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Abdul dissects health inequities to understand why America’s focus on healthcare rather than public health is part of the problem. Then he speaks with Professor Ibram X. Kendi, author of the New York Times Bestseller “How to be an Anti-Racist” about taking on racism in public health and healthcare.

Transcript

Dr. Abdul El-Sayed: Texas passes is one of the most restrictive abortion bans in the country, banning abortions after six weeks, and empowering anyone to sue a provider if they hear about an abortion in the state. This comes amid a wave of assaults on reproductive rights across states. Mucormycosis, or black fungus infection is emerging as a concern among people with COVID-19 in India. A leader of Gaza’s COVID-19 task force was killed and its COVID-19 testing facilities were destroyed in airstrikes by Israel, as cases of COVID-19 begin to tick upward. This is America Dissected. I’m your host, Dr. Abdul El-Sayed.

Dr. Abdul El-Sayed: A few weeks ago, we had the privilege of hearing from Representative Cori Bush, a nurse turned Black Lives Matter activist, turned congresswoman from Missouri’s 1st District. We talked about her fight for Black lives from the bedside to the bullhorn to the buildings that house American power. She shared her own experiences, having her health concerns ignored by health care professionals.

[clip of Rep. Cori Bush] I remember I went to my regular doctor visit and I kept saying something is wrong, and the doctor’s like: oh, no, you’re fine. And I said: no, no, no, something is wrong. When you, you have a sign on your wall that says: if you feel something is wrong, something is wrong, tell your provider. I’m telling you something is wrong. She said: oh, no, you’re fine. And she waved me off. And a week later, I was in the emergency room.

Dr. Abdul El-Sayed: This isn’t just an isolated experience. Indeed, it’s the norm. There’s literally nobody I know who’s Black, whom I’ve asked about this, that doesn’t have an experience like this to report. It’s a systemic problem at the heart of the medical enterprise. Just this month, the American Medical Association, the country’s most powerful association of physicians, released a report admitting the roots of racism at the AMA and in the American medical profession at large. The report outlines racist episodes in the AMA’s past since its inception in 1846. The list is long, incredibly long, and painful to read. However, the AMA systemic racism is not just in the past. As early as February this year, the Journal of the American Medical Association’s podcast, The Voice of Medicine, unveiled how rooted this racism is, even in 2021. JAMA, what doctors call the AMA’s journal, featured a conversation about structural racism between—get this to middle aged white doctors—Ed Livingston JAMA’s Deputy Editor for Clinical Content, and Mitchell Katz, Editor at JAMA’s Internal Medicine-focused journal and CEO of the New York Public Hospital System. Neither of them have expertise or lived experience with it. But Livingston questioned the notion of structural racism in general, saying: I feel like I’m being told I’m a racist in the modern era because of this whole thing about structural racism, but what you’re talking about isn’t so much racism as much as there are populations that it’s more of a socioeconomic phenomenon that have had a hard time getting out of their place because of their environment. And it isn’t their race, it isn’t their color, it’s their socioeconomic status, it’s where they are. Is that a fair assessment? Here’s what JAMAs longtime Editor in Chief said in response:

[clip of JAMA Editor in Chief] Comments made in the podcast were inaccurate, offensive, hurtful, and inconsistent with the standards of JAMA. Racism and structural racism exist in the United States and in health care.

Dr. Abdul El-Sayed: After a petition calling for his removal was circulated and garnered nearly 10,000 signatures, Livingston was asked to resign. The Editor in Chief himself was put on administrative leave. But canning two people in connection to this horribly offensive, inaccurate statement doesn’t change the underlying truth. The podcast is called The Voice of Medicine. And the fact is, whether it’s said out loud or whispered, this is too often what the voice of medicine tells Black folks. For over a century of its 175-year history, the AMA excluded Black physicians. In fact, it played on the racist fear that Medicare would forcibly integrate hospitals to stoke opposition to Medicare. That’s not Medicare for all, but the original Medicare that passed back in the ’60s. The organization’s 83-page report this month details a strategic plan to, quote “embed racial justice and advanced health equity.” The report is an honest and rather thorough assessment of the organization’s roots in, I quote “white patriarchy and affluent supremacy.” The way it excluded doctors of color, used race-baiting in its work, and how all of that has perpetuated health inequities. Here’s Dr. Aletha Maybank, the AMA’s new Chief Health Equity Officer on the report.

[clip of Aletha Maybank] This is a really important part of our mission: promote the art and science of medicine in the betterment of public health. And we’re very critical, understand, like know that we have to embed equity in order to really properly do that, and really to achieve that.

