S3E23: Confronting Anti-Black Racism

Harjit: Hi, everybody. I ate a banana milkshake this morning. JK, I didn't. I just wanted to say that.

Margaux: I had breakfast taco.

Bushra: What makes it a breakfast taco?

Leen: I don't remember having breakfast, or not having . . .

Margaux: Eggs.

Bushra: You add eggs to it?

Harjit: Is anything defined as a taco if it's shaped like a taco?

Margaux: I guess.

Harjit: It's basically the round tortilla.

Margaux: Like a tortilla and then you put stuff in it and you eat it.

Harjit: It's a taco.

Margaux: Yeah.

Harjit: And burrito is if it's closed and not open.

Margaux: Wrapped, yeah.

Bushra: So is an egg roll a burrito?

Margaux: Sure.

Harjit: What a great question.

Margaux: Is it a tortilla?

Harjit: Oh, it could be a crepe. It could be a dosa too then. Oh, my goodness.

Hi, everyone. Welcome to "Bundle of Hers." And today, we have everyone in the studio.

Margaux: Yay.

Harjit: So, today, I wanted to talk a bit about the concept of anti-black racism in medicine. I started understanding this term a couple of years before medical school started. A really big event that started me thinking about this topic is when Trayvon Martin was shot in Florida. And I really started to think about how, as a non-black person of color, I contribute to the continuous marginalization of black people.

So I was pretty much trying to get a better understanding of what anti-black racism means, and I had the privilege to be a part of a group called South Asian Americans Leading Together. The specific thing that we were working on as a group was confronting anti-black racism in our South Asian communities. So I thought it'd be a really good topic to talk about today because it is deeply ingrained in the institution of healthcare and medicine here.

So I first start out with what is racism. And to understand racism, I think there are three core things that we need to understand: stereotype, prejudice, and discrimination. And I have this circular view of the three of those terms.

Stereotypes are beliefs that certain attributes are characteristics of members of a particular group. So it's more of a thought. It's a cognition process.

And then prejudice is a negative or positive attitude towards a certain group that is applied to its individual members. And this invokes an emotion.

And then next is discrimination, which is the unfair treatment of members of a particular group based on their membership in that group, and that is a behavior.

So I see it as a circular thing. So you have the cognition, the thought. Then it invokes an emotion, and then that emotion comes out in behavior.

Racism, the best definition that I was able to find is from the People's Institute for Survival or Beyond. Racism equals prejudice plus power. So anti-black racism is . . . do you all know what a fulcrum is?

Bushra: A fulcrum?

Margaux: Like in physics? Like a teeter-totter?

Harjit: Yeah.

Margaux: Okay. Yes.

Harjit: Fulcrum. English is my second language. Yeah, it's like a teeter-totter. I think that's a good way to describe it.

So anti-black racism is basically the fulcrum of white supremacy. So a fulcrum is anything that provides support by which a lever turns or one that supplies the capability for action. So, for white supremacy to exist, we need anti-black racism.

So, with that definition, we have the term white supremacy, and I wanted to explain that as well.

There are a couple of core tenets that uphold white supremacy. The first is the understanding of slavery and capitalism. So blackness equaled slaveable or property that works to benefit someone else. And then you have genocide and colonialism. People must disappear so land can be taken. And then you have war. Superiors need to protect that land, so they go to war.

So those three concepts really uphold white supremacy, and anti-black racism allows white supremacy to continuously exist.

Bushra: So, when I think about anti-black racism, I think the development of this country is built completely on anti-black racism. And to think that it does not affect you or you haven't seen the effects of it would be a lie.

I'm black. I'm African, African and American, not African-American. There is a difference. For me, I have been in educational space my whole life, and with that, trying to achieve higher education, that isn't necessarily built for me to go up the ladder and be successful. It's been a challenge as far as the ways that I've contributed to that.

I think within my own community . . . my family is from Somalia. It's a country in East Africa. There is colorism that is very apparent within our community. And even though we're black, we still separate ourselves from other people who are also black. And so things that are idealized within the Somali community appearance-wise are lighter skin, straighter hair. So the coarser your hair is, the less attractive you are. A thinner nose. All these things are Eurocentric ideals of beauty, and those are the things that people in my community hold as beautiful.

For me, in my life, it's not necessarily racism, but colorism that we grapple with, and it colors our behaviors towards people who are African-American, meaning black American, in this country within my community. And to say that doesn't affect us would be a lie. That didn't come out of nowhere. You know what I mean? It's deeply ingrained.

