for our patients if we fail to recognize these social injustices. Sounding the alarm is the first step
towards doing public health right, and it’s how we may rally support to break through
and create real change together. So these days, I’m not staying quiet. I’m speaking up about a lot of things, even when it makes listeners
uncomfortable, even when it makes me uncomfortable. And a lot of this
is about racial disparities and institutionalized racism, things that we’re not supposed
to have in this country anymore, certainly not in the practice of medicine or public health. But we have them, and we pay for them in lives cut short. That’s why sounding the alarm about the impact of racism on health
in the United States, the ongoing institutional
and interpersonal violence that people of color face, compounded by our tragic legacy of 250 years of slavery, 90 years of Jim Crow and 60 years of imperfect equality, sounding the alarm about this is central to doing my job right as New York City’s Health Commissioner. In New York City, premature mortality —
that’s death before the age of 65 — is 50 percent higher
for black men than white ones. A black woman in 2012 faced more than 10 times
the risk of dying related to childbirth as a white woman. And though we’ve made enormous strides in reducing infant mortality rates, a black baby still faces nearly three times the risk
of death in its first year of life as compared to a white baby. New York City’s not exceptional. These statistics are paralleled by statistics found
across the United States. A recent New York Times analysis reported that there are 1.5 million
missing black men across the country. They noted that more than one out of every six black men who today should be
between the ages of 25 and 54 years have disappeared from daily life, lost either to prison or premature death. There is great injustice in the daily and disproportionate violence
faced by young black men, the focus of recent protests
under the banner #BlackLivesMatter. But we have to remember that enduring and disparate rates and the occurrence and outcome
of common medical conditions — heart disease, cancer, diabetes, HIV — diseases that may kill slowly and quietly and take even more
black lives prematurely. As the #BlackLivesMatter
movement unfolded, I felt frustrated and angry that the medical community has been reluctant
to even use the word “racism” in our research and our work. You’ve probably felt something
every time I’ve said it. Our medical students
held die-ins in their white coats, but the medical community
has largely stood by passively as ongoing discrimination
continues to affect the disease profile and mortality. And I worry that the trend towards personalized
and precision medicine, looking for biological or genetic targets
to better tailor treatment, may inadvertently cause us
to lose sight of the big picture, that it is the daily context, where a person lives, grows, works, loves, that most importantly
determines population health, and for too many of us, poor health. As health professionals in our daily work, whether in the clinic or doing research, we are witness to great injustice: the homeless person
who is unable to follow medical advice because he has more pressing priorities; the transgender youth
who is contemplating suicide because our society is just so harsh; the single mother who has been made
to feel that she is responsible for the poor health of her child. Our role as health professionals is not just to treat our patients but to sound the alarm and advocate for change. Rightfully or not, our societal position
gives our voices great credibility, and we shouldn’t waste that. I regret not speaking up in Zimbabwe, and I’ve promised myself that as New York City’s
Health Commissioner, I will use every opportunity I have to sound the alarm and rally support for health equity. I will speak out against racism, and I hope you will join me, and I will join you
when you speak out against sexism or any other form of inequality. It’s time for us to rise up and collectively speak up about structural inequality. We don’t have to have all the answers to call for change. We just need courage. The health of our patients, the health of us all, depends on it. (Applause)

Author: Kennedi Daugherty

100 thoughts on “Why your doctor should care about social justice | Mary Bassett

  1. Measurable differences in average IQ between different populations does a far better job at explaining disparate economic and social outcomes, including when it comes to healthy lifestyles and the spread of sexually transmitted diseases, than all this unscientific demagoguery that she's putting forward.

  2. I have not been offended by a TED talk until now. How dare this presenter blame disparate health out comes on racism. Poor whites have worse health outcomes too. Perhaps the good doctor should have taken a few courses that explained causation before opening up HER racist mouth. Disgusting. Truly disgusting and offensive.

  3. poor people die therefore racism because only white rich patiences get the real medicine and everyone else get the placebo

  4. Poor people have problems. There is a bit more poor black people. Then lets help ALL black people, rich and poor. and leave the rest of the poor in the dust. Specially white people, because they are privileged to be born whit the same skin color as bill gates. And that relation should be enough to feed them and get them out of poverty.

    Grate plan.

  5. This channel had just uploaded an awesome video about the future of drones, which I shared on Facebook with the comment "A return to form for TedTalks."

    I'm so disappointed. And ashamed that I'm actually having to consider deleting the link I shared.

  6. I disliked this video because it present an opinion mixed with some skewed pseudofacts, yet I know that by disliking it, I am perpetuating the regressive left's victimhood.

  7. This is a pretty funny video. Here are my favorites:

    * The reason black men in Zimbabwe don't use condoms is colonialism.

