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REBECCA: I'm very pleased to welcome you all here for this year's Nordlander Lecture in Science and Public Policy, which is sponsored by the Science and Technology Studies Department. This lecture is named for Dr. Eric Nordlander, air who graduated from Cornell in 1956. He was an organic chemist who earned his graduate degrees from Caltech and MIT and spent of his career at Case Western Reserve in Cleveland.
Nordlander was an inspiring teacher. And in addition to chemistry, he helped his students learn about the interactions of science and public policy. He died of cancer in 1986. But before his death, he knew that his friends and family were planning a living memorial, support for lecturers at Cornell would promote, through their own personal example, student interest in science and public policy. Among the contributions to the Nordlander fund were many from his students, who wrote passionate letters about the example for them that Eric Nordlander had set out through his own actions. As in the past, we're delighted that Eric Nordlander's friends and family can be with us today, including his children, Ted and Betsy.
Our speaker today, Dr. Mary Bassett, represents the kind of engagement with science and public policy that Eric Nordlander aimed to inspire. So in my very brief introductory remarks, I will not be able to adequately represent all of Dr. Bassett's accomplishments. But I do want to give a very brief sketch of her career, because it demonstrates a persistent commitment to advancing social justice in the area of public health.
Dr. Bassett grew up in New York City and earned her bachelor's degree in history and science from Harvard University and then on her medical degree from Columbia University's College of Physicians and Surgeons. She served her medical residency at Harlem Hospital Center and also earned a master's degree in public health from the University of Washington. After Dr. Bassett finished her medical training, she went on to the University of Zimbabwe, where she was faculty for 17 years. Zimbabwe was then experiencing one of the world's worst AIDS epidemics. And as medical faculty, Dr. Bassett developed a range of interventions to fight that epidemic.
In 2002, Dr. Bassett became the deputy commissioner of health promotion and disease prevention at the New York City Department of Health and Mental Hygiene. And in that role, she directed several initiatives, including bans on smoking and trans fats in restaurants and the requirement that chain restaurants list calorie counts. She also established the department's district public health offices in east and Central Harlem, the South Bronx, and North and Central Brooklyn, which are all areas where communities tend to experience an excess burden of disease. And these offices improved community health in several ways, including, for example, home visiting programs, free exercise programs, and efforts to increase access to healthy food.
Since the fall of 2014, Dr. Bassett has served as the commissioner of the department. Just a few months after taking on this new role, she published a perspectives piece in the New England Journal of Medicine about the challenges that hashtag Black Lives Matter poses to medical and public health communities. And she also very powerful TED Talk on the subject of why doctors should care about social justice. I personally found both of these pieces to be exceptionally helpful in my teaching on these very difficult subjects.
And all of this is to say that in addition to practicing medicine and public health in a way that reflects a profound concern for social justice, Dr. Bassett has been very outspoken in encouraging other doctors to do the same. And Dr. Bassett has received numerous awards for her work in medicine and public office. These include the 2016 Frank A. Calderone Prize from Columbia University's Mailman School of Public Health, which is the most prestigious award in public health. And then just last year, she was elected to the National Academy of Medicine. So I can spend quite a bit more time detailing Dr. Bassett's important work. But I don't want to infringe on her time. So I'm just going to ask us all to please join me in welcoming Dr. Bassett.
[APPLAUSE]
MARY T. BASSETT: Thank you. Thank you, Rebecca. That was really lovely.
[APPLAUSE]
Oh, wonderful-- thank you. Thank you, Rebecca, for that lovely introduction and thank all of you for coming. It is finally beautiful weather outside. And I know it's a busy time of year for students. So I'm very grateful for all who've attended. And I know that many of you are here in the spirit of this annual lecture.
And I also want to thank the Nordlander family and all those who work to preserve the memory of Rick Nordlander. I never knew him. I hadn't heard of him. But I know from his connection of science and policy that he was committed to the idea that science serves a social purpose and that we should never forget that. So I feel that it's really an honor to be here.
I also did notice that the last several speakers have all been women. And I just want to acknowledge to-- I don't know how the process works. But I think you should all know that in both science and in medicine, women continue to face many obstacles. And I believe that in its selection of who is invited that you're also making a statement of the important role of women in these fields.
