Last Updated on January 18, 2024 by BVN
Breanna ReevesÂ
As communities commemorated Dr. Martin Luther King Jr.’s birthday on Jan. 15 by observing the federal holiday, it’s important to recognize King’s legacy and examine what’s been accomplished since his death, and how much work is left to achieve.
Dr. King is notably famous for several speeches he gave throughout his life, including a speech he delivered in 1966 during a Medical Committee for Human Rights Convention in which he addressed health injustice.
“Of all forms of discrimination and inequalities, injustice in health is the most shocking and inhuman,” Dr. King said.
Today, nearly 60 years since King delivered these words, health injustice continues to persist, upheld by the “pathways” through which oppression produces health disparities: population, place, and power, according to Angela P. Harris and Aysha Pamukcu, authors of “The Civil Rights of Health: A New Approach to Challenging Structural Inequality.”
In their paper, published in University of California, Los Angeles’ Law Review, the authors assert that oppression based on race, gender, class, citizenship and sexuality, among other differences, is a “central driver of health disparities.”
Recent reports, research and data have demonstrated that many of the factors pointed out by Harris and Pamukcu do impact quality and access to health, like population, for example. During the start of the COVID-19 pandemic, data from the U.S. Centers for Disease Control (CDC) showed that communities of color experienced higher rates of COVID-19 cases and deaths than white people, when adjusting for age by race and ethnicity.
Another driver of health disparities the authors address is place. They acknowledge that where a person lives and what resources they have access to plays a large role in shaping their health and their quality of life. CDC data from 2010-2015 showed how life expectancy at birth by state and census tract vary greatly across California and even within the same county.
A zip code map created by Quartz showed that from one end of Riverside County to another, the life expectancy gap varies as much as 10 years. Based on the CDC 2010-2015 data, the county’s average life expectancy was 70 years old, but in western parts of the county the life expectancy is 73 years of age compared to 86 years in the eastern part of the county, in cities like La Quinta, for example. Even the neighboring zip code in the region of Desert Hot Springs, next to La Quinta, has a lower life expectancy of 73 years of age.
“We are interconnected in ways that I think the pandemic really brought to light, in the sense that, in a very real way, we are only as healthy as our least healthy neighbor.”
Aysha Pamukcu
In order to address health inequalities and achieve health justice, “understanding the [oppression] to be at the root of social determinants of health holds the potential to transform both public health and civil rights advocacy,” the authors wrote. Social determinants of health include the factors that impact a person’s health including where they live and work, their job, whether they have access to transportation and a host of other factors.
During the COVID pandemic, public health officials in Riverside County hosted large vaccination and testing sites, hoping people would come and get vaccinated. However, they didn’t realize that some community members don’t have transportation to get to the sites or the means to register to be vaccinated.
“What we’d kind of failed to realize in those moments is that each community is so unique, with such different needs, that we almost need to slow down, or else we’re gonna have the opposite effect,” explained Salomeh Wagaw, health equity program director at Riverside Public Health.
“Instead of saving additional lives or providing what we think are resources for all in an equitable manner, we’re actually kind of doing the opposite.”
Achieving health equity requires recognizing that the needs of the community are diverse and creating wide-ranging solutions that reach everyone.
“I think Dr. King really had incredible awareness of the interconnected nature of racial justice, economic justice, health justice, and that’s something that I really take inspiration in,” Pamukcu explained. “And it’s really part of the cornerstone of the civil rights of health.”
Pamukcu, who is also a health justice lawyer and policy fund director at the San Francisco Foundation, believes that one of the biggest lessons that came from the COVID-19 pandemic was understanding that individual-based solutions are limited.
“We are interconnected in ways that I think the pandemic really brought to light, in the sense that, in a very real way, we are only as healthy as our least healthy neighbor,” Pamukcu said. “We are only as safe as those in our community, who are also housed; who also have the ability to shelter-in-place; who also have the ability to work safe and stable jobs, and receive health care and vaccines.”
The COVID-19 pandemic exposed deeply rooted inequities in health, resulting in dozens of local, state and national leaders declaring racism a public health crisis. Pamukcu emphasized the idea that the way society is tainted by racism “has really damaging health consequences for everyone.”
A year after Dr. King addressed health injustice at the medical convention, he went on to give a sermon that encouraged people to understand how interconnected they are.
“It really boils down to this: that all life is interrelated. We are all caught in an inescapable network of mutuality, tied into a single garment of destiny. Whatever affects one directly, affects all indirectly,” Dr. King said during his Christmas sermon.
Embracing King’s health justice philosophy
Applied to health justice, Dr. King’s philosophy advocates for an all-hands-on-deck approach to addressing health disparities. Similarly, the authors assert that developing a civil rights approach to health will call for a collaboration between social justice leaders, civil rights lawyers and public health officials.
“We felt that that partnership between those three groups could be really powerful and transformative,” Pamukcu explained. “And part of the reason that we aim to include social justice movements in our civil rights and health framework, is we really realized that social justice movements are the engines for social change. Those are the folks who can expand our imaginations of what’s possible.”
Across the Inland Empire, local leaders and social justice advocates are working to address health inequality in their own communities. Environmental justice organizations like Center for Community Action and Environmental Justice call attention to the health impacts of the booming warehouse industry in predominantly Latino communities. Reproductive and maternal health advocates across the region work to tackle access and equitable treatment to Black birthing people through education, training and policy.
In agreement with the authors, Wagaw explained that while public health has had a great impact on health-related policies, it will take a multifaceted approach to make permanent system changes.
“When we think about health being a human right, there’s always going to be some sort of policy in place that’s systemically and historically almost having the opposite effect of what public health itself as an entity is trying to address and approach,” Wagaw said.
According to Mara Youdelman, director of federal policy at the National Health Law Program (NHeLP), strong civil rights laws already exist, but there is a lack of understanding and education among public health and health providers.
“We lack sufficient funding for the federal government to do effective implementation and enforcement,” Youdelman stated in an email. “We lack the will to spend the resources and time to ensure that a civil rights approach is imbued throughout the healthcare system, so that every decision made is made from a civil rights approach.”
As a civil rights and health lawyer at NHeLP, much of the organization’s work is rooted in a civil rights approach and has always been as they focus on the Medicaid program and review new legislation as it impacts historically underserved communities.
Youdelman believes a civil rights approach would take a hard look at the U.S. healthcare system and “identify all the problems encountered by people of color and actively work to solve them.” This approach includes examining staffing practices, requiring cultural competency training, accessibility to health facilities, providing language services, among a host of other factors that impact health care.
Over the last few years grappling with the COVID-19 pandemic and exposing and addressing bias in health, many strides toward addressing and reforming structural health inequality have been taken, but there’s still much work to do to reach health equity.
Dr. King’s approach to civil rights left a lasting impact on generations that followed, but perhaps one of the most important lessons of his legacy is endurance. In many of his speeches, Dr. King referenced the importance of enduring the fight for racial, economic and social justice.
“Now let us go out to stick together and stay with this thing until the end. Now it means sacrificing, yes, it means sacrificing at points. But there are some things that we’ve got to learn to sacrifice for,” Dr. King said in a speech during the Montgomery Bus Boycott. “And we’ve got to come to the point that we are determined not to accept a lot of things that we have been accepting in the past.”
This article is published as part of the Commonwealth Health Equity Reporting Fellowship.