Some issues are so complicated and lacking a single villain that we can look at them only periodically to ascertain their current states. One such issue is the persistent inequity in the health care of whites and blacks and other minorities.
Last week, the U.S. Department of Health and Human Services released a comprehensive study of the problem. The report revealed that 58,942 black Americans die needlessly every year because the United States has failed to push their disease and death rates down to the same levels as those for whites in the areas of heart disease, homicide, cancer, low birth weight, cirrhosis and diabetes. That figure is so appalling, even frightening, that it is tempting to shake one's head numbly and walk away. After all, the problem has persisted for decades.
Moreover, the causes of this disparity between the health of whites and blacks are numerous. The government report cited poverty, lack of health insurance and inadequate prenatal care and noted that minority Americans "have not benefited fully or equitably from the fruits" of biomedical science.
But the causes are even more complex. Take the case of homicide, for example. The leading cause of death for black males between 15 and 44, homicide ranked on a par with cancer as the second-leading cause of "excess" deaths among blacks under 70. (With great insight, the report viewed homicide as a health problem because 10 percent of homicides are related to drug abuse and 50 percent to alcohol abuse.)
Departing HHS Secretary Margaret M. Heckler attributed most of this health gap to "knowledge and life style." And there is some truth to this in many of the categories. But the vast majority of inner-city blacks strongly oppose crime and violence. Psychiatrist Alvin F. Poussaint cites a combination of forces for black-on-black homicide -- biological, cultural-environmental, psychological -- as well as the perpetrator's self-image and frustration level. "Many of the problems in the black community are related to institutional racism," he says, "which fosters a chronic lack of black self-respect, predisposing many poor blacks to behave self-destructively and with uncontrollable rage."
Frankly, the report's response to its own findings is lamentable. Although it stated that many of the deaths are preventable, no new federal or state programs were recommended. Instead, Heckler said she was focusing on new initiatives that could be achieved with existing resources through added education, research and "outreach" programs. Clearly, many of the problems could be solved with jobs and housing.
Still, the report's findings leave a responsibility for the black community itself, and I would like to issue to that community this challenge: What can we do help ourselves?
Clearly, there must be changes within our communities, and I suspect part of the answer lies in more grass roots leadership to promote good role models, and in the nurturing of individuals.
The typical black American of 35 to 40 was probably nurtured in a cohesive black community where young people were given the same message to achieve and work hard by their parents, schools, churches and communities. Moreover, segregated housing patterns kept black professionals and working class people living side by side, thus providing successful adults as everyday role models. With the advent of fair-housing laws, many better-off blacks moved out of these communities, leaving behind many people who feel defeated by life and hopeless.
In studies of the ones who were were left behind, psychologists have found two kinds of inner-city black males -- those who successfully cope with stress and those who don't. The successful ones were from families who supported middle-class ideals, encouraged their children to participate in church and social groups, and didn't allow them to go out except as a family.
Perhaps one solution is to connect more successful blacks with strong family life and child-rearing practices with people who need help. Middle-class blacks who live in suburbia or other good neighborhoods may need to take on the task of helping provide good values and nurturing to an inner-city child who is not their own. Numerous examples already exist of people and groups trying to make a difference. But more needs to be done, and on a larger scale.
What would happen if every successful black in Washington made friends with one young kid and spent one hour weekly in a mentorship program? I don't know the answer. But make no mistake about it, if we fail to try something, when the next survey of minority health status is made, we will still be numbly shaking our heads in despair.