Margaux: So, like you're saying too, Bushra, I have also been in the educational space for the majority of my life. And growing up here in Utah, which is a predominantly white state, I was also in private education. So I was very isolated from the experience of black people. And while we learned about it in history, I think that the way I contribute and the way I'm thinking about it now is through ignorance, because it was never, I don't think, a blatant thing to be racist or anti-black racist. But now I'm learning the ways that I am as a white person benefiting from white supremacy. Even though it's something that I denounce and I don't agree with, I am inherently benefiting from it on some level.

And so I think through ignorance and not taking active steps to . . . since I had been so isolated . . . and I'm trying to do this now, go and understand the impact that this persistent social norm of white supremacy still has.

And that's such a triggering word and it's still something that I'm navigating as a white person, because for me it can still be very . . . you want to shun away from it, but I think we need to dissect what it actually means and move away from the emotional label of white supremacy and understand that every single white person in this country benefits from white supremacy.

Harjit: Yeah. Margaux, I actually think it's so powerful that you said that because in college, I would always be like, "I can't be racist." Because inherent in the definition of racism is power plus prejudice. And black, indigenous, people of color, they don't have that power. But I can be an anti-black racist. And I think that was really difficult for me to cope with when I went on this rabbit hole of learning about anti-black racism.

I actually wanted to also mention, because as an Asian-American I'm often seen as less threatening, we have conditional power in society. All because I'm Asian-American doesn't mean that I am away from being able to perpetuate anti-black racism.

When we combine that power and prejudice against another group as people of color, we're still participating in systemic racism. I think that's the biggest lesson that I learned. And it was really hard for me too, because I was like, "Oh, this doesn't make sense," because it really shifted the way that I thought about things.

And when I think how I am or my community is furthering anti-black racism, I think the model minority, I will say, myth really creates that divide. As Asian-American people or as a South Asian, we are just hard workers and we do X, Y, and Z. I grew up with that. And I grew up thinking that that's why we're just progressing more than other people, and not really understanding in history the model minority myth was created by the majority to divide groups that are marginalized. And I think that's how I continued to perpetuate anti-black racism, is buying into that myth.

Margaux: And too, in that vein, I think we need to deconstruct what white supremacy is, like the pillars of it that are supporting us, and start to use our voice as white people to dismantle the system that inherently benefits us. And that's an uncomfortable thing to do, but it's something that is necessary for the white community to even out the fulcrum, I guess, or destroy the fulcrum, whatever metaphor we want to choose to use.

Harjit: Thanks for saying fulcrum. I apparently didn't know how to say it.

What about you, Leen? What are ways that you have either contributed to anti-black racism or anti-blackness that has been continuously reinforced in your communities?

Leen: Okay. So, when we say . . . sorry, I guess never realized this, but anti-black racism . . .

Margaux: It's not anti-racism.

Leen: It's not anti-racism. That's why I was sitting here, I was like, "Anti-black . . ."

Margaux: It's racism against specifically black people.

Leen: Yeah. I think my experience is actually the lack of that experience. I think raised in southern Utah I wasn't very much exposed to the black community. My best friend in high school, out of ignorance I would call her African-American, and she would say, "No, I'm black." And she was the only black person I knew in my high school, and that's how we gravitated towards each other because we were the only two people of color, I guess.

And I think starting from that comment is when I started realizing like, "Wow, I really don't know anything about what's going on in the bigger world than outside of my bubble."

I want to say probably the first time I actually started actively looking for information was when I started following Shaun King on Twitter and Instagram. And it really brought to light how much is going on out there and how much people are not talking about it and how much media labels are mistitling things and making it sound like, for instance, it's just scapegoating people in that sense. They put the blame in the wrong place and they make it sound like, "Oh, it's their fault for being shot," and things like that. And it was mind-blowing, to be honest.

And for once, I related like . . . I felt very guilty in a sense. It's like as a Palestinian we're always labeled wrong, and here's another group of people that is just experiencing the same thing and I didn't know about it. And so I would have to agree with Margaux on my ignorance in that aspect.

And then even in this year especially, going on through fourth-year and going to interviews, I started realizing how much there are disparities in healthcare with the black community.