I'm going to talk today about a topic that is very important to me both personally and professionally. And I hope to convince you at the end of my talk that by talking about racism, by acknowledging in particular the importance of what's come to be known as structural racism, that we not only addressed an important moral issue of our time, but we also improve on our commitment to high-quality, technically-excellent public, that doing better in this regard is not only a way of improving our impact on society, but it's also a way of doing our job better. So I was advised by my team, many of whom are quite young, that I had to start out by saying a few words about myself. So I'm going to do that. I don't really-- this isn't my favorite thing to do.
But I want to acknowledge my father, [? Emmett ?] Bassett. So I mentioned that my father was a bench scientist. And he was a very important person to me. And he, all his working life, was committed both to the pursuit of science and the pursuit of social justice. And that affected me. The photo is not here, but as a college student, I became involved in the free health clinic movement and in Boston worked as a volunteer at the Black Panther party's clinic.
Many people remember the Black Panther Party as a party that publicly displayed arms, wore black berets, used militant slogans. And they've forgotten part of the equally important part of the Black Panther party's work, which was delivering services-- free breakfast programs, free health care. And I had the privilege of working with many physicians who I later learned were prominent in their own chosen field who also volunteered at the free health clinics that I served as the evening administrator for as a college student.
I went on to train at Harlem Hospital, where I witnessed the sickest patients that I have ever seen. And I've worked, as you've heard, in many different places, including Zimbabwe, an underdeveloped country. At the time that I was an intern at Harlem Hospital, the likelihood that a man from Central Harlem would survive to the age of 65 was lower than that of a man in Bangladesh, one of the world's poorest countries. And the only reason that women did better is because of the truly dire situation of Bangladeshi women.
I became active as a house staff officer. I was a member of the house staff union. We led a strike against the city hospital system, not for bread and butter issues, not for wages or hours, both of which would not have been bad issues to have a fight over. But our efforts were all directed at improving the quality of care that we delivered to our patients. We didn't want to have to practice without enough nurses to take care of our patients, without enough transport aides to take our patients to the x-rays. And well, that's me. You know, I'm old enough that I don't mind looking at pictures of myself when I was young.
[LAUGHTER]
And then I went on and trained. Many of you may be familiar with the work of Nancy Krieger, also pictured in this photograph. We wrote a paper many years ago called "The Health of Black Folk." And it remains one of my favorite publications. It was published in a magazine that still exists but was probably an unconventional place to publish a paper like this called Monthly Review. And we talked about many of the ideas back then that I'll be reviewing with you today.
I left and moved to Africa, to Harare. And of course, I found there, just as I had in my hometown of New York City in Harlem, that the circumstances of people's lives are what determine how their health evolves. And I lived in Zimbabwe till 2002 and then returned to work at the health department. You've heard the many things that I've been involved in. Actually, as commissioner, we worked on getting sodium labeling. This was a ribbon cutting for the first lactation room at the health department. All city buildings now are required to have a lactation room if they can locate the space.
And then I went back to working in Africa in something that we didn't mention, an interlude working for a private foundation. And in February of 2014, I was appointed health commissioner by Bill de Blasio, mayor who ran a platform that there should be one city that serves all of its people. So this is what I'm going to talk with you-- that was the bit that was supposed to be a preamble. That was for the students so that you can see that I grew up like you are growing up and responded to my times. And I must say that it's so inspiring to see students returning to activism after a period of a lull. And I continue to learn from the young people I work with at the health department, of whom there are many.
So today, I'm going to talk about the concept of structural racism and review with you what we mean by racism, how we talk about it, and how and why we should care about it when we talk about the health of the population, and finally, what we can do about it. Because if there's anything that I feel very strongly about, it's that we have to link knowledge to action. And that's why over the years, I've come to see myself as a public health practitioner.
And I'm going to start out with what will be my final slide and then take you through how I get to this slide. And it begins by stating a proposition on which I hope we can all agree, that as a group, all humans are created equal. That doesn't mean that I am equal to you or to you or you are equal to the person next to you. But as a group, we are all equal. And we, therefore, have to ask ourselves how to explain the patterning of disease by social position, including the patterning by race, and ask ourselves what explains the variation in risk factor exposure and disease outcomes so heavily patterned by race in our society?