    * The reason black babies in the US die three times more than white babies is racism. (no mention of the parents)

    * The reason there are 1.5 million missing black men in the US is due to injustice. (no mention of gangs)

    Is this woman insane, or what?

  8. The epitome of imposing stigma and discrimination upon people and populations, pushing people to the dangerous fringes, thereby justifying unwanted interventions and draconian controls. Lord, save us from those who want to save us.

  9. People are saying that Social Justice is a problem? What? Where did that come from?
    We need to seek social justice for the good of all !

  10. Silly me, I thought doctors and other medical professionals should care more about treating people than social justice.

  11. Really poor choice on a speaker TED. When did TED Talks focus on this bizarre demagoguery? A Medical Professional is there to help sick and injured people. Not play societal police. The job is tough enough as is without projecting their preferred emotions onto every scenario and alienating people.

    This is just crap DevilFinding.

  12. Social justice makes sense in parts of Africa where there actually is a need for it, but usually people who care about social justice have many bad ideas and a lack of critical thinking skills.

  13. wow this isnt even a tedx? i used to get mad at this sjw bullshit, but now i enjoy watching them sperg out. it just shows the rest of the world what those "sexist, racist, misogynist neckbeards" have been saying for a decade: sjw are cancer

  14. Jeez. Social Bullshit is being moved to the main channel. Hope this cancer doesnt spread to the ted-ed channel

  15. It seems as though the issue here is not whether equality is a good thing or not; rather it's whether we already have equality or not. When you see it as though equality is not here yet, social justice seems like common sense. However, when you look at it as though equality has been around for a some time now, it appears as though SJWs want minorities to be treated better than majorities. Unfortunately I cannot discern a simple solution for finding out which is the case.

  16. How ridiculous. Please stop it with this "social justice" nonsense. If this is the kind of trash that TED is peddling now then count me out.

  17. man this is a load social justice bull. every ethnicity has been put into slavery in the past often by people of their own ethnicity. i bet her statistics come from first world for white and third for black. it is a matter of where not what color

  18. Let's not discuss her topic of inequality in medical care, let's just call her an idiot for mentioning social justice and black lives matter. -YouTube commenters

  19. Rwandan genocide: Promoted and broadcast over radio by Catholic priests and nuns.
    Rwandan Aids epidemic: Exacerbated by Catholic priests and nuns.

  20. When did she break down how racism was at the root of the inequalities? Oh, wait, she… didn't? At all? Just bald claims bereft of evidence? TED, up your fucking game.

  21. I can't believe so many people so strongly and cartoonishly oppose the idea of treating everybody respectfully. Ah well, just keep on wallowing in contumacy!

  22. The combating against social justice is as immature as any 4 year old. AS IT LOOKS, people are literally denying the social justice which was outlined in the first 10 seconds of the video that it was about Zimbabwe's independence. Which this itself has a lot to say: People are literally getting angry at human independence.

  23. why? why would you do this?
    Ted subscribers are critical thinkers… the mortal enemy of whatever movement you want to call this
    you will lose many thinkers, and gain many sheep by these kinds of videos

  24. Health is not an opinion, Social justice is great to sell Gender studies overpriced education, but is has no value on STEM.

  25. Things that I learned from this valuable TED talk:
    4:30 Culture of male superiority, forced migrant labor and colonialism give you AIDS.
    4:42 Mary Bassett is sad that white people didn't get AIDS.
    8:35 As the New York City's health commissioner, her job is to care only about people of her own color.
    10:50 Black lives matter more then other people's lives.
    12:18 Mother is not responsible for her child's health.

  26. Important, valuable, meaningful presentation about real and difficult existing challenges, tragic and full of need to be strong.

    This, lightened with a nice dose of comic relief provided unwittingly and gratuitously by 2600+ and counting infantile dimbulbs who see "social justice" in the title and immediately turn down even further than their baseline functioning on all relevant faculties of mind, heart, sense, and imagination…and especially this parody band fronted by the relative few handful of them who can actually function well enough to string two words together at a time and eventually form a sentence that is somewhat intelligible to higher functioning sapient beings, who nevertheless do so in perfect self parodying tragicomedy exemplification of just what their boggle is.

    So, bravo on two fronts — TED for keeping on what they have started from the getgo, and the hecklejeckle crew for providing the muppetlike source of chuckles even in the face of all this dark reality that the more mature among us actually must face in the real world.

  27. I guarantee that almost all of those that disliked this video didn't watch it through – they just saw the words 'social justice' and hit the thumbs down button. I'd love to see data on how long people watched this video compared with other TED videos of similar lengths.

