Thursday, July 6, 2017

Life, Liberty, and the Pursuit of Social Justice

“We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness.” Declaration of Independence, adopted in Philadelphia, July 4, 1776.

“…one Nation under God, indivisible, with liberty and justice for all. The Pledge of Allegiance, adopted by Congress in 1942.

As we celebrate Independence Day, think about Crispus Attucks, the first person to die in the American Revolution. He was a person of color who was part of a crowd in Boston standing up to British soldiers sent to quell the American resistance. The mob threw snowballs; the soldiers fired guns. The soldiers were put on trial for murder and defended by future U.S. president John Adams. His words describing Attucks have a modern tone, “This was the behaviour of Attucks;-to whose mad behaviour, in all probability, the dreadful carnage of that night, is chiefly to be ascribed.” At the end of the Boston Massacre trial six soldiers were found not guilty of murder. Two were convicted of manslaughter and given the penalty of thumb tattoos.

Justice was a central issue at the founding of our country and remains so today.

Public health is based on the principle of social justice – a recognition of the shared nature of our individual and societal welfare and a belief in the collective responsibility to assure that all people have their basic human needs met and no one unfairly benefits to the detriment of others. This foundational principle of public health is embedded in the stated American value that we celebrate every July 4th “that all men are created equal.” 

Despite our lofty democratic and public health visions of a socially just America, we are far from achieving that goal. Our societal shortcomings are seen in the disparities and inequities in health and economic status, educational achievement, and environmental quality that disproportionately impact populations of color, American Indians, the LGBTQ community, and people with disabilities.

A lack of social justice breeds social isolation, fear, alienation, and mistrust which impacts all parts of our society. I thought of those consequences of injustice as I watched and listened to the recordings of the shooting of Philando Castile and reflected on the “not guilty” verdict in the Yanez trial. I realized that if we are to learn from this event and move toward a more socially just society, our perspective can’t solely be a legal one. We must also focus on the emotional, ethical, and moral issues that connect us as human beings and which hold the potential to unify us as a community.

That human connection was palpable as I listened to the voice of the innocent 4-year-old child who had just witnessed a fatal shooting. Hearing the fear in her voice as she worried about her mother’s safety and recognizing her stress and anxiety as she took on the role of protecting her mother brought tears to the eyes of this pediatrician and pain to the soul of this grandfather. It made me sad and angry because I knew that this was an avoidable catastrophic adverse childhood experience (ACE) that threatens this child’s immediate well-being and her long-term health. All I could do at the time was cry and send prayers. But there is much more we can do – much more that we must do to create a safe, inclusive, and socially just society.

“Trauma-informed care” is one strategy available to address childhood trauma, but in public health we must go beyond care to the prevention of ACEs. We must address the precipitators of events like this shooting; what I call “Adverse Societal Conditions” (ASCs) –– the racism, sexism, classism, homophobia, and intolerance of diversity that have been a part of America since its founding.

We know how ACEs impact an individual, but we must recognize the evidence that ASCs affect everyone. Not just African-Americans who fear for their life every time they are stopped by the police. Not just transgender people who are bullied for trying to make peace with their identity. Not just Muslim women who are harassed and attacked for wearing a hijab. Not just immigrants who are systematically labeled and derided as terrorists, rapists, and criminals. Everyone! Including affluent, educated, white, and politically powerful individuals.

Just as “trauma informed care” helps heal the wounds of ACEs, we need an approach to heal the wounds of ASCs – the social isolation, fear, alienation, and mistrust of diversity that is too common in our society. The path to that healing might be contained in the origin of the word “heal,” from the Old English word “hal” which is also the root for health, whole, and holy. If we are to become a healthy society, we must heal our societal wounds and become whole. That is our sacred duty.

Our focus on Advancing Health Equity has been a small step in this healing process. The Triple Aim of Health Equity is centered on the value of “social cohesion” and creating a sense of belonging. It’s a step in making the community whole that can lead to better health. Building on that belief, our 2017 Statewide Health Assessment focuses on that notion of “belonging.” My hope is that this assessment will frame the action steps necessary to build social cohesion and make our community whole and healthy.

Because of societal injustices we are all less safe, less secure, and less whole. We will never heal, we will never be healthy, until we can become whole. Our sacred public health work is to help create a socially just society that advances health equity. That is also part of our civic responsibility to build community and strengthen democracy so “that government of the people, by the people, for the people, (all the people) shall not perish from the earth.”

Happy Independence Day.