CardioExchange Archive

In a 1966 interview for CBS News, Martin Luther King, Jr., described a riot as “the language of the unheard.” King believed that nonviolence was the path to change, but he also knew that unrest in America’s urban communities is a symptom of economic inequality and of the unequal treatment that too many black men, women, and children in our country face.

This week’s events in Baltimore (and in other cities this past year) have given me greater insight into the constant state of vulnerability that many of our black brothers and sisters feel every day. The anger and frustration expressed in both nonviolent and violent protests in Baltimore reveal a hard truth: A growing number of our fellow citizens, especially if they are black, feel unheard, unseen, unrecognized — invisible.

What happened in Baltimore goes beyond policing. It has more to do with growing, systematic inequalities that disempower large swaths of our population. Young black men, especially, face a toxic combination of racism, poverty, economic inequality, and injustice — in an environment where many leaders cannot even agree that a minimum wage of $7.25 an hour is unlivable and that healthcare should be a universal right.

As members of a community of physicians and researchers, we would be foolish to treat patients in a vacuum, without awareness of the social, economic, and political determinants of health. Poor patients with chronic conditions of heart failure, end-stage renal disease, or COPD are hard-pressed to be “compliant” with their treatment regimens, given their many competing priorities.

Last year, after attending the American Heart Association’s Quality and Cardiovascular Outcomes (QCOR) conference in Baltimore, a dozen of us stayed on to volunteer at the Bea Gaddy Family Center, a multiservice center for homeless families and other people in need of food.  The director, Cynthia Brooks, eloquently explained that health is often the fourth or fifth priority for many of the center’s clients, who contend each day with finding food, shelter, safety from drug violence, and jobs.

I called Cynthia the day after the Baltimore riots, which occurred within one block of her center.  She was saddened by the damage and the loss, noting that most Baltimore residents were horrified at the violence in their beloved city. Anger at the death of Freddie Gray was warranted, no doubt, but looting and arsons only worsened the social and economic climate in blighted areas of Baltimore. The torched CVS stores were used by many poor residents to shop for food and needed medications, especially in sections that are “food deserts.” Other CVS stores in the area were temporarily closed, further depriving poor residents of this central source of food and medicine. The implications of the riots are clear — fewer jobs as shops are closed, longer distances to walk or take a bus to get basic necessities, and the likelihood of even less future economic development in the poorest parts of Baltimore.

When I asked Cynthia what the local community needs most, she did not discuss the issue of policing. Her response was quick and clear — the critical need for mentors for Baltimore’s youth. She explained that many young people in the area have no relationships with anyone outside the blighted sections of their city — so, for them, hope is an illusory concept, and many have simply stopped pursuing their dreams.

If every child had a big brother or sister, if every teen had a mentor who was employed in a stable job, Cynthia explained, it would transform Baltimore by breaking down walls of division between rich and poor, black and white. It would allow residents who live outside the inner city to move from viewing residents in poor parts of East and West Baltimore as “the other” to seeing them as civic partners. Bonds would be forged, friendships built, and relationships sustained so that each would understand the other better. Cynthia acknowledged that mentors are only a first step, but nonetheless a vital one in giving employers and businesses the courage to double-down on bringing economic development to blighted parts of Baltimore, thereby benefiting the entire city.

The socioeconomic and political determinants of health have been well studied by physician researchers, social scientists, public health experts, and policymakers. As a physician, I believe that we are in a unique position to be mentors for disadvantaged youth in our cities. Many of us also have important civic and business connections, and we should work hard to engage business leaders in thinking creatively and courageously beyond the usual profit motive.

If we can build relationships as big brothers and big sisters, if we start conversations on both sides of the economic divide, if we encourage businesses to see investments in poor communities as an opportunity to make a fair profit while paying fair wages, we will give our poorest patients a better chance to remain healthy and lead a full life. In doing so, we can move from decrying the riots as destructive to promoting constructive peace for people who feel unheard and powerless.

JOIN THE DISCUSSION

What role do you think physicians should play in areas with great economic challenges?