And there are basically two ideas. One is that it's the people. Something is different about the people as classified by their social position. So when we're talking about race and in our country, most of our literature on race focuses on black-white differences. But they apply to people of color as a rule. Or is the context?
And what I hope to convince you of over the following minutes-- and I'll try and go a little faster so you can get out and enjoy this beautiful day-- is that if we decide that it's the people, either their genes or their culture or their behavior, that's a racist idea. And part of what we need to do to undo racism is to identify and refute racist ideas. Now I use a pretty simple definition of racism. It's not just personal preference or personal prejudice. It's the ability to act upon that personal preference or prejudice.
Racism wouldn't exist without the existence of power. And at the health department, we've been using this taxonomy of racism, of internalized, interpersonal, institutional. And a more recent phrase-- and many people interchange institutional and structural racism-- the more recent phrase is structural racism. This photograph is from a study that was done by the Clarks-- Kenneth and Marie Clark. It was cited in the Brown versus Board of Education decision. And it's of a boy, a young boy, as you can see from the photograph, being asked to indicate his preference for a doll.
And these dolls were shown to very young children. And overwhelmingly, when asked to identify the smart doll, the pretty doll, the good doll, black children picked the white doll. So already, before the age of six, children have already adapted and adopted the belief systems that exist within our society.
And a teenager in a high school in New York repeated this study in the 1990s. And it's heartbreaking to watch. Because we still have the exact same findings, that black children indicate a preference repeatedly for the white doll. And in that film, the student says to the little girl who has picked the white doll, and which doll looks like you? And she points at the black doll.
So interpersonal racism is what usually occupies the minds of people in universities and health departments and institutions as a whole. This is the experience of prejudiced behavior between individuals. The main strategy that we have been adopting in recent years is the use of implicit bias training. And it doesn't have to be intentional. You don't have to discriminate against somebody overtly. You might just be acting on belief systems you have about what constitutes intelligence, what constitutes competence, and a whole realm of unintentional slights, microaggressions we now understand comprise part of interpersonal racism.
Institutional and structural racism are different. These don't require the private prejudices of individuals to function. They work without the bank director saying, you're black. And I don't like you. And I won't take a chance on you. Because he already has a set of directives that say, we don't lend in these neighborhoods, which just happen to be black neighborhoods.
And the distinction between institutional and structural racism is that institutional racism is based on single institutions and constitute sets of discriminatory practices. It's these sorts of practices that limited entry into universities, discrimination along various manifestations of social position. But structural racism is more global. And it spreads across institutions. And I'm going to read the definition, if you can all see it, I hope. Because I and others, did we wanted junior researchers to take the lead on this paper. This is a series that was published in The Lancet in February a year ago on equity and equality in health in the United States. And we, in this paper, define structural racism as involving interconnected institutions whose linkages are historically rooted and culturally reinforced. It refers to the totality of ways in which societies foster racial discrimination through mutually reinforcing inequitable systems that in turn reinforce discrimination beliefs, values, and the distribution of resources, which together affect the risk of adverse health outcomes.
So the important thing to remember about both structural and institutional racism is that they operate silently, that you don't have to have the existence of overt prejudice for them to work. They work without people having articulated or even implicit views that are racist, because they're structured in to how we allocate resources in our society. And in our society, black disadvantage has been normalized and is considered practically permanent. A very widespread belief is that the various damages related to our legacy of enslavement and Jim Crow afflicted on the community of people of African descent has rendered them unequal.
Now we are in a very difficult time now. There's a lot of contests in our national conversation. You may be aware, although they walk back from it, that the CDC, trying to be helpful, indicated a number of words that would be considered damaging for any applications-- the word vulnerable, the words equity. There were seven of them. I managed to use all seven in a tweet.
[LAUGHTER]
And we also saw the really shameful response to the devastation in Puerto Rico, which I am proud to say the health department in New York City has twice sent teams to Puerto Rico to show solidarity with our neighbors. Many people of Puerto Rican descent live in New York City. But on display there also were the contested idea of what it is to be American.
