Unequal Treatment

These past two days I’ve been at a summit on race and equity. Specifically, A Call to Government and Community. The conference goes across spheres and participants represent housing, justice, immigration, education, the arts, and health. It has been full of stories and ideas –ideas that I agree with and ideas that I don’t agree with. Overall, I feel privileged to be a part of this conversation.

Taking ownership for my part in racism is not easy. There are times when I think “Well, I didn’t do that” or “I don’t think that.” But, as difficult as it may be for me to admit it, I am part of a bigger picture that benefits white people.

In a piece called “When white people don’t know they’re being white” Jody Fernando says this:

When white people don’t recognize how our position of cultural dominance influences us – when we don’t know that we’re being white – we can be like bulls in a china shop, throwing everything in our wake askew without even realizing what we’ve done. For us, this understanding begins with learning a perspective of cultural humility and seeking to understand another’s experience without judgment.  May more of us boldly begin to walk on this long and winding path.

Part of what the last two days have been then, is a soul-searching on what this means to me personally and professionally.


In 2002 the Institute of Medicine released a report called Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care.

The report was a landmark study that documented the disparities that racial and ethnic minorities experience even when their insurance and income are the same. Prior to the study, many thought that the narrative of disparities verbalized by both patients and health professionals was just that – a narrative. Or they thought that it was about health care access. The conventional wisdom was that if you give a person health care access the disparities will go away.

In fact, they found this to be categorically false. In compiling hundreds of studies across the nation, documented disparities were found in almost every area of health care. The results were absolutely clear: Racial and ethnic minorities get poorer quality of health care then white people. Here are just a few of the disparities that were found:

Cover of "Unequal Treatment: Confronting ...

  • Receipt of appropriate cancer treatment
  • Pain control – Minority patients more likely to be under-medicated for pain than white patients (65% vs. 50%), more likely to have severity of pain underestimated by physicians
  • Mental health services – “plagued by disparities.” One study indicates 44% of White English speakers to 27.8% of Blacks received treatment after a diagnosis of depression.
  • Heart procedures – including bypass surgery
  • Diabetes – from diagnosis to amputations disparities were found in diabetic care
  • Pediatric Care – Less satisfaction, cite poorer communication, perception of lack of response

It is a thorough report that shows many factors contributing to these disparities, some of which are stereotypes, unconscious bias, and lack of cultural competency. The report gave a number of recommendations and also demonstrated that we have a long way to go to provide equal treatment for the minority populations in the United States.

And that brings me to Tuskegee. 

Between 1932 and 1972 the public health service of the United States enrolled 600 poor, black men into a study to document the effects of untreated syphilis. Approximately 400 of these men had syphilis before the study began. The men enrolled thought they were receiving free health care from the government and they were promised food, burial insurance, and medical care for participating in the study. They were merely told they had ‘bad blood’ and were never treated for the disease. In the early 1940’s Penicillin had become a standard and effective method of treatment for the disease. None of these men received penicillin, in fact – treatment was never offered for 40 years. The study is known as the infamous Tuskegee Syphilis Experiment.

It has been 42 years since Tuskegee and to this day, it is difficult to get African Americans to participate in research studies. It does not take a rocket scientist to wonder why.

It was 30 years after Tuskegee that the report Unequal Treatment was released.

“For a serious offense,” writes psychiatrist Aaron Lazare “such as a betrayal of trust or public humiliation, an immediate apology misses the mark. It demeans the event. Hours, days, weeks, or even months may go by before both parties can integrate the meaning of the event and its impact on the relationship. The care and thought that goes into such apologies dignifies the exchange. For offenses whose impact is calamitous to individuals, groups, or nations, the apology may be delayed by decades and offered by another generation.”*


I am a white woman. Anyone who reads this blog and has seen any pictures knows this. I did not grow up in this country and did not think about race – ever. I was raised as a privileged white minority in a country that still had memories of British occupation where whites ruled and were regularly sent to the head of the line. I now work as a nurse in public health with minority populations and regularly confront issues of racism and unequal treatment in health care.

The disparities that happen in health care have historically been wrong. The disparities that occur these many years later are wrong. There is no other word for it. They are wrong and a corporate apology is in order.

And I want to apologize. It doesn’t matter that I was not involved with Tuskegee. It doesn’t matter that I was not one of the care givers in any of the studies documented for Unequal Treatment. What matters is that I am part of a health care system that has routinely discriminated against people because of their color; a system that has treated people unequally based on their outward appearance, not their presenting symptoms.

