People’s health has to do with social class. But the keepers of official U.S. statistics, alone among their kind in the industrialized world, make no use of class in analyzing health data. Class counts. That’s a reality that might perk up wishful thinkers by providing them with direction, specifically the task of defending the rights and interests of working people.
Last year, Vicente Navarro, public health teacher at Johns Hopkins University, spoke to graduating medical students there. His remarks appeared in the June 2004 issue of Monthly Review. Navarro notes that throughout the world, and especially in the United States, working people and the poor are sicker and more prone to early death than the well off.
Where labor movements are strong, according to Navarro, where socialist political parties contend for power, where policies of income redistribution prevail, that is where universal health care exists and where life expectancy is long and children thrive.
The neglect of class relationships also holds back efforts to broaden physician recruitment. Because physician attitudes can either help with efforts to change the system, or interfere, reformers have seen the need for developing a corps of sympathetic doctors. Navarro notes that new doctors still know much more about cellular, genetic, and microbial causes of rare diseases than they do about the social causes of common illnesses. Many of them lack tools for social analysis, and even motivation.
Progressive medical educators saw affirmative action as a means for attracting and educating students who as physicians would have a social conscience. Minority student enrollment rose from less that 2 percent in 1965 to 10 percent in the early 1970s. The gains then slowed, and enrollment since then has hovered at around 10 to 12 percent. In the face of fierce legal and political assaults, the defenders of affirmative action, however, did not retreat. Yet the minority share of the general population had risen to 22 percent as of the year 2000.
Now, because of affirmative action, Black and Latino students who apply to medical schools have the same likelihood of success as white applicants. Nevertheless, racially oppressed students still face barriers. They are growing up in a class-fractured society, and a disproportionate number of them face discrimination based on class difference. Likely as not, their early schooling is inadequate, and parents, up against economic chaos, focus on immediate survival. The children are deprived of opportunities to dream or prepare themselves educationally for graduate study. They opt out.
In fact, relatively few Blacks, Latinos, or whites of working-class origins are able to study medicine. We examined the income, educational levels and occupations of 96,500 families of white medical school freshmen, and 10,200 families of their Black classmates. The data covered 11 years between 1990 and 2000 and was provided by the American Association of Medical Colleges. The families of 25 percent of the Black students earned $26,000 or less annually. Fifty percent of the Black families earned $49,000 or more, another 25 percent earned $80,000 or more. The families of 25 percent of the white students earned $48,010 or less. Half of them earned $75,000 or more. The top 25 percent earned $120,000 or more. Fifty percent of the Black fathers have completed college, while only 13 to 16 percent of all African-American adults are college graduates. Twenty-five percent of the white students’ parents have doctorate degrees. Over an 11-year period, from 30 to 36 percent of the Black students’ fathers and 16 percent of the white students’ fathers were engaged in working class jobs. Clearly, most medical students, Black and white, have solid middle and upper class identities.
Once the fight for social justice is informed by class analysis, points of struggle intersect. Campaigns for educational equity and universal health care are joined. That way, doctors knowledgeable about working class realities will be on hand to take part in reordering the health system. Health care for the people has to come from the people, and be provided by doctors and nurses who identify with the people.
(See: W.T. Whitney, “Becoming a physician: Class Counts,” Nature, Society, and Thought 15:3, p. 261).
The author can be reached at pww@pww.org.
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