OP-ED: 8 minutes, 46 seconds …

As I took a knee for 8 minutes and 46 seconds on Friday to protest the brutal killing of George Floyd by police, I thought about the adage of “think global, act local.” Eight minutes and 46 seconds doesn’t seem like a long time until you are kneeling on the concrete, thinking about how long it must have seemed to Mr. Floyd, terrified, living out the last minutes of his life, prone, pinned down under another man’s knee. It was enough to think about how I can step up and use my own privilege as a white physician to create change.
The ongoing disenfranchisement and killing of black people is a public health crisis that all physicians, and indeed all persons, should feel compelled to counter. Though slavery ended, its effects continue to linger in social determinants of health, which are disproportionately impacted by race. Things like where people are born and grow, their socioeconomic status, education, community, support systems and access to healthy food choices account for over 50% of their health. This includes what diseases they are at risk for, how well-controlled their diseases might be, their access to quality care, how long they live, and what they die of. Children born just 5 miles apart in Philadelphia have a 20-year difference in their life expectancy because of factors like these.
These social determinants of health are stacked against black people, and it starts at birth. Black infants are more likely to die than white infants. Black people have less access to healthy food and neighborhoods, and are more exposed to air pollution. Despite the official desegregation of schools, black children typically attend predominantly minority, more poorly funded schools with fewer opportunities.
These factors cannot be divorced from the violence and poorer health outcomes to which they lead. Black people are arrested and incarcerated at higher rates and receive stricter sentences for the same crimes, and like George Floyd, Breonna Taylor, and so many others, many will die at the hands of the police.
They have higher rates of obesity, diabetes, and other chronic diseases, and they are less likely to receive recommended medical care. We are seeing this play out with the coronavirus pandemic, in which black patients are more likely to die. Medicine, far from being able to combat these inequalities, aids them in persisting. Implicit bias is a recognized problem in medical education, and black people are under-represented in medical training.
The U.S. has a long history of racism, but no single group has faced the sheer number or size of hurdles that black people have. Black Americans face immense societal and institutional inequalities. We must educate ourselves and our communities, call out racism when we see it, step up as allies for people of color, and work to find solutions to the roots of the problem. This includes ending police violence, eliminating food deserts, increasing educational opportunities, mitigating the impact of pollution, combatting implicit bias in medicine and other institutions, ending the over-policing of minority communities, and increasing the representation of people of color in all leadership roles.
As a physician it is my duty and privilege to care for all people regardless of their race, ethnicity, linguistic background, ability, gender identity, political opinion, sexual orientation, national origin, or any other characteristics, while still keeping in mind the disproportionate risks, discrimination, and health disparities faced by certain patients. Each one of us has a duty to get involved in our local community; by acting locally all across the nation we can force larger change and accountability so that our children and grandchildren aren’t still demanding that we recognize that Black Lives Matter.
Anna-Binney McCague is a local internist and pediatrician.