And it was really surprising to me when I interviewed at one school how they were saying . . . their population is 90% black and they were saying, "Our life expectancies are about 50 years old. We actually don't have geriatric medicine here." And then when we were meeting with the Professionalism and Diversity Committee, which is a committee that was created post the 2016 election, we also discussed how pain scores for the black community versus everyone else are totally discrepant when it comes to how physicians approach how much pain patients are in. And that was also mind-blowing.

So I think fourth-year has definitely really opened up from just being on social media for me and reading things online to actually being . . . or at least seeing the experience, even though it's just like a smidge of it.

Harjit: A sliver. You're starting to make those connections.

Leen: Yeah.

Margaux: I think that's something I've also experienced too, Leen. Like you, I went to social media, and I think that's where social media can be a very great tool, is to access communities and voices that you would never have exposure to otherwise, especially in a state like Utah for us. But it is even more impactful to see it and to hear it and to sit down face-to-face at schools or places that are very different like this. It makes it that much more real, and it also makes the harmful impact of ignorance, that at least I grew up with, so much more real to me.

Bushra: I think it's important to mention that racism is seeped into the fiber of this country. It's just a fact. But what angers me the most is that we say that we treat people based off of recommendations, based off of evidence. But if that were true, then these numbers wouldn't be what they are right now.

Harjit: Yeah. Black Americans, they continue to have the worst health outcomes of any racial group. Black men have the shortest life expectancies, just like Leen mentioned. Black women have the highest maternal mortality rates, and black babies have the highest infant mortality rates.

Bushra: Even when you look at socioeconomic status, it does not make a difference in mortality rates in black people.

Leen: They can be rich black people, but still have these same statistics.

Bushra: Exactly. Part of me thinks, "Well, maybe what we learn in med school is like inherently racist." You know what I mean?

Harjit: Yeah.

Bushra: I can't help but think that. Or maybe it's something that we pick up within the culture of medicine that makes us geared towards that. I don't know what the answer is, but it is frustrating. When my family members end up in the hospital, I want them to get excellent care, but are they going to receive excellent care? I don't know.

Margaux: On your point too, Bushra, we talked about on our prior episode about decolonizing medical research. I would go back and listen to that episode for more background on what you're saying, Bushra. But the key point being that a lot of research that we use today as evidence-based medicine does not include black populations, black men or black women. And so only now are we starting to see studies that include this population and actually are providing data that will help us treat specifically black people.

But until we include and be very intentional about how we are applying the evidence that is basically studied on white men for the majority of cases, we have to acknowledge that that deficit exists in medicine and we have to be intentional in how we are treating those patients.

Leen: One thing that strikes me when it comes to essentially this inequality in medicine is . . . I mean, the first thought that comes into my head is when people would use the "all lives matter." They use the argument saying, "But all lives matter, not just black lives." And you see it so well in medicine. You say, "Yeah, here we are learning about the human body and yet we have all this . . . we don't have any evidence-based medicine to support the black community. So tell me how all lives matter."

Harjit: Going off of this topic of "all lives matter," there's one thing that I've been thinking a lot about. When the civil rights movement happened and black people were fighting for their rights, the outcome of that was as an Asian-American, as a South-Asian-American, I benefited from everything that they fought for. That's another huge distinction I see, because sometimes I'm like, "If I am supporting the things that black people are fighting for, I'm benefiting from that too." But I don't know if the reversal is true.

And that's another thing that I wanted to mention, because I think that me working towards anti-black racism is not only me working towards black individuals, but it's also me working towards my communities. And growing up, I didn't think about it that way. So, if I continuously try to do work towards anti-black racism, I am doing work towards racism, period. And that seemed really powerful for me.

Margaux: I wanted to bounce off your point. When you said working towards stopping anti-black racism will benefit you, as a white person, I think I take the view that a lot of the privilege that I have been given as a white person, what that means in terms of working against anti-black racism is stepping back and giving away some power or privilege that I have innately been enjoying as a white person.

And so I think it's a very different dynamic depending on who you are and what part of white supremacy and the system that you are benefiting from. And so, for me, it's reconciling . . . I need to be okay giving up something. It's a very different dynamic, but we need to be okay with that.

Bushra: It would be great if people recognized that racism still exists and acknowledge that. I think that to call it by its name, it becomes easier to combat that. I think there are a lot of people who think that racism doesn't exist anymore. "Slavery is over. I don't know why you guys are complaining about this." Every institution that you can think of is affected by it, and like you said, Margaux, a lot of people have a lot of privilege and a lot of power. The amount of change that we can make with people simply acknowledging that privilege and power, I think, would be immense, and it would be a great starting point.