Now this is a history that goes back a long way. And I think it's always worth-- this is by an artist in Baltimore. And it's just worth seeing how little green there is in this arc of history, that the first documented presence of an enslaved African in what we now call the United States was in 1619. So we're soon approaching 400 years. It wasn't until 1865 that formal enslavement of Africans was ended following a very brutal war between the states. And it was quickly followed by a long run of segregation, which in many ways reenacted and enshrined the disadvantage of people of African descent.
I put in brackets here this-- I don't know if my point-- yeah, here. That was my youth. I was really lucky. That was a period that's a very special period within the green-- '65 to 1980, when Ronald Reagan was elected president, that followed on the passage of the Civil Rights Act, the Voting Rights Act, and many other things-- Medicaid, Medicare. As you may know, Medicare was responsible for desegregating hospitals in the United States. Environmental-- I mean, a whole host of the Great Society legislation opened up a new period in the United States which began to change with the election of Ronald Reagan. And so my adult life has been speaking out against the rollback of the advantages that gave me the opportunity to go to the universities that you heard described that I attended and have the opportunities I have. These are now being rolled back.
But the idea of what explained black-white differences is as old as the existence of racist ideas in our society. And I thought I would just highlight a few of them. Many of you may have heard of drapetomania. How many of you have heard of this disease? Very good-- I'm impressed. I say that. But hardly anybody ever raises their hands.
And this was a disease described in the years before the beginning of the Civil War that caused enslaved people to run away. That was a sickness. It won't surprise you that it was treated with whipping. And it was a form of pathologizing what many of us would consider an appropriate response to human bondage.
And after the Civil War, another-- and this guy was not a loony tune. He was a very well-respected physician, a Southerner, Samuel Cartwright. Frederick Hoffman was an immigrant. He came originally-- I don't know whether he's Austrian or German. And he used data following the emancipation of blacks to show the very high rates of mortality among the newly-free people of African descent. And he interpreted these data to show that the lack of fitness of blacks. They were free, but they were dying off. In fact, he projected that blacks would vanish entirely because they lacked fitness to be free. And that was what explained the very high mortality rates.
And I won't go through this slide, because I should try and make up some time. But you should be aware that even in the time that these things were published, there were voices that spoke back against them. And during the whole period of enslavement, there were people who criticized the use of enslaved labor in the United States. And this was Du Bois, a titan of any race of the 20th century. And he pointed out that it was the living conditions of the newly-freed African-Americans, not their ancestry, that caused the very high rates of mortality in the black population.
Even really well-regarded people, like Jane Addams, who we all venerate-- she's a founder of social work. She established the wonderful settlement house movements, the idea that one should go among the poor and share their lives. But she didn't think that these strategies would work for black people. Because she felt black peoples just didn't have the kind of tradition that European immigrants had. And we see this narrative replayed.
So blacks had high mortality rate because they were inferior. Immigrants had higher mortality rates than native-born. But that was because of the many difficulties that they faced. And we're seeing the same narrative replayed as we engage with the problem of opioid addiction, which in our country as a whole, certainly in my city, has transitioned from being prescription painkillers to being a problem of heroin. But we are not seeing the response that we saw when heroin flooded our neighborhoods.
The current epidemic is being ascribed to the failure of the American dream to reach many white workers. And words are being used like an epidemic of despair, diseases of despair. We see a completely different coverage of opioid dependence in our media. And we, in many ways, see this dichotomy as reminiscent of what happened when crack cocaine came in. And it was treated so differently than powdered cocaine. These differences in framing have real-world implications.
The therapeutic interventions are what we now think a mostly white opioid epidemic should use. And this is bittersweet for me, because I agree with that. The people who are dependent on drugs need treatment, not punishment. But there's no doubt that this was not the response when most users were people of color.
And I thought I would just take a moment to go through-- some of you may be familiar with these Princeton researchers who published these very scary data showing rising mortality rates in a 10-year swath, midlife, older midlife-- I don't know-- of whites. And here, I guess the authors, one of whom is a Nobel laureate, Angus Deaton, and Anne Case, felt that the right comparators for whites in midlife were people in France, Germany, England. So they didn't include anybody else from the United States.
