An article in the Yale Alumni Magazine told the story of Clyde Murphy, a black man who was a member of the Class of 1970. Clyde was a success story. After Yale and a law degree from Columbia, Clyde spent the next 30 years as one of America's top civil rights lawyers. He was also a great husband and father. But despite his success, personally and professionally, Clyde's story had a sad ending.
Un artigo da revista de exalumnos de Yale contaba a historia de Clyde Murphy. Un home negro, membro da promoción de 1970. A de Clyde é unha historia de éxito. Tras saír de Yale e graduarse en Dereito pola Universidade de Columbia, Clyde foi durante os seguintes trinta anos un dos mellores avogados de dereitos civís dos Estados Unidos (EE.UU). Tamén foi un gran marido e un gran pai. Porén, malia o seu éxito, persoal e profesional, a historia de Clyde tivo un triste final.
In 2010, at the age of 62, Clyde died from a blood clot in his lung. Clyde's experience was not unique. Many of his black classmates from Yale also died young. In fact, the magazine article indicated that 41 years after graduation from Yale, the black members of the Class of 1970 had a death rate that was three times higher than that of the average class member. It's stunning.
En 2010, aos 62 anos de idade, Clyde finou a causa dun coágulo de sangue nun pulmón. Clyde non foi o único ao que lle aconteceu algo así. Moitos dos seus compañeiros negros de Yale tamén morreron novos. De feito, o artigo da revista indicaba que 41 anos despois da súa graduación na Universidade de Yale, os alumnos negros da promoción de 1970 presentaban unha taxa de mortalidade tres veces superior á da media da clase. É abraiante.
America has recently awakened to a steady drumbeat of unarmed black men being shot by the police. What is even a bigger story is that every seven minutes, a black person dies prematurely in the United States. That is over 200 black people die every single day who would not die if the health of blacks and whites were equal.
EE.UU acordou recentemente ante o balbordo constante dos disparos da policía a homes negros desarmados. O que é mesmo máis grave é que cada sete minutos unha persoa negra morre de xeito prematuro nos EE.UU. Isto quere dicir que máis de 200 persoas negras morren cada día e que non morrerían se negros e brancos tivesen a mesma saúde.
For the last 25 years, I have been on a mission to understand why does race matter so profoundly for health. When I started my career, many believed that it was simply about racial differences in income and education. I discovered that while economic status matters for health, there is more to the story. So for example, if we look at life expectancy at age 25, at age 25 there's a five-year gap between blacks and whites. And the gap by education for both whites and blacks is even larger than the racial gap. At the same time, at every level of education, whites live longer than blacks. So whites who are high school dropouts live 3.4 years longer than their black counterparts, and the gap is even larger among college graduates. Most surprising of all, whites who have graduated from high school live longer than blacks with a college degree or more education.
Durante os últimos 25 anos, entregueime á misión de entender por que a raza ten tanta transcendencia para a saúde. Cando comecei a miña carreira, moitos crían que se trataba simplemente de diferenzas raciais en renda e educación Descubrín que, se ben o estatus económico é importante para a saúde, a historia non remata aí. Se, por exemplo, observamos a esperanza de vida aos 25 anos, aos 25 anos de idade, hai unha fenda de cinco anos entre negros e brancos, mais a fenda por nivel de educación tanto en brancos como negros é mesmo maior que a racial. Porén, ao mesmo tempo, en tódolos niveis educativos, os brancos viven máis tempo que os negros. Entón, os brancos que abandonan o instituto viven 3,4 anos máis de media que os seus homólogos negros. A fenda é aínda maior entre os graduados universitarios. Pero o máis sorprendente é que os brancos que rematan a secundaria viven máis tempo que os negros licenciados ou con educación superior.
So why does race matter so profoundly for health? What else is it beyond education and income that might matter?
Así que, por que a raza resulta tan transcendental para a saúde? Que pode haber alén do nivel de formación e a renda que importe tanto?
In the early 1990s, I was asked to review a new book on the health of black America. I was struck that almost every single one of its 25 chapters said that racism was a factor that was hurting the health of blacks. All of these researchers were stating that racism was a factor adversely impacting blacks, but they provided no evidence. For me, that was not good enough.
