Who decides who is worthy of living?
By Michelle Molitor and Nicole Young
I went down a dark rabbit hole recently reading everything I could about eugenics and the 1918 flu pandemic.
Tuba City Regional Health Care Center CEO Lynette Bonar wears a mask April 14, 2020. The hospital on Navajo Reservation in Arizona has seen a spike in COVID-19 cases.
Source: USA Today
Image: Michael Chow/The Republic
I was curious because in every part of our country where data is being recorded and disaggregated, racial disparities have emerged that look eerily similar to those at play in 1918.
Today, Black people are dying of COVID-19 at higher rates than their peers. Indigenous and Navajo people are dying at higher rates than their peers. And while many, from the U.S. Surgeon General to Senator Bill Cassidy of Louisiana to Dr. Anthony Fauci, are comfortable scolding people for the pre-existing conditions that put them in greater danger when it comes to COVID-19, very few state or federal leaders are willing to directly address the persistent neglect Black, brown, and Indigenous Americans suffer at the hands of their healthcare providers — and the fact that this neglect is itself linked directly to those pre-existing conditions.
The resulting language of personal responsibility fails to address the root causes of what we are seeing now: systems that are not “broken,” as some might claim, but were in fact built to both disregard and profit at the expense of Black, brown, and Indigenous lives.
The rhetoric that results blames Black, brown, and Indigenous people — the groups that suffer the most direct and serious consequences of the COVID-19 pandemic — for not having the means to diagnose and treat the illnesses that could exacerbate the virus. And it is disturbingly similar to what would have been said about the same groups in 1918.
1. Ground in history.
A hundred years ago, as the 1918 flu pandemic engulfed the world and left 50 million people dead in its scorching wake, a similar, if more extreme, view of worthiness and death governed the public dialogue.
At the time, it was believed that the poor themselves were the cause of the disease. Their uncleanliness, the squalor of their living situations, and their lack of information was chiefly responsible for the ongoing spread of the disease in the minds of the press, health officials, and government leaders.
Their deaths, consequently, were an acceptable price to be paid to the virus. The pseudo scientific movement that provided the fuel for this thinking (and the abhorrent policies that followed) was called eugenics.
Eugenics was all about the valuation of human life: determining who should live and who should die. American eugenics sought to sort people based on their perceived IQ or intelligence and sterilize those people deemed “morons,” “idiots,” or “imbeciles” without their consent.
Black and Indigenous people were specific targets of eugenicists, who deemed them inferior or less than human. American eugenicists joined their thinking to Western ideologies of previous centuries that were used to justify slavery and genocide. In the early 1900s, Black doctors and health professionals were forced to establish their own hospitals and care facilities in order to ensure adequate treatment for Black patients.
American eugenics was the basis of Hitler and the Nazis’ promotion of a “master race,” which spurred the Holocaust. And as recently as 2010, state laws and U.S. Supreme Court rulings in favor of eugenics have led to the forced sterilization of Black people, incarcerated people, and women across our country.
Understanding eugenics and how its rationale is resurfacing in this moment of global chaos is essential to creating a more liberated world.
As a country, we’ve accepted the reality that to be Black, poor, and disabled puts you at greater risk of death from coronavirus. We’ve normalized the truth that an Indigenous man living on a reservation in Arizona has a higher likelihood of death from this virus than his white counterpart living in the same state.
But we can make a different set of choices about who we want to be as a society. We can reject false notions of unworthiness and ask ourselves the right questions about the disparities we’re seeing.
2. Listen to those most impacted.
If Black, brown, and Indigenous people are dying because they have higher instances of undiagnosed underlying conditions, are we interrogating why those illnesses exist in the first place? Is allowing so many of a country’s citizens to live with unidentified (and, more often than not, untreated) illnesses a personal failing or a systemic one?
Have we constructed a reality in which it is literally impossible for Black, brown and Indigenous people to receive the same level of care as their fellow citizens? And if so, how can we deconstruct something so vile?
Residents of Louisiana’s “cancer alley” have been at the mercy of big industrial plants for decades. Their water is toxic and their land is radioactive. Many are Black, Latinx, and poor, often without the means to seek out a living in places where their land and water are not being poisoned. Not surprisingly, cancer alley residents are being ravaged by this virus.
Listening to the residents of places like Reserve, Louisiana, or Flint, Michigan, those whose quality of life have been deeply impacted by corporate greed and systemic neglect, is the only path forward. We must build a healthcare system centered on those whose family members and loved ones are dying of COVID-19 at the highest rates.
At the center of this shift must be a deep conviction that every life and voice matters as much as our own.
3. Advocate for radical change.
“Why do we need a healthcare system?” Charlie Hill, President of the Hampton Roads Prostate Health Forum, asked when The Equity Lab spoke with him on April 16th, 2020. “What is it that you want to achieve? Do you want people well?” Hill challenges the notion that we are at all unified on a local, state, or federal level about what we want our various healthcare systems to achieve.
He and his wife, Golden Bethune-Hill, a registered nurse and former vice president of Riverside Health System, say we must be clear about what we want to accomplish. If we want people to be well, they say, we need to have a vision for what wellness looks and feels like for every patient at every touchpoint.
Bethune-Hill started the Newport News Community Free Clinic a decade ago to serve the mostly Black, largely uninsured residents of the 23607 area code. Black-led hospitals like Whittaker Memorial Hospital, which served Newport News’ Black residents from 1915 to 1985, are shuttered due to lack of funding access. In their absence, Black residents must rely on care that is less personal, less rooted in community, and less focused on that goal of wellness that Bethune-Hill sees as critical to effective care.
Advocating for radical change, in Hill and Bethune-Hill’s estimation, is not only explicitly naming what we want health care to accomplish, but also delivering medical care with dignity to those with the highest need.
Bethune-Hill doesn’t see the current reality of racialized COVID-19 morbidity as more important than the simmering inequity underlying it. For her, it is about caring for Black, brown, Indigenous, and other disproportionately impacted people every day: “I don’t want to see people dying because they have strokes. African-Americans are dying of strokes at rates twice those of others. I don’t want to see people having heart problems because of bad dental care.”
“I don’t want to see people dying because they have strokes... I don’t want to see people having heart problems because of bad dental care.”
4. Build and iterate.
Racialized morbidity rates for infectious diseases like COVID-19 only begin to abate when we advocate for doctors and elected officials to speak openly about racialized outcomes in health. Morbidity rates will be reversed only when we build and fund systems that serve Black, brown, Indigenous, and other disproportionately impacted people first.
We must construct systems that provide nuanced ways of helping people with transportation issues, mental health issues, etc., and then we must rapidly iterate as we learn how those interventions work.
We must entrust doctors who are closest to the most affected patients with leading the sector, ask patients what they need, and facilitate funding to meet those needs.
Fred Royal, the Milwaukee head of the NAACP, walks empty streets near his home in a largely Black neighborhood hit hard by the coronavirus. He knows three people who have died.
Source: ProPublica
Image: Darren Hauck, special to ProPublica
As Charlie Hill says, the current pandemic is “not about toilet paper; it is about fear and uncertainty."
Therefore, it is incumbent upon us to build a future in which Black, brown, Indigenous, and those most impacted need not fear that their race is a certain death sentence.
Want to learn more?
Watch PBS’s documentary Part 1: Dawn of the Modern Age of GeneticsRead CNN’s The Risk to Native American Nations from COVID-19 and How American Racism Influenced Hitler
This is the second in a series of blogs that examine current issues of race and equity through the lens of history. Read the first in the series here.