David Line and Allen Line
This summer has intensified the discussion in the United States about “Black Lives Matter”. This motto and movement became more prominent after the shooting of a Black man in Ferguson, Missouri, in July 2014. Since then, Presidential candidate Hillary Clinton and many others have retorted, “All Lives Matter.” This raises the question, do we need to single out Black and minorities when we develop policies that impact the right to health, and people’s capacity to lead healthy and happy lives?
The vision statement of the US public health strategy Healthy People 2020 is, “A society in which all people live long, healthy lives.”1 This is an eloquent way of saying all lives matter. The Healthy People 2020 vision statement, coined in 2009 prior to the kickoff of Healthy People 2020, raises an interesting question for the public health profession. Is it necessary to highlight the many health disparities of minority populations to ensure the health of all? Human rights would answer with an unequivocal, ‘yes’.
“Healthy People: The Surgeon General’s Report on Health Promotion and Disease Prevention,” written in 1978 with a target date of 1990, was the original Healthy People. Subsequent editions have been Healthy People 2000, Healthy People 2010, and Healthy People 2020, each with its own vision, mission, goals, topics, objectives, and targets. Healthy People 2010 was the basis on which many public health departments were funded during the Bush Administration. While Healthy People 2020 does not hold the weight of its predecessors, it is still an important document since many states have adopted its objectives and targets as their own.2 Healthy People 2020 states its vision is to protect and support all lives. But does it actually do this? Can it protect and support all lives without addressing issues specific to minority communities? Should the US public health strategic plan address determinants of health that are specific to minorities? We believe it should, on the basis that all people have human rights entitlements to health and the social determinants of health. Here we argue that the United States Constitution supports this position.
The underlying premise of the US Declaration of Independence is that everyone is created equal and all have an innate right to life, liberty, and pursuit of happiness. The equality standard was not fully understood as applying to all, however, until the 13th, 14th, and 15th Amendments were added to state specifically that all men are equal. In 1776 and 1870 it was not enough to say, “All men are created equal.” In Section 1 of the 14th Amendment it was intoned that Black men were created equal. Further, this led to the 15th Amendment stating that race and color shall not be used to prohibit anyone from voting. Even these Amendments to the Constitution were not sufficient to protect Black people; civil rights acts needed to be passed over the last 150 years. In the case of all people being created equal, the US stated it, amended the statement, and then acted on it. Even so, it is far from realizing a state of equality.
While the right to equality has had much attention in the US legal system, the same is not true for the right to health. According to human rights law, irrespective of ratification of any particular treaty, all people are entitled to the highest attainable standard of health.3 So we ask, is the right to health also guaranteed in the Constitution? Is there coverage based on the document as a whole, or is there a void from which a government of the people and for the people has no responsibility to the health of the people?
The strategic public health plan for the US government, Healthy People 2020, appears to come up short when addressing health issues that particularly impact minority populations. Environmental issues impact minority communities at a much greater rate than they do white communities. The Toxic Waste and Race in the United States report found race to be a more significant variable than socio-economic status and regional differences in the location of commercial hazardous waste facilities.4 It found “three out of five Black and Hispanic Americans live in communities with uncontrolled toxic waste sites.”5 The conclusion of the report was to “strongly urge” federal, state, and local governments to consider the impact on minority communities when locating hazardous waste sites. Accordingly, we urge that Healthy People 2030 takes a strong stand to eliminate discrimination against Black and minority groups in any future selection of toxic waste sites and, importantly, works towards reducing the number of toxic waste sites overall.
Healthy People plans have all included goals to reduce health disparities between ethnic groups. In Healthy People 2000, Goal 2 aimed to reduce health disparities between minorities and whites. By 2000, 10 years after the goals were set, 16% of the objectives and sub-objectives associated with reducing health disparities had been met, compared to 22% of all 318 objectives and sub-objectives. In the same time period, 62% of the objectives associated with disparities for Blacks were met, as were 53% for Hispanics.5 Healthy People 2010 oversaw minority groups achieving 3% more of the objectives where ethnicity was a measurable variable than did the population as a whole. However, the level of improvements was not as great in minority populations as they were in white populations.7
There are welcome additions to Health People 2020 including the topic of Social Determinants of Health which has 31 objectives, one of which is about reducing all populations’ exposure to environmental hazards. But it does not target the equal distribution of hazardous waste sites.
A human rights based solution to the problem of the inequitable distribution of hazardous waste sites should not only inform Healthy People 2030 but be implemented immediately on the basis of non-discrimination. This should involve the elimination of all hazardous waste sites starting with those located in the most disadvantaged areas, and most populous areas. Until the environment can be decontaminated, people living near such sites should be provided free and accessible health care and other social determinants, such as good quality water, should be addressed. People in these communities must be well informed and participate in any decisions about their health and the environment.
The omission of such approaches in Healthy People 2020 leads us to question whether this important public health document really addresses all lives, and whether we need to identify specific minority communities to cover all lives. When we think of the “Black Lives Matter” versus “All Lives Matter” debate, the salient questions are: does the US provide enough service and information for everyone’s right to health to be protected and fulfilled, and given the poorer health and living conditions in Black and minority communities, how will this inequity be addressed?
A human rights based approach to the development of Healthy People 2030 would include not only people with the technical expertise to address the environmental and social determinants of health that inequitably impact on Black lives, but also Black people who live in these conditions. Only then can objectives be determined that might address the inequalities, and be monitored by the people disadvantaged by inequality.
David Line is Associate Professor, Masters of Public Health Program, College of Graduate Health Studies, A.T. Still University, USA.
Allen Line is a retired Reverend, Southern New England Presbytery, USA.
Please address correspondence to David Line firstname.lastname@example.org
- Office of Disease Prevention and Health Promotion. 2016. History & Development of Healthy People. June 20. https://www.healthypeople.gov/2020/about/History-and-Development-of-Healthy-People.
- Office of Disease Prevention and Health Promotion. 2016. Environmental Health. June 20. https://www.healthypeople.gov/2020/topics-objectives/topic/environmental-health/objectives.
- International Covenant on Economic, Social and Cultural Rights, United National General Assembly, 1966
- Commission for Racial Justice. 1987. “Toxic waste and race in the United States.” United Church of Christ. http://d3n8a8pro7vhmx.cloudfront.net/unitedchurchofchrist/legacy_url/13567/toxwrace87.pdf?1418439935.
- ibid, p15
- Healthy People 2000. 2001. “Healthy People 2000 Final Review.” cdc.gov. http://www.cdc.gov/nchs/data/hp2000/hp2k01.pdf.
- Keppel, Kenneth, Tamyra Garcia, Suzanne Hallquist, Asel Ryskulova, and Lesley Agress. 2009. “Comparing Racial and Ethnic Populations Based on Healthy People 2010 Objectives.” National Center for Health Statistics. October 14. http://www.cdc.gov/nchs/data/statnt/statnt26.htm.