    Also, do this many people really believe that institutionalized racism and gender discrimination doesn't exist, at all? That it doesn't subconsciously affect how people, including themselves, act? It's ironic, in a way – the people who believe it isn't real are the ones whose thoughts and actions have been most affected by it.

  28. It is sad that that people like this exist. She clearly
    wants to help people but is still in an racist and regressive mindset that
    prevent her from seeing the actual problems.

  29. Bye bye TED…you used to be GOOD, but more and more, you are just becoming another platform for progressive bullshit.

  30. I believe every parent wants the best for their child and if they cannot provide it then it is likely that their environment has a great deal to do with it. I agree with this TED speaker she acknowledges that many health issues are outside doctors or patients hands. They are down to the systemic inequalities which make people unable to access the best possible lives. Inequalities lead to health disparities. Systemic racism within the US leads to worse health for those who are poorer and disenfranchised.

  31. I'd like to point out that she's doing what every other person talking about social justice is, and while its a noble cause to fight for equality you're suggesting we tip the scales in your favor wherever it isn't. See, there's several benefits to every race or both genders, transgendered people or what you morons refer to as "cisgenders" in an attempt to offend people. Every type of person get these advantages and disadvantages at birth and, while law should treat them equally, people won't ever treat them equally and if you give them more rights than white wo/men you cause more problems for this balance than you realize. You have to take into account that what you're suggesting gives no actual statistics and will only shift oppression and you're asking a country that's majority is white to stop favoring white people and that's the problem.

  32. Do this:
    1) Pause the video (very important).
    2) Dislike the video (do not loose your precious time looking at it: you'll end up dumber if you do).
    3) Read the comment section (you will not be disappointed).
    4) Move on…

  33. God this woman has power and these ideas. Our world is over, the lunies have been let out of the asylum and are running things.

  34. To the people use to the dumb stigma around the word "social justice" because it associated with SJWs and safe space and all that BS. This video is far from that, its actually about something serious for once, please watch before commenting.

  35. The main issue
    which you are focusing that racism is the cause of the health disparities. I respectfully
    disagree because I don’t think there is racism in the health care system. When
    the patient is sick and goes to the hospital, the main question asked is about
    their health problem. No doctors and nurses ask for race and class. No
    treatment is provided on the basis of their race. No patients are ignored. All
    the patients are treated with respect and same treatment. Doctors have their
    professional ethics regarding patient care. Patients are not biased in any
    condition rather they are supported as per their need. Health care
    professionals believe in the good outcome of the patient and gives advice on
    how they are more benefitted. Legally every people have right to health care
    services. So, there is no discrimination in the health care system

    The
    epidemic of AIDS which is mentioned in the video is not the cause of the
    racism. Neither the AIDS patients are neglected nor the social injustice is
    responsible for it. I think poverty is cause of all the health problems in the
    black Americans not due to race. This video would be effective if it was not
    about the racism and social injustice but about the poverty which is causing
    the health problems and the remedies for it. Thus, there is a social justice
    and racism is not cause for the health disparities.

  36. Mary Bassett needs to be reminded of the root cause of the AIDS and Ebola pandemics that she speaks of — which is humans having direct contact with, and interference in the non-human animal world. It's not just about injustices to humans . It's karmic in that what we do the animals we do to ourselves. Thus not being dismissive of the massive slaughter of chickens in the ritual of Kaporos on public streets which violates several health code violations , as well as animal agriculture across the board. If she was really on the ball, she'd care about animals as well as humans, and be sounding the alarm for the vegan imperative. Courage Mary, yes courage — to not sell out for political expedience. We are in real trouble with health commissioners like you.

  37. If Mary Bassett cares about social justice, then why is she ignoring an atrocity that she, as the Commissioner of the NYC Dept of Health, has the power to stop. The health of some of NYC's poorest residents is needlessly jeopardized because Commissioner Bassett refuses to enforce multiple health codes that are violated during a mass ritual animal slaughter that takes place on public streets. She and the DOH turn a blind eye to the illegal pop-up slaughterhouses and the blood, body parts and feces of thousands of dead and dying animals because the people who perform the ritual represent a powerful voting bloc. Google "Mary Bassett" and "Kaporos" to read out this atrocity and betrayal of public trust.

  38. These comments. Sad, and y'all call yourselves doctors. You really don't give af about people. Just the money that come in

  39. Added for: If a major network on YouTube (THIRTY ONE AND A HALF MILLION SUBSCRIBERS on all of their channels) can't make smart decisions, but some guy like me who acts like a cop while sitting on his bed (with not even a proper computer chair) can, then something's wrong. At least have ONE video from the other side's perspective (even as an April Fool's prank).

  40. Reading the comments and the number of dislikes just proves the notion that the privileged will never accept the reality

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