Friday, October 10, 2014

Review: Body and Soul: The Black Panther Party and the Fight Against Medical Discrimination by Alondra Nelson

"Quando dou comida aos pobres chamam-me de santo. Quando pergunto por que eles são pobres chamam-me de comunista."

"When I give food to the poor, they call me a saint. When I ask why they are poor, they call me a communist."

Dom Hélder Pessoa Câmara (1909 – 1999), Catholic Archbishop of Olinda and Recife, Brazil, 1964 to 1985

University of Minnesota Press, 2011, 289 pp.

Professor Alondra Nelson (Twitter) has written a book which all activists should read. It focuses on the advocacy, activism and ideology of the Black Panther Party (BPP) in healthcare.

The BPP saw healthcare in the United States as proof of white supremacy and regarded its provision as a necessity for movement building and outreach. Over time, it required each of its branches to establish a community health center. The health centers were required to staff or have access to biomedical professionals and empower the patients in decisions regarding their treatment. They promoted a view of health beyond the biomedical model. Poor health outcomes among black Americans were the inevitable result of policies which limited their political clout and economic opportunities, and only revolutionary socialism could address these issues. Healthcare was one example of a good which should be provided regardless of profit, and these community health centers were proof of this concept.

Most fascinating to me was the BPP's work in the field of sickle cell anemia and its resistance to the medicalization of violence.

Sickle cell anemia is familiar to me. My father co-authored a paper in this field, and I mentioned it in "Health, Public," an encyclopedia entry I wrote for Africa and the Americas: Culture, Politics, and History, edited by Richard Juang and Noelle Morrisette. When I was a child, I was diagnosed with anemia, but I never had any symptoms. Later physicians told me that I likely had fewer, larger red blood cells than the "norm" (i.e. northern European) as part of the genetic legacy of peoples from malaria-endemic regions.

While black American health activists had been addressing sickle cell conditions to the extent their resources permitted, a 1970 article in the Journal of the American Medical Association by Dr. Robert Scott seemed to bring together all of the BPP's talking points:
Health care priority for sickle cell anemia (SCA) should be based on its prevalence, severity, and on a standard of support set for similar conditions. Sickle cell anemia occurs in about one in 500 Negro births and median survival is still only 20 years of age. In 1967 there were an estimated 1,155 new cases of SCA, 1,206 of cystic fibrosis, 813 of muscular dystrophy, and 350 of phenylketonuria. Yet volunteer organizations raised $1.9 million for cystic fibrosis, $7.9 million for muscular dystrophy, but less than $100,000 for SCA. National Institutes of Health grants for many less common hereditary illnesses exceed those for SCA. Prevalence data in cities with sizeable black populations show that SCA is a major public health consideration. More appropriate priority for SCA depends on improved public and professional understanding of its importance.
The BPP began learning how to conduct screenings, and, when a new screening procedure which didn't require a blood draw and whose cost was minimal emerged, the BPP launched widespread screening campaigns in public places. It also fundraised for these efforts and attempted to mobilize researchers who shared its social vision of health to research cures and treatments for sickle cell conditions. It published articles and its leaders gave interviews refuting white supremacists who used sickle cell conditions as evidence that black Africans and their descendants were genetically inferior to white Europeans.

In 1972, researchers at University of California at Los Angeles drafted plans to create the Center for the Study and Reduction of Violence and sought financial support from Governor Ronald Reagan and the California legislature. The BPP and allies saw these groups as defining violence in the United States as a medical problem requiring a medical solution, i.e. medicalization or biologization. The BPP rejected this view, as exemplified by H Rap Brown's (Jamil al-Amin) famous quote, "violence is as American as apple pie."  A coalition of groups was successful in convincing the state of California to cease supporting research along these lines.

These BPP successes, however, did not result in ending morbidity and mortality discrepancies among races in the United States, much less socialist revolution. There are of course many reasons for this, including police repression. But in the cases of sickle cell anemia and the medicalization of violence, liberal solutions from the biomedical world, namely increasing resources developed for sickle cell diagnosis, treatment and research and extending the protection of medical ethics to prisoners in United States jails, who would have been the experimental subjects in the UCLA center's research, blunted the BPP's radical arguments.

And yet this legacy of activists providing healthcare to the people the state ignores lives on. I have given some money to University Muslim Medical Association Community Clinic in Los Angeles over the last 10 years, and I learned from Dr. Nelson's book that a former BPP member and worker at one of its clinics, Norma Armour, helped found it.

The Islamic Medical Association of North America publishes a guide to operating a charity clinic. It has also published video recordings of sessions where people involved in these clinics discuss their operations.

To the extent that any of these clinics focus on patients' participation in decision-making and on a social vision of health, it is part of the BPP legacy.

Dr. Nelson has a 16-minute video from Book-TV about this book.

Her most recent book is Genetics and the Unsettled PastThe Collision Between DNA, Race, and History which she co-edited with Keith Wailoo and Catherine Lee. (Rutgers University Press, Paperback, 9780813552552, 370pp.) (Twitter)

Updated October 11, 2014: The concept of medicalizing away social phenomenon is at the heart of Edward Said's Orientalism and its Reader's Digest version, Covering Islam. Define a group. Develop a methodology to use in the study of that group which is not used on any other group. And, then, what do you know, you find that there are factors unique to that group which cause a phenomenon. I've blogged a lot on the War on Terror, but the reading I'd recommend which has several examples of medicalizing is Arun Kundnani's The Muslims are Coming!.

Updated September 23, 2015:
Updated February 18, 2017: Commemoration of 50th Anniversary of Desegregation of Medical College of Georgia