Ao comezo da década dos noventa, encargáronme a recensión dun novo libro sobre a saúde da poboación negra dos EE.UU. Abraioume o feito de que case cada un dos seus 25 capítulos dixese que o racismo era un factor que estaba a afectar a saúde dos negros. Todos os investigadores participantes afirmaban que o racismo era un factor que afectaba negativamente os negros mais non achegaban ningunha proba. Para min, aquilo non era bo dabondo.
A few months later, I was speaking at a conference in Washington, DC, and I said that one of the priorities for research was to document the ways in which racism affected health. A white gentleman stood in the audience and said that while he agreed with me that racism was important, we could never measure racism. "We measure self-esteem," I said. "There's no reason why we can't measure racism if we put our minds to it."
Algúns meses despois, participei nun congreso en Washington DC e dixen que unha das prioridades da investigación debía ser documentar de que maneiras afectaba o racismo a saúde. Un señor branco ergueuse de entre o público e dixo que, se ben coincidía comigo en sinalar a importancia do racismo, nunca poderíamos medilo. "Medimos a autoestima", díxenlle. Non hai razón para non podermos medir o racismo, se nos poñemos mans á obra.
And so I put my mind to it and developed three scales. The first one captured major experiences of discrimination, like being unfairly fired or being unfairly stopped by the police. But discrimination also occurs in more minor and subtle experiences, and so my second scale, called the Everyday Discrimination Scale, captures nine items that captures experiences like you're treated with less courtesy than others, you receive poorer service than others in restaurants or stores, or people act as if they're afraid of you. This scale captures ways in which the dignity and the respect of people who society does not value is chipped away on a daily basis.
Así que me puxen mans á obra e desenvolvín tres escalas. A primeira recolle experiencias graves de discriminación, como ser inxustamente despedido ou ser inxustamente detido pola policía. Con todo, a discriminación preséntase en situacións máis correntes e sutís e, así, a miña segunda escala, chamada "Escala de Discriminación Cotiá", recolle nove elementos que reflicten experiencias como ser tratado con menos cortesía que outros, recibir un peor servizo en tendas e restaurantes ou ver como a xente actúa como se tivese medo de ti. Esta escala captura algunhas das formas polas que a dignidade e o respecto dunhas persoas que a sociedade non valora, vai minguando día a día.
Research has found that higher levels of discrimination are associated with an elevated risk of a broad range of diseases from blood pressure to abdominal obesity to breast cancer to heart disease and even premature mortality. Strikingly, some of the effects are observed at a very young age. For example, a study of black teens found that those who reported higher levels of discrimination as teenagers had higher levels of stress hormones, of blood pressure and of weight at age 20. However, the stress of discrimination is only one aspect.
A investigación revela que os niveis máis elevados de discriminación correlacionan cun alto risco de padecer un amplo abano de doenzas, dende hipertensión a obesidade abdominal, pasando por cancro de mama, doenzas cardíacas e incluso mortalidade prematura. Sorprendentemente, algúns dos efectos obsérvanse en persoas moi novas. Por exemplo, un estudo realizado con adolescentes negros, revelou que os que aducían altos niveis de discriminación na adolescencia presentaban un nivel elevado de hormonas do estrés, de presión arterial e de peso aos 20 anos de idade. Porén, o estrés causado pola discriminación é apenas un aspecto.
Discrimination and racism also matters in other profound ways for health. For example, there's discrimination in medical care. In 1999, the National Academy of Medicine asked me to serve on a committee that found, concluded based on the scientific evidence, that blacks and other minorities receive poorer quality care than whites. This was true for all kinds of medical treatment, from the most simple to the most technologically sophisticated. One explanation for this pattern was a phenomenon that's called "implicit bias" or "unconscious discrimination." Research for decades by social psychologists indicates that if you hold a negative stereotype about a group in your subconscious mind and you meet someone from that group, you will discriminate against that person. You will treat them differently. It's an unconscious process. It's an automatic process. It is a subtle process, but it's normal and it occurs even among the most well-intentioned individuals.