Dr. Abdul El-Sayed: I am grateful for the critical work people like Dr. Maybank and others are doing to force this conversation at the highest levels of American medicine. And yet I wonder how effective it’ll even be. See, what Dr. Livingston voiced on JAMAs podcast is unfortunately a more accurate reflection of what many in medicine feel about racism, than what’s expressed in the report. And that’s because in the end, it’s a justification for our failure as a health care system to take on and uproot structural racism in the first place. And when we fail, it’s just easier to blame the patient than own the blame ourselves. That blame on patients, it’s disgusting. And the systems doctors blame instead of ourselves are, if you take a closer look, just outrageous. When Dr. Livingston stated, and I quote again “it isn’t their race, it isn’t their color, it’s their socioeconomic status” he was being not just insulting, but also incredibly lazy. Blaming socioeconomic status stops short of actually asking why socioeconomic differences exist and persist between Black folks in America and their white counterparts in the first place. Because here’s the thing, when you say that differences in health are a product of differences in socioeconomic resources, but you deny structural differences and opportunities and access, what you’re really saying is that the differences are because Black people don’t take advantage of the opportunities and resources that you say are equally available to them. You’re arguing that these differences are, in effect about quote unquote “culture.” You’re not saying it directly, but the conclusion that Black folks are sicker because of culture is really about all of the tired, lazy tropes that our culture has imbibed about Black people: that they don’t work hard enough, aren’t smart enough, etc. And that’s bullshit. And it is deeply insulting.

Dr. Abdul El-Sayed: The other excuse that doctors and scientists often make for structural racism is biology. For example, one article published early in the pandemic about Black-white differences in hospitalizations said there could be, and I quote “some unknown or unmeasured genetic or biological factors that increase the severity of this illness in African-Americans,” completely ignoring the fundamental structural differences in access to everything from testing to being able to work from home. Another example comes from a September paper in JAMA which suggested that Black folks may suffer higher rates of COVID-19 because—get this—the expression of a certain gene in nasal epithelium. That, of course, despite the fact that we don’t know much about what that gene actually even does, and that LatinX folks who face many of the same structural barriers to health and health care had higher rates of COVID-19, but didn’t have higher rates of expression of the gene. Doctors are jumping over their white coats to ignore the obvious structural differences in access to basic resources: clean air, potable water, good schools, reliable well-paying jobs, secure housing—that often shape health in the first place. But the biomedical establishment’s push to attribute differences in health to either a biological or a cultural difference has a long route in health and medicine. In fact, we hear it all the time in recommendations that are made about health even outside of clinics and hospitals. Ever hear this term:

[voice clip] My tips and tricks on how to live a healthy lifestyle.

[voice clip] If you’ve been following me for a while, you know that I try my best to live a healthy lifestyle

[voice clip] And just overall living a healthy lifestyle.

Dr. Abdul El-Sayed: I want you to think about what that actually means. It means that the way to be healthy is to live a quote unquote “healthy lifestyle.” Aside from the fact that there’s no real definition for what exactly that is, it has some really problematic consequences. It means that if you’re sick, it’s because you didn’t live a healthy lifestyle. And that means your illness is a function of a series of bad decisions, perhaps a problem with your culture. It ignores the fact that, quote unquote “healthy lifestyles” are a lot harder to have when you have to work two jobs, when you don’t have a grocery store within miles of your home, you don’t have reliable transportation and can’t afford a car, you’re constantly facing eviction from your home, and the air you breathe makes you sick in the first place. Turns out most people can’t afford hot yoga or green smoothies or Lululemon. Healthy lifestyles is a construct that implicitly blames people for their own illness, and fails to account for systematic structural differences in access to a healthy lifestyle in the first place. So when we talk about health inequities and structural racism in health, the problem isn’t just a few racist doctors. It’s the structure of the system itself. The fact that we’ve given our entire health care system over to corporations who simply profiteer off of us when we get sick, or people who want to sell us something to stay healthy. If that’s all we do, then we necessarily exclude people without the resources our structural racism has robbed them of in the first place. We systematically exclude Black people. And that’s exactly where the AMA is still failing to fully embrace its responsibility to uproot structural racism. The AMA continues to oppose solutions that would put Black Americans on equal footing in clinics and hospitals around the country, like Medicare for all. Why? Money. The AMA worries about whether doctors who on average make over $200,000 a year might lose some income if in fact we gave health care to everyone. And when we put our greed above our patients, we still fail, even if we acknowledge the racism inherent in doing that. Indeed, it’s not enough to acknowledge the problem or even tinker around the edges. You have to do something at the core of the problem itself. Today, I wanted to sit down with someone who’s been thinking about structural racism for a long time to help us think through what an antiracist health care system would really look like. So I reached out to Professor Ibram X. Kendi, author of the New York Times bestseller “How to Be an Antiracist.” My conversation with him after the break.

