By Bill Braun placed on site by permission
As I reread this thread several reference points emerged for me. One, data
that suggests that different groups of people exhibit different disease
behavior. Science may help uncover better answers as to why this is. Two, data
that suggest that different groups of people have different mean levels of
community health. The humanities (theology, philosophy, ethics, sociology,
applied anthropology, etc.) may help uncover better questions as to why this is.
Third, and encompassing the first two, is the state of "normative blindness".
These are the mental models about which members of the dominant culture -
dominant in the practice of medicine and research, and dominant in society at
large - are largely unaware, and which significantly shape (a) the questions we
already know about and the manner in which we select them for further study, and
(b) how we go about discovering new questions to ask.
From my own study, work, and reflection on white male privilege, I suggest that
there are stages through which we progress (and through which we will progress
only if we approach the question of privileges through the lens of challenging
the status quo, and doing so with intentionality).
1. Normative Blindness - what we are born into and accept as normal, the way
things are and the way they ought to be.
2. Cognitive Dissonance - The sense that something is amiss, and something
should be done to correct it, while concurrently remaining convinced (a) that we
deserve the good fortune we were born into and (b) of the merit we deserve as a
result of individual effort and accomplishment.
3. Moral Imperative - Having moved to a position where we see moral dilemmas in
the privileges we have concurrent with a deep sense of reluctance to give them
up, based on the rationale that no one of us as an individual did anything wrong
to receive them, therefore no one of us as an individual has any responsibility
to relinquish them.
4. Understanding Identity In The Context of Institutional Privilege -
Acknowledging that the advantages we received as a fluke of birth were not
earned, and that advantage only has meaning in its opposite, being
disadvantaged; identifying with privilege as a member of a race and a gender,
giving up our personal claim to individual accomplishment. (This
does not suggest that individuals do not work hard to accomplish things, only
that the same work from different starting points results in different end
points.)
5. Activism - beginning to take action, that entails personal risk, on two
levels. One, becoming cognizant of the transactional privileges one receives
each day and to refuse delivery on those privileges. (For example, I'm in line
behind a person of color and the white clerk looks right through her to offer me
help; knowing that when my male voice
silences a female voice, it will be seen as routine, if not preferable.) Two,
committing to change the way institutions behave. The risks are many though the
one that tends to emerge early and is very difficult to deal with is being
perceived as a race traitor.
In summary, we cannot gain the necessary insights by relying just on science or
just on the humanities. They are interdependent, and progress toward effective
disease Dx and Tx, and improving access and community health disparities based
on race, will require inquiries that emerge from the intersection of the two.
In the ongoing conversation on "what is Family Medicine?" perhaps FM can stake
out this interface, and change the manner in which society conceives of health
justice.
Bill Braun
Minorities, Admissions, and Underserved
The "best candidate" or the "best person" is frequently where white male
privilege exerts its influence. In my observations, many institutions do a
decent job of assembling the long list of candidates that reflect a broad
spectrum of folks. It is the quest for the "best candidate" or the "best person"
that folks "not like me" fail to make the short list, or fail to be selected
from the short list.
"Not like me" tends to manifest itself in expressions such as, "s/he has
terrific credentials and qualifications, but something tells me that s/he just
won't fit our program well - I cannot say why, it is just a gut feeling." This
results in the common perception among women and people of color that they have
to be "twice as good" as their white/male counterparts.
One way to test if that phenomena is at work is to look at the folks who are in
the institution/program and ask, "Can I say with confidence that everyone of
them is indeed the best there is?" If not, then some dimension of white/male
privilege may be influencing decision making with regard to the selection
progress.
I head Julian Bond, then President of the NAACP, speak at the Cleveland City
Club several years ago. He was asked about affirmative action. He replied that
he did not have a terribly high opinion of it, but found it necessary. He
offered that the need for affirmative action would be over when mediocre people
of color were working alongside mediocre white people.
Although candidates for residency programs have gifts and motivations that make
them special when compared to people in society at large, I suspect that when
examined within their cohort, a number of them are ordinary. If the "best
people" that are sought in the future are pegged against the "best - but
ordinary - people" who have been admitted in the past, the rationale for
actively seeking (affirmatively if you will) under-represented folks can be
appreciated from a different point of view.
I've also come to understand that "all folks are welcome" is a prescription for
maintaining the status quo. If more women and/or people of color are wanted,
then invitations must be issued, and programs must be made attractive to them
before the invitation is extended, not after. This
places the focal point of change where it belongs, on white males, changing from
within.
If programs alert themselves to the privileges that are acting themselves out in
the assessment of candidates, they may find that Robert's call for the "best
people" comes close to Martin Luther King Jr.'s call for measuring the character
of the person. White males have not cornered the
market on character, and we must learn to assess and evaluate character
differently if the character of the mean ordinary person, which describes many
physicians in practice (again, within their cohort), is to steadily rise.
Bill Braun
Bowman Comments at Character, Color, Admissions, and Physicians
WHITES SWIM IN RACIAL PREFERENCE Tim Wise, AlterNet
In criticizing affirmative action at the University of Michigan, Bush made clear
the inability of yet another white person to grasp the magnitude of white
privilege.
http://www.alternet.org/story.html?StoryID=15223