A discriminación e o racismo inciden de moitas outras maneiras na saúde. Por exemplo, existe discriminación na atención sanitaria. En 1999, a Academia Nacional de Medicina dos EE.UU. convidoume a tomar parte nunha comisión que concluíu, baseándose en probas científicas, que os negros e outras minorías reciben unha atención de peor calidade que os brancos. Isto acontece con calquera tipo de tratamento médico, dende o máis simple ao máis sofisticado tecnoloxicamente. Unha posible explicación a este patrón podería ser o fenómeno coñecido como "prexuízo implícito" ou "discriminación inconsciente". Segundo as investigacións dos psicólogos sociais, se unha persoa ten un estereotipo negativo sobre un grupo no seu subconsciente ao coñecer alguén dese grupo, discriminará esa persoa. Tratarao de maneira diferente. É un proceso inconsciente, un proceso automático. É un proceso sutil, mais é normal e acontécelles mesmo ás persoas con mellores intencións.
But the deeper that I delved into the health impact of racism, the more insidious the effects became. There is institutional discrimination, which refers to discrimination that exists in the processes of social institutions. Residential segregation by race, which has led to blacks and whites living in very different neighborhood contexts, is a classic example of institutional racism. One of America's best-kept secrets is how residential segregation is the secret source that creates racial inequality in the United States. In America, where you live determines your access to opportunities in education, in employment, in housing and even in access to medical care. One study of the 171 largest cities in the United States concluded that there is not even one city where whites live under equal conditions to blacks, and that the worst urban contexts in which whites reside is considerably better than the average context of black communities. Another study found that if you could eliminate statistically residential segregation, you would completely erase black-white differences in income, education and unemployment, and reduce black-white differences in single motherhood by two thirds, all of that driven by segregation. I have also learned how the negative stereotypes and images of blacks in our culture literally create and sustain both institutional and individual discrimination.
Pero canto máis afondaba no impacto do racismo na saúde, máis perniciosos se tornaban os seus efectos. Existe discriminación institucional, é dicir, discriminación que se dá nos procesos propios das institucións sociais. A segregación residencial por razas, que se traduce en negros e brancos vivindo en barrios moi diferenciados, é un exemplo clásico de racismo institucional. Un dos segredos mellor gardados dos Estados Unidos é o de que a segregación residencial é a fonte secreta da desigualdade racial do país. Nos Estados Unidos, o lugar no que un vive determina o seu acceso a oportunidades en educación, emprego, vivenda e incluso en acceso a atención sanitaria. Un estudo realizado nas 171 meirandes cidades dos Estados Unidos concluíu que nin nunha soa destas cidades os brancos viven nas mesmas condicións que os negros e que os peores contextos residenciais dos brancos son considerablemente mellores que o contexto medio das comunidades negras. Outro estudo probou que se conseguísemos eliminar estatisticamente a segregación residencial erradicaríamos por completo as diferenzas raciais en renda, educación e desemprego e que reduciríamos a fenda racial en número de familias monoparentais en dúas terceiras partes. E todo iso é ocasionado pola segregación. Aprendín tamén como os estereotipos negativos e a imaxe dos negros na cultura estadounidense literalmente orixinan e perpetúan tanto a discriminación institucional como a individual.
A group of researchers have put together a database that contains the books, magazines and articles that an average college-educated American would read over their lifetime. It allows us to look within this database and see how Americans have seen words paired together as they grow up in their society. So when the word "black" appears in American culture, what co-occurs with it? "Poor," "violent," "religious," "lazy," "cheerful," "dangerous." When "white" occurs, the frequently co-occurring words are "wealthy," "progressive," "conventional," "stubborn," "successful," "educated." So when a police officer overreacts when he sees an unarmed black male and perceives him to be violent and dangerous, we are not necessarily dealing with an inherently bad cop. We may be simply viewing a normal American who is reflecting what he has been exposed to as a result of being raised in this society.