Margaux: I agree, Bushra. I think there's a lot of power in calling it out and calling it what it is, because right now it's so triggering, the words white supremacy and racist. And nobody wants to be called that or have their thoughts or even think that they're benefiting from a system that is racist, but I think if we can start to normalize that that's what the system is, then we can put those emotions aside and actually look at it for what it is and start to figure out how to dismantle it, how to provide equity amongst the disproportionate distribution of power and privilege that exists right now.

Leen: I think people also need to recognize that trauma is generational. It's not just something that . . . slavery happened then, but the trauma changes form, racism changes form, and that energy is still going from generation to generation. And that causes different changes in environment. It causes different changes in health. And until we actually put a force to stop it, it's just going to keep rippling through time.

I think overall it's really fascinating how much . . . I'm going to say the human race because I feel like when it comes to color, especially with black racism, it is not something just in the U.S. I think it's all over the place with the ethnocentric ideals of beauty that we talked about. But it's just fascinating how we all have the same amount of melanocytes and it's just the amount of melanin that's causing all of this ridiculousness.

Harjit: How do you all feel like we can start combating that? I think mentorship is really important. And for me, combating anti-black racism, although I am not into law and policy, I think that'd be a great place to start.

But how I try to do it is, one, to be aware, aware that even I can perpetuate that, and also to help create pipeline programs or focus on mentorship so we can increase the racial and ethnic diversity of medicine.

Leen: Honestly, I think it's action. If we need physicians to represent this group, we need physicians who look like this group. That's what I'm thinking about in healthcare, but it applies to all areas of life. We just need to start raising this community. We're out there, we're talking politics, but there's still this cycle that just keeps going.

Bushra: I like that you said that, Leen, just because I feel like a lot of people . . . I guess we're talking about healthcare specifically, but a lot of people of color, specifically black people, don't apply for higher education simply because they've been taught that they can't make it. In order to succeed, black people are meant to be exceptional at every aspect, whereas you don't see that kind of pressure within the white community.

Margaux: What action looks like for me right now is just listening. I think that's the key thing, is to not . . . you want to inject your own voice and your own opinions, but sitting back and listening to the stories to understand what the barriers are, to understand what the discrepancies are, to understand what the problem is from the source.

And then secondly, calling out . . . using these words and normalizing that that is racist, the system is racist, and whenever I understand or find out something new about how the system that I'm working in is negatively impacting black people, or any population for that matter, calling it out and having conversations with other white people about it. Whether they say something that's racist or feed into inherently a racist system, just starting that conversation and normalizing the ability to talk about it.

Those are the things I'm doing right now, but I agree that action needs to be amplified by a thousand or more, because like you said, Leen and Bushra, action is really how we're going to change things.

Harjit: Yeah. Margaux, I also agree with that. One actionable item is having those conversations with your sisters, your brothers, your family members.

Margaux: Your classmates.

Harjit: Your classmates, right. Bringing all that up is very . . . it's been hard conversations, but I think it's so important.

Margaux: And I think that's key. They are hard conversations and they're not always going to go well and you're not always going to feel good about it at the end, but at least you said and you pointed it out. And I think the more happens . . . even if that other person is defensive or upset by what you're trying to talk about, even that first step of just bringing it up and putting both of you outside the comfort zone will make progress eventually.

Harjit: Yeah. Is there anything else anyone wanted to add, or should I wrap it up?

Bushra: I guess anti-black racism, not cool. Let's not do it anymore. And that's the end of that story. It's real simple. You feel what I'm saying? Stop being racist.

Leen: I don't know how you're not getting this. It's not that hard.

Harjit: I 100% feel what you're saying. And I appreciate everyone's vulnerability because, in a sense, we have said we contributed to an act of anti-black racism. I have been an anti-black racist. And though that's hard for me to say, I want to learn from that.

And thanks for having this difficult conversation with me. I do feel like I had several years to think about this, but even me, I'm still forming my thoughts, and I hope that we all continue to work towards combating anti-black racism within our communities, within medicine.

And if there are any other thoughts anybody else would like to add, please find us on Instagram @bundleofhers. Send us a direct message. We'd love to hear what you think about everything that we spoke about.

Have a wonderful day. I mean, it could be morning, afternoon, or evening. Just have a good day.

Bushra: Until next time, bye-bye.

Leen: Have a good life. Have a good season.

Bushra: It's just like can we not be racist?