But you can see. This is scary. The mortality rate is rising in this group. And it's overwhelmingly due to suicide, liver disease, and opioid use. And they interpret this as the loss of the social compact in our society with its working class. It's most pronounced among white men without a high school education.
Now I had my team do the slide over. It doesn't look as dramatic, but there they all are. This is this group here at the top with the mortality. And I had them put in the mortality rates of people of African descent, black, blacks. That's the green line. So what do you see there? Well, one, they didn't put it in the picture. It's going down. That's good. It's still twice as high as the rate is among whites. That's bad.
And when asked on the record why they didn't include this, they said, well, it didn't fit. And it wasn't what we were interested in. But the narrative that has accompanied this is that the focus on people of color has led to a neglect of poor whites. And so we're headed in the right direction with blacks. And meanwhile, nobody was watching as things went off the tracks for whites. So I think that's a very dangerous argument. But we can come back to that if we have any appetite for question and answers after all the photographs of what I'm--
This is how we think about it. Structural racism really forms the foundation that supports internalized, interpersonal, and institutional racism. This matters to health because it matters to just about every social outcome. Because it creates all the inequities that we often speak of as social determinants of health. It drives the differences in housing stock, job opportunities, educational attainment, which underlie the inequities in health.
And I'm going to talk you through an example. You're the second group that I've tried this with. I usually use residential segregation as an example of structural racism. But I've been working on an example that is based on mass incarceration as an example of structural racism. Now mass incarceration is not just the action of a prejudiced police officer on the street who prefers to arrest black people. It has to do with the segregation of our neighborhoods, the over-policing of some neighborhoods. It has to do with our judicial system. It has to do with our social welfare policies. It has to do with our educational system. So it fits our definition of structural racism. It involves multiple institutions, all of which work together to adversely affect the social determinants of health.
And the use of legal systems to replicate racial repression after the end of the period of slavery also has a long history. These are examples from the whole chain gang, convict leasing, sharecropping, the use of vagrancy laws, sundown towns, which were all white after dark. All of these were actions that were enforced by violence and were supported by state institutions.
This is a very famous photograph. But the top of it is missing. This is a joyous crowd watching the lynching two black men. You can see, I think, that they seem like they're at a party. And so these were very public events. This wasn't happening in a quiet forest in the dark. These were very public events that constituted a form of domestic terrorism that drove the great exodus from the South of the black population.
And the prevalence of lynching was higher than had been documented. Bryan Stevenson has been cataloging lynching. And he is up to 5,000 of them. And I want to acknowledge again that, particularly the black community in the North, protested against this. I want to know that these were contested in their day.
But what we saw happening-- you know that there's been a lot of conversation about lethal encounters between the police and particularly young black men. This is a graph that I always have a little bit of trouble with. So I'm going to take a minute and talk you through it. These lines here are high income counties for blacks. These are low income counties for blacks. And these are the riots or the uprisings, whatever you want to call them, of the 1960s, which occurred mostly in wealthy cities. So the black population would be counted as high income because it was done by county level income measures.
And you can see that this is whites here at the bottom. So now you can see that for both blacks and whites that income doesn't seem to make that much difference in terms of risk of lethal encounters with the police. The main difference is race. And it's about the same. So it's good. It's gone down. In New York City, we don't have a particularly lethal police force.
But as it went down, something else was also happening. This decline here was matched by this, the rise in incarceration rates. Since the mid '70s, our prevalence has really begun to spiral up. It only leveled. You all know we incarcerate at a higher rates than anywhere else in the world. And we incarcerate minority groups overwhelmingly. So it plateaued and has begun to level. But you can see that our rates of incarceration remain at extraordinarily high levels. And nearly 3/4 of people in federal prisons are black or Latino, as are the majority in state.
Now this is a question of justice. But it's also a question of health. The experience of incarceration is bad for people's health, by and large. Our data in New York City show that even time spent in our jails, particularly with the use of solitary confinement, is very risky to health in terms of self-harm. And of course, those who are incarcerated aren't the only ones who experience adverse outcomes. They leave families behind. And those families also, they're prone to both mental and physical health issues.
