Forty-four years after Lyndon Baines Johnson signed the Civil Rights Act, egregious racial and ethnic inequities persist in health status and health care. As vigorously documented by the Institute of Medicine’s sentinel 2002 report, Unequal Treatment, the life-expectancy gap has widened by race, with blacks living five years less that whites on average. Closing this gap will take nothing short of a Health Rights Movement—a sweeping social revolution bearing some of the hallmarks of the Civil Rights Movement.
Now as then, leadership matters. Your administration can appoint visionary health champions to lead your health agenda: the U.S. surgeon general, secretary of Health and Human Services, directors of the National Institutes of Health and U.S. Centers of Disease Control and Prevention (CDC), and the medical leadership of the armed forces. For models, look to two former surgeons general: C. Everett Koop, who moved HIV/AIDS from the shadows to the spotlight, and David Satcher, one of the first to embrace mental health as an integral part of public health.
Another key ingredient: Funding that empowers the very people most impacted by disparities to come up with solutions. The CDC’s AIDS Community Demonstration Projects (1989 to 1994) led many groups to adopt HIV risk-reduction practices, meanwhile strengthening the effectiveness of local agencies and activists. Another stellar example of harnessing the participation of ordinary people lies in the National Institute for Environmental Health Sciences (NIEHS) under Kenneth Olden, the first African American to lead any National Institutes of Health agency. Olden hosted regional town meetings to solicit citizens’ ideas and engage them in research studies. Today, disadvantaged communities have greater protection against environmentally linked health problems, from which they suffer disproportionately. Today, building community partnerships is a priority within NIH, a practice your administration should expand.
In addition, your administration can foster consumer action by funding constituency-building and health-advocacy training through organizations ranging from the venerable National Urban League to Mothers Against Drunk Driving. Activist groups build the pressure necessary for change. We need to support disenfranchised groups who are willing to stand up—the Rosa Parkses of health—and unite against the over-marketing of tobacco, alcohol, and junk food to poor communities of color, health education classes that omit key information for teens, and street violence that makes outdoor exercise unsafe.
To redress racial and ethnic health inequalities, we’ll need a transformation of society that can only be generated from the top down and the bottom up. By fostering a Health Rights Movement, your leadership can create healthier living conditions and quality health care for all.