Unequal Power Relations: Biomedical Ethics,

Unequal Power Relations: Biomedical Ethics, Black and White One's membership in a racial, ethic, religious, or cultural group can easily determine one's place in society, particularly if the group to which one belongs is not considered to be representative of the majority national culture. The United States has long prided itself on being the home of the free and of the brave, a melting pot, where peoples from the far corners of the globe come together in mutual respect and harmony. Multiculturalism and culture diversity are buzzwords in contemporary society.

Educators, activists, politicians, and media spokespeople extol the virtues of getting a long, and champion the rights of the oppressed. Yet, America has a long history of oppression against perceived "others." The country was founded on a system of economic exploitation of those who were different, men and women brought from Africa to labor on plantations. Even after slavery's abolition, ethnic immigrants from Europe and other parts of the world were often paid sub-par wages, and virtually compelled to live and work under adverse conditions.

Deeply ingrained prejudices dictated attitudes toward groups considered "different." Often, as in the case of African-Americans, even expectations became lowered, and along with them standards of care and behavior. For generations, African-Americans were denied basic services such as healthcare and education. In terms of medical care, Blacks were prohibited access to White hospitals and medical schools and facilities. A policy of "separate but equal," kept African-Americans clearly unequal. Still today, African-Americans more commonly face more limited healthcare choices than other Americans.

They are victims of economic and social disadvantage, and sometimes outright prejudice. Access to decent healthcare is a fundamental human and civil right, and one that belongs to all American citizens. African-Americans must continue the struggle against unequal power relations and fight for the healthcare that they deserve. The unequal relationship between Blacks and Whites in America dates back to the earliest period of the country's history.

The first African-Americans were brought as slaves to Virginia in 1619, their descendents becoming, within a few generations, subject to perpetual servitude and numerous highly-restrictive laws designed to control their behavior and subject them to the White majority.

An entire line of reasoning was cobbled together from a combination of supposed religious sanction, direct observation, and imposed social realities that made of Black men and women creatures not quite human, and undeserving of any real civil or human rights: Black people of African descent were believed to be hyper-sexed, unskilled, uneducable, stupid and criminal by nature.

They were deemed without souls, savages, and in need of white civilization to help and protect them in their state of perpetual "childhood." The European imaginary conceptualized the Black body as fit for slavery, a mere thing destined to serve those that were considered superior (read: white). In their very being, through divine sanction, Blacks were believed to be docile creatures, hewers of wood and drawers of water; they were believed to be servants of servants.

(Yancy, 2004) This myth of an inherent Black African inferiority would have profound consequences on racial relations for many years to come. Even after the ending of slavery, conditions continued to exist under which Black Americans - theoretically equal under the constitution - were treated as second-class citizens. The proscriptions of Jim Crow would constitute the next phase of Black oppression by Whites.

The system known as Jim Crow was intended to perpetuate White superiority and domination over Blacks by creating an atmosphere in which "separate but equal" was the norm of everyday life. Distinct facilities were maintained for members of each race. Thus Blacks could not attend White schools, use White hospitals, or even share a public restroom with Whites. While supposedly "equal," facilities for African-Americans were nearly always noticeably inferior to those provided for majority Whites. In terms of healthcare, African-Americans faced special difficulties.

As Blacks were not permitted to make use of White hospitals and medical centers, they were forced to go to Black doctors who were far less numerous than their White counterparts and, in most cases, ill-trained because Blacks were not permitted to study medicine at the properly staffed and maintained White medical schools, a situation that, in the words of the first African-American ever admitted to the University of North Carolina's School of Medicine, J. Charles Jordan was, "greatly jeopardizing the health of all the citizens of our State" (Thomas, 2003).

Blacks were simply being denied a level of care that was widely available to Whites. Without proper training and preparation, most African-American physicians were simply not qualified to treat the full range of conditions treated by their White counterparts. As well, the great shortage of Black doctors meant that many African-Americans simply did not have access to even the limited supply of services. Furthermore, in an age before government healthcare programs, African-Americans suffered disproportionately form the affects of poverty, and simply could not afford medical care.

In 1964, for example, the Department of Health, Education, and Welfare found that the state of Alabama's payment of $15 a month for each dependent child was less than half what was actually needed (De Jong, 2005). At the same time, in the Mississippi Delta, the average Black family earned an appallingly low $500 while the White landowners were the nation's wealthiest farmers (De Jong, 2005). As recently as 1967, the problems of healthcare amounted to the most basic concerns of malnutrition.

As Jack Geiger, director of Tufts University's health outreach program in the Delta, pointed out, "What we saw was an agricultural people, displaced by mechanization of the cotton fields, sitting on the richest land in the United States with nothing to do, and having to go hungry" (De Jong, 2005). Poverty and prejudice were taking a dire toll. Thus the problems facing African-Americans were two-fold. Healthcare was unavailable for both socio-political reasons, and as a result of severe economic disadvantage.

