Central PA Medicine Summer2020 - 21

daup h i n c m s .o rg

WHITE PRIVILEGE DESPITE
POVERTY
Being White enabled me to get an education in an adequately funded public schools
and have adequate spacious housing. Being
White enabled me to walk in a store without
being eyed suspiciously or people around
me thinking I was up to no good. My seven
siblings and I went to the physicians' and
dentists' offices when it was emergent or
urgent but not for routine care because
of scant to no insurance. We did not get
vaccinations because they were considered
too expensive and/or unnecessary by our
parents. When you have eight children in
eleven years, you tend to be poor. We were
hungry and ate sometimes rotten vegetables
and fruits as well as food surplus items. The
rotten fresh produce, when available, was
consumed because we were hungry and
had no choice if we wished to eat. I did not
eat cheese for many years because of the
semi-rancid taste "surplus cheese" had. My
parents and none of the eight children had
run-ins with the law while we were living in
the family home. We children knew there
would be no bailouts. I imagine if there
was a run-in with the law, a way to aid us
would have been found, unlike my Black
and brown citizens who likely would not be
able to do so. I am glad none of my family
tested the judicial system, but we weren't
subject to arrest because of our skin color
or being from the wrong part of town. I
went to college and medical school all the
while working and using scholarships and
loans. I had White privilege.

POPULATION DENSITY
AND ASTHMA
Let examine the reasons for this shocking
difference. Population density allows more
efficient spread of infectious disease. Asthma
rates are higher in densely populated areas
because of pollution, cockroach and other
SOCIAL DETERMINANTS
pest infestations (insects will go where they
OF HEALTH
find food more easily with higher populaMuch of these ills can be largely explained tion density making that more likely), and
by social determinants of health as only noise as well as other stressors. If there is
22% of an individual's health status is eosinophilic asthma which can be difficult
explained by genetics and biology and 7% to control, a widely advertised new drug
by medical care whereas the remaining 71% (anti-interleukin-5 receptor-alpha antibody)
is external. Some physicians recognized has been effective but horrifically expensive.
that poor people lived shorter and sicker The drug has an average wholesale price of
lives. Not until the early part of the twen- $5963.02 a dose requiring repeat injections
ty-first century was there any systematic every 8 weeks after an every 4-week series
categorization of the externals. In 2003 times three. My argument is for better
the World Health Organization Europe housing and less pollution of air. This would
suggested social determinants included be cheaper than the ongoing $6000+ outlay
stress, early life, social exclusion, work, every 8 weeks. It probably would make the
unemployment, social support, addiction, rest of the family healthier as well.
food, transportation and the social gradient.
In 2011 the World Conference on Social ADVERSE CHILDHOOD
Determinants of Health had 125 delegations EXPERIENCES
create the Rio Political Declaration on
Adverse childhood experiences are related
Social Determinants of Health. It called to poorer health in childhood and reaches
for new policies across the world to fight into adulthood. There have been numerous
health disparities and encouraged global studies through American Academy of
collaborations. Social determinants of health Pediatrics (AAP) and American Academy
are part of recent medical school curricula. of Family Practice (AAFP) validating these
Yet are we doing better when it comes to observations. If you live in a crowded neighthe care of our Black population? We are borhood where illicit drugs and violence
not. I am going to argue we all must do abound, you are more likely to have an
better with most of the better outside the adverse childhood experience. Poor parexam, office, clinic or hospital room.
enting patterns get repeated in subsequent
generations. Child abuse and the heinous
BLACK LIVES MATTER
ZIP CODES, LONGEVITY AND
sexual abuse and exploitation cross all colors.
When we hear Black Lives Matter, what HOUSING DENSITY
But crowding gives more opportunity for
do we hear deep inside us? We should hear
Zip codes are linked to longevity and density adverse childhood experiences. Imagine
the stories of people of color who were of housing. In Massachusetts where the rate of the horror of seeing a neighbor, friend, or
kidnapped and enslaved by our ancestors health insurance is the highest in the nation, family member being beaten, raped, or
and continue to have multiple barriers Boston, Massachusetts has startling differences murdered by others − sometimes even the
today. Most Whites do not have those in longevity based on zip code and in just a police who are supposed to be protectors.
barriers. Enough is enough!
nine-mile distance. A resident of Roxbury Imagine this if you have no words or voice
which is predominantly Black and has Boston's as many young children do not have. We
The color of your skin should not deter- highest density of population has an average must do better.
mine your destiny but here in the United life expectancy of fifty-nine years while the
States of America it often does. Your skin resident of Back Bay has a ninety-two-year
Continued on page 22
color often determines where you live, go to average life expectancy. That is thirty-three
school, shop for food and other items, get years less for the resident of Roxbury.
or even find health care, find employment
and type of job, how you are policed and
sometimes even if you live. SARS-CoV2
(COVID 19) and the recent deaths of
George Floyd, Breonna Taylor and too
many others by police actions should make
us hear Black Lives Matter.

Central PA Medicine Summer 2020 21


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https://www.nxtbook.com/hoffmann/CPAMed/CPMSummer2020
https://www.nxtbook.com/hoffmann/CPAMed/CPMSpring2020
https://www.nxtbook.com/hoffmann/CPAMed/CPMWinter2020
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https://www.nxtbook.com/hoffmann/CPAMed/CPMSummer19
https://www.nxtbook.com/hoffmann/CPAMed/CPMSpring19
https://www.nxtbook.com/hoffmann/CPAMed/CPMWinter19
https://www.nxtbook.com/hoffmann/CPAMed/CPMFall18
https://www.nxtbook.com/hoffmann/CPAMed/Summer2018
https://www.nxtbook.com/hoffmann/CPAMed/CPMSpring18
https://www.nxtbook.com/hoffmann/CPAMed/CPMWinter18
https://www.nxtbook.com/hoffmann/CPAMed/Fall2017
https://www.nxtbook.com/hoffmann/CPAMed/CentralPAMedicine_Summer17
https://www.nxtbook.com/hoffmann/CPAMed/CentralPAMedicine_Spring17
https://www.nxtbook.com/hoffmann/CPAMed/CentralPAMedicine_Feb2017
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