To use some of the words of Aaron Lazare who I quoted above – these offenses were calamitous to individuals, to groups, to our nation as a whole.

In Notes from No Man’s Land, author Eula Biss talks about being a teacher at a public school in Harlem. A young boy a foot taller than her hissed at her in the hallway. As she sat in the principal’s office, waiting while the principal went to “hunt him down,” another kid stepped into the office. She writes the following about the interaction:

“I’m sorry I sexually harassed you.” I stared at him. He wasn’t the same kid. “But it wasn’t you.” I said finally. “Yeah,” he said as he pulled down his baseball cap and started to walk away, “but it might have been my cousin.”*

So today, as the conversation on race and justice is at the forefront of my mind, I borrow from the last sentence of Eula’s book. I apologize for the unequal treatment that is a present part of our health system. I apologize for Tuskegee. Because no – it wasn’t me — but it might have been my cousin.

*As quoted in Notes from No Man’s Land by Eula Biss page 189

Note: this blog post was adapted from a piece written in February, 2014

2 thoughts on “Unequal Treatment

  1. Thank you for this piece, Marilyn. As you well know, the “race issue” has been a problem in the United States for hundreds of years, and will likely outlive you and all of your readers; but I believe that slow, steady progress *is* happening, and I believe that your blog entry above is another small part of the healing.
    People like you (and me), who have been overseas and have experienced – and enjoyed – other cultures, and spent treasured time with people of other races – and people who are able to attend summits on race and equity – they (we) have an unfair advantage in beginning the understanding of what it is like to not be white, and what privileges we take for granted as white Americans. Like starting a marathon an hour before everyone else gets to start.

    So this comment is aimed at people who haven’t had our advantages; and to people who have been told that their white-ness makes them blind to the problems faced by non-white minorities. And that they will never see what a black person (for example) has to deal with. That is a hurtful thing: to be told that your color makes you blind to certain facts of life, and – again, because of your color – you will never really know what life is like for people of other races. I am white, and I have had those things said to me; and I have been bothered by the seeming reverse-racism of being confronted with this “fact”.

    So here is my (hopefully helpful) suggestion:
    If you live within driving distance of Memphis, Tennessee – or maybe will be passing by there on a road trip this summer – please consider visiting the National Civil Rights Museum in the city. From Wikipedia: The museum is built around the former Lorraine Motel, where Reverend Martin Luther King Jr. was assassinated on April 4, 1968.

    A particularly good reason for you to visit this specific site is that from 2012 to 2014, a lot of money and effort were spent to turn this historic site into a very well-done cultural information center. There are so many excellent exhibits: you can crouch uncomfortably with slave-statues in the hold of a ship, and imagine what it was like for human beings to spend months forced to maintain an uncomfortable squatting position on the way to America, as their family members died of disease and starvation next to them; you can stand in a cell just like the one that Dr. King was imprisoned in, for fighting for rights that white people already had. You can cross a replica of the Edmund Pettus bridge (from Selma, Alabama) imagining that you are carrying a sign reminding people that you might not be white, but you are still a man.
    There is also a disconcerting design to the building that makes the exhibits somewhat claustrophobic – you do (intentionally, I believe) feel like you are going through a long tunnel without light, and unnerving sounds (like an actual recording of civil rights protesters being beaten) are played via carefully hidden speakers – with a noticeable psychological effect. My wife Julie has a fear of underground spaces and she had to leave the museum to catch her breath about half-way through.

    But my suggestion for white people to help themselves see outside their “white-ness” is not just going to a museum and looking at the exhibits. I haven’t found a better place than the National Civil Rights Museum, but I doubt it is enough. So, here is the extra step: Early in the tour there is a statue of a slave woman with a baby, standing on a crate and being auctioned off by white slave trader. Look at that woman – and see your grandmother. Look at the baby and see your father, before he learned to talk. Look at the man carrying the “I am a man” sign and see your uncle or brother. Cross the bridge and hear the sounds of your pastor and church choir being beaten. Look at the crouched slaves and see your great-grandparents and your grandfather’s brother, who died pointlessly half-way through the voyage, sitting next to them. Sit in the cell with your grandmother, who spoke out against her child being strung up by an ignorant white mob.
    The pictures on the walls of the museum don’t show “black people” enduring hundreds of years of abuse; they show family members – mothers, fathers, brothers, sisters, sons, daughters, grandparents. Imagine them being yours. It will be a little easier to see outside one’s white-ness after that.


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