So we know also that people who are incarcerated often also live in communities where there are high levels of police activity, which creates a general atmosphere of trauma and anxiety. The neighborhoods in New York City where we, in the previous administration, instituted stop-and-frisk, it's banished from New York pretty much-- I think that's not an overstatement-- are far more likely to have poor health. So this is a graph that shows how incarceration rates line up with our nonwhite neighborhoods.
And this is a photograph that is held in the collection of the Museum of Modern Art. It shows the removal of people from communities of central Brooklyn. You can see that the number of people taken out of certain communities is just staggering.
And these are the neighborhoods that have all kinds of other health problems. These are unrelated in terms of what I think of as a doctor. Asthma has a very different origin than stroke or drug use. But the same neighborhoods colored in the darker color on this slide line up with the neighborhoods that are also sending people to jail. These are also the neighborhoods where people aren't completing high school. And of course, these data are rather sort of almost numbing. But they have behind them many stories, only a few of which we get to know.
This is Kalief Browder, a young man who was arrested, incarcerated for three years, at least a year of it spent in solitary confinement before his charges were dropped. He was charged with stealing a backpack. And two years after he got home, he committed suicide. And his mother died shortly thereafter.
Eric Garner, who is immortalized by his final words, I can't breathe, died as a result of a chokehold. And his daughter died recently. She died at the end of last year, a young woman, as you can see. She had an asthma attack and died.
So now I'm up to telling what we're trying to do about some of this. So this is a system that cuts across many institutions that has resulted in depriving people of their liberty, exposing them to disease-causing conditions, and disrupting communities. The data are probably best for mental health impacts. But I think that it stands to reason that we would see other outcomes.
So I'm going to tell you a little bit about what we're doing at the health department. This is the leadership team of the health department. When I joined the health department, there were no members of the senior leadership team who were either black or Latino. So we changed. That's different. We are very different, much more diverse leadership team, the most diverse in the history of the health department, I believe. And we even added a man. We've never had a problem with having women in health, although I'm only the-- let's see. I'm the fourth woman to be health commissioner in the 200-year history of the health department.
And we are undertaking, as an organization, to train everybody on our staff on implicit bias. We've trained a sixth of the staff. And we also are requiring that everybody get educated about the impact of social determinants on health.
We are implementing new programs. And these are what some people call place-based approach. We've established offices in neighborhoods, as you've heard, that have higher rates of disease, neighborhoods that have had consistent disinvestment over many years. And we are in these neighborhoods using buildings owned by the department to co-locate people. This lecture was supposed to be over. So apologize to whoever was trying to reach you.
And so we are starting these co-located with community-based organizations. One of the things that I really think that we can do better is align the work that is being done by many people in communities. So the price of admission to getting very subsidized rent in our buildings is co-planning on important health issues. We're focused on the problem that has gotten increasing attention of the gap in infant mortality and maternal mortality.
We're working with the police department. We probably are the only health department in the country that has a signed memorandum of agreement to review all deaths related to police involvement. We're doing jointly with the police department. We as a health department report on mortality. And we believe that our numbers have been inaccurate. So we're working together with the police department to improve the capture. Nationally, the data suggests that only half of the deaths related to police action are reported as such.
We're also working to put together teams of mental health professionals to respond with police to calls for emotionally disturbed persons and are helping the police get better training in de-escalation so that our hope is that we'll see fewer-- that they will be less likely to use their weapons and more likely to seek other means of intervening in deescalating situations. We're working on promoting access to bail in our jails. And we just got a very big grant from the district attorney's office to improve the connection to primary care of formerly incarcerated people, seeing the primary care setting as a place that we can begin to address many of these problems.
I've talked about opioids. And New York City has seen a rapid rise between 2015 and 2016 in the number of opioid deaths. But it had been rising for years. And you can see unusually this northern end of Staten Island is an affluent area. And this reflects the diversity of the opioid epidemic. But if we only focused on Staten Island and sought to only get rid of Staten Island's overdose deaths, because the population of Staten Island is so small, we would only reduce opioid deaths by 10%.