The overt discrimination that was enshrined as the norm throughout the South was largely swept away by the Civil Rights Act of 1964, and various Supreme Court decisions both before and after. From now on, Blacks could exercise their political muscle and demand better conditions. They could no longer be denied jobs, or admission to schools and medical schools simply because of the color of their skin. Yet, equal rights on paper did not bring equal rights in reality.

Nowhere on Earth is healthcare as expensive as it is in the United States of America. According to the National Coalition on Healthcare, the United States spent a whopping $2.3 trillion on healthcare in 2007, a figure that equals to $7,600 a person, or sixteen percent of the entire United States GDP (National Coalition on Healthcare, 2008). The total for 2007 was expected to represent a 6.9% increase over that of the previous year, a rate twice that of inflation (National Coalition on Healthcare, 2008).

As a result of these high costs, a majority must attempt to obtain some sort of health insurance. African-Americans are significantly less likely than Whites to possess even an employer-based plan, and are twice as likely to be completely uninsured despite the fact that many are actually covered by Medicaid (Copeland, 2005).

Furthermore, the conditions under which many African-Americans live, in densely populated high crime urban neighborhoods, health problems are endemic, with notably high rates of infant mortality and a significant gap in overall mortality rates between Blacks and Whites which gaps have changed surprisingly little despite programs like Medicaid (Copeland, 2005). In addition to such obvious socio-cultural artifacts as the continued impoverishment of many African-Americans, there are other factors which work against improvements in the overall health and well-being of African-Americans.

Most health programs are geared toward White social and cultural assumptions and patterns. Diseases that disproportionately affect Blacks, such as hypertension and diabetes are frequently affected by lifestyle factors. Thirty percent of African-Americans are obese as compared to twenty-eight percent of Whites, many Blacks being poorly nourished and getting little exercise - twenty-three percent of all Americans have lifestyles described as "sedentary" while 55-75% of Black women rarely exercise, and 30 to 66% of Black men (Paschal, Lewis, Martin, Dennis-Shipp & Simpson, 2004). Paschal, Lewis, et al.

studied a community-based health program that was foreseen as an intervention to combat obesity and obesity-related health problems. Their findings noted the importance of an attention toward the cultural values of the African-American population, especially a recognition of the diversity of even this population: Programs like this also shows the importance of disseminating crucial health status and behavior information on minorities, and implementing such programs in inner-city and rural areas.

In order to screen and determine the baseline levels of behaviors of minority populations, health disparities will likely not be reduced until we determine what are the health behaviors and status of minority populations. (Paschal, Lewis, Martin, Dennis-Shipp & Simpson, 2004) African-Americans have often not been the subjects of specific medical research, with professionals relying on results gleaned from other populations. As studies like the above show, approaches developed for majority Whites may not work for African-Americans, or even for all African-Americans as a result of cultural differences.

The suggestion that lies behind this study is that healthcare professionals must look into the details of everyday life and seek to understand how the aspirations of diverse groups affect their choices and goals. On deeper cultural levels, African-Americans also face unique problems that relate to health and well-being. The African-American family appears almost endangered in modern day America, and African-Americans face thereby a real problem when it comes to finding the necessary familial and community support when faced by major health crises.

In area after area, Blacks do not receive the same kind of aggressive treatment as received by Whites. In a study of 53,000 African-American heart attack victims, it was found that Whites received much more aggressive treatment and care, while only forty-seven percent of impoverished African-Americans received treatment in intensive care units as compared to seventy percent of Whites in similar economic circumstances (Jewell, 2003, p. 196).

African-American children lack solid family structures to take care of them, and who end up dependent on state child welfare departments are also commonly neglected and victimized. In a 2002 Florida case, Rilya Wilson a five-year-old African-American girl was missing for more than a year while her caseworker reported her to be doing fine in foster care.

Upon investigating the circumstances of this failure to report the girl's disappearance, it was discovered that the social worker had not made monthly visits as demanded by official procedures, and that, in addition, such practices were widespread throughout the department, This case.. [being] yet another indication of how social systems establish and maintain policies that are contributing to the destabilization of African-American families, even those families struggling and striving to meet the basic social and economic needs of their members." (Jewell, 2003, p. 226).

The African-American family is struggling to survive, and the healthcare professionals that are charged with trying to save it, do little to help, and much that contributes to its decline. People in the lowest income households are six times as likely as others to have difficulty in meeting a basic need, while one-third of all African-American families vs. only seventeen percent of Whites face these difficulties (Casper & King, 2004, p. 73).

The social breakdown and economic disadvantage of African-American families is creating a healthcare epidemic that is scarcely challenged by current programs. Unfortunately, disparities in healthcare and general health and well-being can often be traced to more profound, and longstanding, social and cultural arrangements. African-Americans have been at the bottom of.