Health effects of inequality

Poster of Mary Bassett with words "the big three"

February 6, 2019—Mary Bassett became director of the François-Xavier Bagnoud (FXB) Center for Health and Human Rights and François-Xavier Bagnoud Professor of the Practice of Health and Human Rights last September. She previously served as commissioner of the New York City Department of Health and Mental Hygiene from 2014 to 2018.

What interested you about the position of FXB Center director?

The FXB Center allows me to bring together commitments that I’ve had throughout my working life—improving the health of populations and understanding that inequality is a threat to people’s health.

These ideas were part of the origin of FXB as a center for health and human rights. [Founding Director] Jonathan Mann clearly articulated that the HIV/AIDS epidemic is related to disenfranchisement and marginalization. It was a very important case to make, and it remains a unique perspective in public health.

I’m excited about being the Center’s fifth director. My hope is to build on its accomplishments and current work, and also to develop new areas of focus.

What are your goals and priorities for the Center?

For me, the purpose of public health is practice. The FXB Center is well-positioned to serve as a place for research that can be applied to advocacy as well as to build the knowledge base.

I would like to see us do more work like the recent study on the true death toll in Puerto Rico from Hurricane Maria. A team that included Satchit Balsari, a research fellow at FXB and associate professor in emergency medicine at Harvard Medical School, and Associate Professor of Epidemiology Caroline Buckee revealed that despite the government’s initial claim that there were only 64 deaths from the storm, thousands more may have died in the months that followed from loss of infrastructure and access to medical care. Their work will help policymakers plan for the true scale of devastation from this kind of event.

Addressing structural inequality is another very important priority for me. Many challenges that create humanitarian crises are related to this type of inequality—for example, migrants fleeing because they have no future in their country. This is an area where I’d like to see us include more of the domestic as well as the global in our work.

We held a seminar in December on the Department of Homeland Security’s proposed rule change around the regulation on “public charge”—a term used to describe immigrants who primarily rely on public benefits. Currently, only those who need cash assistance are considered a public charge and could have visa or green card applications denied. But, under the new rule, a much larger set of benefits would be included in this eligibility criteria, including non-emergency Medicaid, Medicare Part D low-income subsidy, and SNAP (food stamps). Confusion about this policy may affect more broadly immigrants’ use of social services, because of fears of being deported if they use their benefits.

Another domestic issue we are taking on is the opioid epidemic. We have launched a collaboration with the University of Michigan, at the request of Dean Michelle Williams and Harvard President Lawrence Bacow. Two symposiums are planned next year—in Michigan in May and in Massachusetts in October. The one we will host will focus on stigma and access to treatment, and I hope that it will generate steps for action.

What are some of your formative experiences in public health?

My pathway to public health really began when I was a resident at Harlem Hospital in the early 1980s. I came to realize that the problems my patients were facing were not ones that I could solve inside the hospital.

After that, I joined the medical faculty of the University of Zimbabwe, during a time when the country was consumed by AIDS. That experience was surprisingly relevant to my job as commissioner of the New York City Health Department. Once again, I was dealing with a leading cause of death—in this case, chronic disease—that was experienced differently by populations based on race and income. We kept a focus on equity even as we responded to an outbreak of Legionnaire’s Disease and the threat of the Ebola and Zika viruses. This meant listening to affected communities and making it clear that city government would not tolerate any populations becoming stigmatized. FXB has used similar approaches.

I’ve always been outspoken about the need to see structural racism as an antecedent to the social determinants of health. The fact that communities of color are more likely to face adverse circumstances—such as low-wage jobs, poor quality housing, and lack of access to healthy foods—is not talked about enough. There’s a level of discomfort about using the word racism. But I feel very strongly that we need to describe these issues as they are.

Amy Roeder