So it's been very important to acknowledge the locations where heroin never left-- true of the Bronx, for example, and Central Brooklyn-- which continue to comprise half of our overdose deaths. And we are doing many different things to tackle this epidemic. We want to see fewer people die, more people access treatment. And that underlies our commitment to distributing naloxone.
We're working hard to use media to destigmatize treatment. We have a wonderful campaign out now that shows people who look like any of us-- I could be on methadone talking to you now-- to show how treatment gets people able to get their lives back. And very courageous individuals on treatment with buprenorphine and methadone stepped forward to tell their stories because the risk of relapse for people on opioids is extraordinarily high. And we need people to understand that they should be on treatment. So these are some of our campaigns. And I think this probably was a slide, but I'm just worried if I just should keep going so we have a chance for a few questions before 5:00.
[VIDEO PLAYBACK]
- I was about five years old. My mother overdosed. She wouldn't move. You know, sometimes, you know, what you go through in life will push you till you want to numb everything. Lean was something that helped me with that. Codeine, we called it lean.
When I was under the influence, I wouldn't leave my house. And I won't play with my kids. It just kills your spirit. It just-- and I remembered what happened to my mother. I caught myself. You take bupe. And within 15 minutes, all those symptoms go. You no longer crave for the drug. It can make you get back on track because there's no more the dark cloud anymore. It's gone. I'm Mitchell. And I'm living proof that Bupe treatment works.
[END PLAYBACK]
MARY T. BASSETT: This is still in progress. It's not a final. But I thought I would show it to you, that it's very important that we destigmatize substance use and that we make people aware that there are treatment options that work. And it's important that we show all kinds of people are living with opioid dependence. So we are working to expand it. We're expanding our syringe exchange programs because these have been absolutely critical in ensuring that we don't have hep C and HIV accompany the resurgence of heroin.
So recently, we've also undertaken some policy initiatives. We are joining lawsuits that are cropping up across the country, making the case that the drug companies knowingly pushed opioids on physicians and that they should share the burden, not only government, of responding to an epidemic that they so profited from. And I'm just going to give you a few more examples of things that we do. We are very serious about our data.
This is something that I don't have time to tell you about. But it was an analysis that we did that showed that each one of these lines are somebody who has to travel to New York, travel to this location. I never knew so many people lived in New Jersey, Connecticut, and Westchester worked at the health department. But they do apparently. And it turns out that whole swaths of New York City would not be covered in the event of an emergency if people who lead these locations where vaccines or some kind of antidote would be handed out had to walk to those locations. We would have no coverage in the South Bronx, for example. Because nobody who's in a management position in the health department lives in the South Bronx.
And it has a happy end to this story. Because by turning to the city workforce as a whole, we have been able to cover those locations. The sanitation department, for example, has people who are in leadership roles who live in the South Bronx. We publish a lot of data by neighborhood and make it available to those neighborhoods.
And last, our efforts focusing on Zika-- we were able to use our data to show that immigrant neighborhoods in our city weren't benefiting from testing for Zika and to change that. So the racial lens has a long arc. But it affects how we do our work, our decision to focus resources on communities that have not-- the people in them are not inferior. They've suffered from long-term disinvestment. And the health department should invest more there. And we are using our efforts to better target our efforts.
And I'll return to the slide that I started with before we went on this long trip together and the proposition that all humans are equal, that we differ because of differences in circumstances, in resources and opportunity. We don't differ because we are different fundamentally or inherently as people.
So I want you to do this going forward, that ask yourself when this person is trying to explain a racial difference in disease. And if they're talking about the problem is the people-- they don't follow advice. They don't do what we tell them. That's a racist idea. OK. Thank you very much.
[APPLAUSE]
Mary Bassett, commissioner of the New York City Department of Health and Mental Hygiene, examined the health implications of mass incarceration and police repression to elucidate the impact of structural racism on health, April 23, 2018 as part of the Nordlander Lecture Series. Sponsored by the Department of Science and Technology Studies, the Nordlander Lectures in Science and Public Policy are given by distinguished scholars and public intellectuals engaged in important policy areas.