Un grupo de investigadores reuniu nunha base de datos todos os libros, revistas e artigos que un estadounidense medio con formación universitaria le durante toda a súa vida. Isto permítenos ollar para esta base de datos e comprobar como os estadounidenses van vendo certas palabras emparelladas a medida que van medrando na súa sociedade Así, cando aparece a palabra "negro" na cultura estadounidense, de que vai acompañada? "Pobre", "violento", "relixioso", "preguiceiro", "alegre", "perigoso". Cando aparece "branco", as palabras frecuentemente emparelladas son "rico", "progresista", "convencional" "perseverante", "exitoso" "culto". Entón, cando un policía sobreactúa ao ver un home negro desarmado e o percibe como violento e perigoso, non temos necesariamente por que estar a tratar cun policía intrinsecamente malo. Pode que simplemente esteamos a ver un estadounidense normal actuando como reflexo daquilo ao que estivo exposto como resultado de medrar nesta sociedade.
From my own experience, I believe that your race does not have to be a determinant of your destiny. I migrated to the United States from the Caribbean island of Saint Lucia in the late 1970s in pursuit of higher education, and in the last 40 years, I have done well. I have had a supportive family, I have worked hard, I have done well. But it took more for me to be successful. I received a minority fellowship from the University of Michigan. Yes. I am an affirmative action baby. Without affirmative action, I would not be here.
Na miña experiencia persoal, creo que a raza non ten por que determinar o destino dunha persoa. Eu emigrei aos Estados Unidos dende a illa caribeña de Santa Lucía, a finais dos setenta na procura dunha educación superior. E nos últimos 40 anos foime ben. Tiven unha familia que me apoiou, traballei arreo. Foime ben. Pero costoume máis prosperar. Fun beneficiario dunha bolsa para minorías da Universidade de Michigan. Si, son fillo da discriminación positiva. Sen discriminación positiva, non estaría aquí.
But in the last 40 years, black America has been less successful than I have. In 1978, black households in the United States earned 59 cents for every dollar of income whites earned. In 2015, black families still earn 59 cents for every dollar of income that white families receive, and the racial gaps in wealth are even more stunning. For every dollar of wealth that whites have, black families have six pennies and Latinos have seven pennies.
Pero nos últimos 40 anos, a comunidade negra dos Estados Unidos non tivo tanto éxito. En 1978, as familias negras dos Estados Unidos gañaban 59 céntimos por cada dólar de salario dos brancos. En 2015, as familias negras aínda gañan 59 céntimos por cada dólar de salario percibido polas familias brancas. A fenda racial no relativo á riqueza é mesmo máis escandalosa. Por cada dólar de riqueza dos brancos, as familias negras suman seis centavos e os latinos, sete.
The fact is, racism is producing a truly rigged system that is systematically disadvantaging some racial groups in the United States. To paraphrase Plato, there is nothing so unfair as the equal treatment of unequal people. And that's why I am committed to working to dismantle racism.
É un feito que o racismo está a xerar un sistema totalmente corrupto que sistematicamente desfavorece certos grupos raciais nos Estados Unidos. Citando a Platón, non hai nada máis inxusto que tratar igual aos que son diferentes. Por iso estou comprometido co traballo para erradicar o racismo.
I deeply appreciate the fact that I am standing on the shoulders of those who have sacrificed even their lives to open the doors that I have walked through. I want to ensure that those doors remain open and that everyone can walk through those doors. Robert Kennedy said, "Each time a man" -- or woman, I would add -- "stands up for an ideal or acts to improve the lot of others or strikes out against injustice, he sends forth a tiny ripple of hope, and those ripples can build a current that can sweep down the mightiest walls of oppression and resistance."
Valoro profundamente o feito de me erguer sobre os ombreiros daqueles que sacrificaron ata as súas vidas para abrir as portas que eu puiden atravesar. Quero asegurarme de que esas portas fiquen abertas e de que calquera poida atravesalas. Robert Kennedy dixo, "Cada vez que un home –ou muller, engadiría eu– loita por unha idea, actúa para mellorar a vida dos outros, ou se ergue contra as inxustizas, envía unha pequena onda de esperanza, e esas ondas poden crear unha corrente, capaz de derrubar os máis poderosos muros da opresión e resistencia.
