New York City Health Commissioner Dr. Mary Bassett has worked in public health for more than 30 years. She helped lead the city's response to the Ebola scare last fall, and over her career has tackled a range of hot-button issues: the AIDS epidemic, access to maternal care, universal pre-K, cigarette regulations, sugary soda and trans-fat bans, and calorie counts at restaurants, to name a few.
Like many in public health, Bassett is committed to creating policies that address serious health conditions such as obesity, diabetes, heart disease and addiction, and that ultimately improve and prolong quality of life.
But she says there's one chronic condition most people in the field aren't even discussing: Racism.
Bassett -- who was appointed by New York City Mayor Bill de Blasio to lead the city's Department of Health and Mental Hygiene in January 2014 and also served in former Mayor Michael Bloomberg's administration -- recently published a piece in the New England Journal of Medicine on what she believes is ultimately driving health inequality and what can be done about it.
She writes: "Should health professionals be accountable not only for caring for individual black patients but also for fighting the racism -- both institutional and interpersonal -- that contributes to poor health in the first place?"
CBS News spoke with Bassett about why she thinks the #BlackLivesMatter social movement, which burst into the headlines after the deaths of Eric Garner and Michael Brown, is relevant to the future of health -- in the exam room, medical schools and public policy. This interview has been condensed and edited.
The hastag #BlackLivesMatter has been everywhere. How do you think this applies to health care?
As a public health physician I care not only about access to health care, but also people's overall health, to which health care delivery is only one contributor. People's health is determined more by their everyday lives, not so much by access to health care.
The issue raised in the movement that arose under that hashtag really broadens the question of what we're talking about when we talk about the impact of racism on black health and well-being. Violence plays a role in black health -- a tragic role -- but it is only a part, not even the main part of the enduring gap that we see in the health of the U.S. population of African decent.
You report that in your search for studies about health care disparities, none of them contained the word racism in the text. Why do you think that is?
I think that it refers to the fact that people have difficulty using the word racism. They consider it a word that can be divisive. When I use it, I'm using it to reflect the fact that the concept of black inferiority-white superiority is not only carried by individuals, but also is reflected throughout our society and our institutions.
In order to explain why we get such different patterns of health across populations, we have to be prepared to talk about racism. We're talking about conditions as different as diabetes, HIV and hypertension. When we see such a wide array of outcomes, patterned in this way, we need to ask ourselves the question of why.
Environment plays a big role in health. Do you think doctors don't consider that enough when they see patients?
When a doctor talks to a patient they may give the person a lot of good advice but they need to go further and try and think about what the individual's opportunity is to follow that advice. That leads us to ask questions about things that take place outside the health care sector.
Access to healthy food varies tremendously by neighborhood. Our neighborhoods are frequently patterned on the basis of residential segregation.
Do you think that patients often experience racism when they go to seek help from a doctor? When the story emerged about Ebola patient Thomas Eric Duncan, many critics said they believed the hospital turned him away because he was poor, black and uninsured.
Someone who is black, poor and uninsured will experience challenges in our health care delivery system. In New York City, we're very lucky, we have a very robust public health hospital system that has a mission not to deny anyone from care on the basis of their ability to pay. When I began talking about Ebola early -- before we had a patient in New York, and even before the patient appeared in Dallas -- I really wanted to make it clear to everyone that they shouldn't delay seeking care because they were concerned about the ability to pay.
We have substantial evidence that there is bias in our health care delivery system. The Institute of Medicine Report published a seminal piece called "Unequal Treatment" over a decade ago, which found that across a whole range of conditions, black patients were less likely to be appropriately managed, less likely to be referred for appropriate treatment and had poorer outcomes. This was a systematic observation that also spoke to the fact that we have to begin talking about racism.
I want to make clear that a conversation about racism isn't a conversation about blame. It's a conversation that should be forward-facing, because it's within our hands to change this. It's about beginning to talk more openly about the possibilities of what is referred to as implicit bias [in the New England Journal's accompanying article] -- the judgments that people make because how they were brought up, educated and taught to think about other people.
You've also noted there's a lack of diversity in the health care workforce. Only about 4 percent of the physician workforce is black. How is this contributing to the problem?
The proportion of African Americans in medical schools has declined in the last 10 years. The decline has mainly been for black men, which is a source of concern.
This matters, but not only because it's unfair. We believe a young black child should have the same opportunity to become a doctor as any other child. But it also hampers our work. There's good evidence to show that a more diverse workforce delivers a better product, including health care.
I graduated from medical school in 1979. I grew up in New York City and went to medical school in New York City in the same neighborhood where I'd grown up in northern Manhattan, a largely black and Latino neighborhood. I was the only black woman in my graduating class.
What can the medical community do to change this?
One thing is clear: When we as a community turned our attention to diversifying the student body for medical schools and other allied health professionals, we succeeded. There was a big change between the 1950s and the 1960s and 70s. Reasserting our determination -- for the good of our profession, as well as in the name of democracy and fairness to achieve more diversity in our student body -- is something we can do collectively as a profession.
It means recruitment of those students, it means paying attention to the faculty, which of course is even less diverse than the student body. It means lots of different actions.
[In New York City] we have been investing very early in the process. The mayor's investment in universal pre-K will go a long way toward addressing the inequalities we've seen emerge so tragically early in language development. At age 3, the number of words you know predicts how well you'll do on reading tests in third grade, predict your likelihood of graduating from high school and so on. There are many, many changes that can together contribute to more success in diversifying the health workforce.
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