I am optimistic today because all across America, I have seen ripples of hope. The Boston Medical Center has added lawyers to the medical team so that physicians can improve the health of their patients because the lawyers are addressing the nonmedical needs their patients have. Loma Linda University has built a gateway college in nearby San Bernardino so that in addition to delivering medical care, they can provide job skills and job training to a predominantly minority, low-income community members so that they will have the skills they need to get a decent job. In Chapel Hill, North Carolina, the Abecedarian Project has figured out how to ensure that they have lowered the risks for heart disease for blacks in their mid-30s by providing high-quality day care from birth to age five. In after-school centers across the United States, Wintley Phipps and the US Dream Academy is breaking the cycle of incarceration by providing high-quality academic enrichment and mentoring to the children of prisoners and children who have fallen behind in school. In Huntsville, Alabama, Oakwood University, a historically black institution, is showing how we can improve the health of black adults by including a health evaluation as a part of freshman orientation and giving those students the tools they need to make healthy choices and providing them annually a health transcript so they can monitor their progress. And in Atlanta, Georgia, Purpose Built Communities has dismantled the negative effects of segregation by transforming a crime-ridden, drug-infested public housing project into an oasis of mixed-income housing, of academic performance, of great community wellness and of full employment. And finally, there is the Devine solution. Professor Patricia Devine of the University of Wisconsin has shown us how we can attack our hidden biases head on and effectively reduce them. Each one of us can be a ripple of hope.
Hoxe son optimista, pois ao longo de todo Estados Unidos albisquei ondas de esperanza. O Centro Médico de Boston vén de engadir avogados ao seu equipo médico para os facultativos poderen mellorar a saúde dos seus pacientes, ao encargárense os avogados das necesidades extrasanitarias dos pacientes. A Universidade de Loma Linda (California), construíu un centro pasarela (Gateway College), preto de San Bernardino para ademais de prestar atención sanitaria, poder achegar competencias laborais e formación laboral a unha maioría predominante de individuos con baixos ingresos, para estes poderen obter as competencias necesarias para achar un traballo decente. En Chapel Hill, Carolina do Norte, o Proxecto Abecedarian atopou o xeito de garantir a redución do risco de doenzas cardíacas entre negros que andan pola trintena, ofrecendo un coidado diario de calidade desde o nacemento ata os cinco anos. En centros extraescolares de todo Estados Unidos Wintley Philips e a US Dream Academy están a romper o círculo de encarceramento proporcionando formación e orientación académica de alta calidade a fillos de reclusos e nenos con atraso escolar. En Huntsville, Alabama, a Universidade de Oakwood, unha institución historicamente negra, está a amosarnos como mellorar a saúde dos adultos negros, incluíndo un exame médico como parte da orientación aos novos alumnos, fornecéndolles a eses alumnos as ferramentas necesarias para elixir opcións saudábeis e fornecéndolles anualmente un historial médico para poderen supervisar os seus progresos. E en Atlanta, Georgia, a ONL Purpose Built Communities erradicou os efectos negativos da segregación, convertendo un proxecto de vivenda social asolagado polo crime e anegado pola droga nun oasis de vivendas de ingresos mixtos, de rendemento académico, de benestar comunitario e de pleno emprego. E finalmente, chegamos á solución Devine. A profesora Patricia Devine, da Universidade de Wisconsin amosounos como combater de raíz e eliminar os nosos prexuízos ocultos. Cada un de nos pode supoñer unha onda de esperanza.
This work will not always be easy, but former Supreme Court Justice Thurgood Marshall has told us, "We must dissent. We must dissent from the indifference. We must dissent from the apathy. We must dissent from the hatred and from the mistrust. We must dissent because America can do better, because America has no choice but to do better."
Este traballo non será sempre doado pero o antigo xuíz da Corte Suprema, Thurgood Marshall, xa o dixo: "Debemos discrepar. Debemos discrepar da indiferenza. Debemos discrepar da apatía. Debemos discrepar do odio e da desconfianza. Debemos discrepar, porque Estados Unidos pode facelo mellor. Porque a Estados Unidos non lle queda outra que facelo mellor".
Thank you.
Grazas.
(Applause)
(Aplausos)