[ad break]

Dr. Abdul El-Sayed: I’m recording on my end. Are you recording on yours?

Dr. Ibram X. Kendi: OK, starting.

Dr. Abdul El-Sayed: All right, fantastic. Can you introduce yourself for the tape?

Dr. Ibram X. Kendi: My name is Ibram X Kendi and I am the Director of the Boston University Center for Antiracist Research, the author of How to Be an Antiracist, and the host of the new podcast, The Antiracist.

Dr. Abdul El-Sayed, narrating: Professor Ibram X Kendi is best known for his New York Times bestseller, How to Be an Antiracist. His leading-edge work on critical race theory and antiracism in America have helped frame this moment in our reckoning with racism and how we finally uproot it. But he’s also someone who’s thought a lot about health. He wrote passionately about his fight with colon cancer in his book and the support and insights of his spouse, Dr. Sadiqa Kendi.

Dr. Abdul El-Sayed: I want to dive right in. Obviously, we are coming out of—God willing—a pandemic moment. And this moment is also a moment of a reckoning with anti-blackness in our society following the murder of George Floyd. How has this moment changed the way that you think about racism in America? Of course, you wrote How to Be an Antiracist before this, but what has this shown you? How has this complicated or clarified your thinking about racism in our society?

Dr. Ibram X. Kendi: I think probably the most important aspect of my thinking that has changed has been that, I write about and talk about, and think it’s important for us, to feel and be hopeful that we can radically transform our society, that we can transform our health care system to make it equitable and just for all. I think it was really in the last year that I started to really think that those transformations are within reach and I think because of the fact that, you know, last June there were three quarters of Americans saying that racism is a big problem. The fact—now, obviously, that was the height, it started coming down, you know, after that—but the fact that so many Americans recognize, and so many entities from the CDC to, to counties are declaring racism a public health crisis. I mean, these are the types of things that were sort of unheard of three years ago, you know, five years ago. And so I feel like I’m almost encouraged and I was certainly encouraged that last year, and I’m even encouraged now, in this moment of a brutal and vicious sort of attacks against those of us who are trying to to challenge racism, because that means we’re actually achieving.

Dr. Abdul El-Sayed: One of the things I really appreciated about your book, How to Be an Antiracist, is that it’s rooted not just in a, in a strong critique, an academic analysis of the circumstances of our lives. It’s rooted in your own story, right? You open it up by talking about your own experience in recognizing a lot of the ways that racism patterned your own thinking as a young person, and your experience both in high school and in college. And you talk in the end of the book about your experience fighting colon cancer. Can you talk to us about that, and about what that taught you about how racism and race shape health and health care in our society?

Dr. Ibram X. Kendi: Well, first, I gleamed so much from being a patient, you know, of metastatic cancer, and then even I should also add being a husband to a physician, being a husband to an E.R. doc, a pediatric E.R. doc. And, you know, E.R. docs, like E.R. nurses and others who work in emergency departments, in many ways see regularly all the problems with our health care system. They see in a very tangible way the effects of social determinants of health. And so I think both of those, really I have almost come to have a very, a clearer understanding and analysis of different aspects of racism. From something as important as talking about racism or even when we’re describing someone is being racist, framing this as a diagnosis. And really the reason why to me the framing of diagnosis—and people understanding that their nation is being diagnosed with racism, that they as individuals are being diagnosed as having racist ideas, is because when people think of a physician or someone else diagnosing them with a serious illness, typically we think of that person trying to help us, even though we may feel horrible, as I felt horrible when I was diagnosed with Stage IV colon cancer. So it allows people to then recognize that then in order for them to get healing, it’s going to necessitate some pain. In order for us to transform our health care system, we’re going, there’s going to have to be some pain. And so I think there’s, there’s that. But then I think it’s also that what will be those transformations be? Well, it’s actually quite similar to how we treat metastatic cancer, that there’s typically a local treatment and a systemic treatment. And we know that something or part of the body needs to be treated because there’s tumors—the tumors of racial health inequities, that’s what, the racial health inequities are literally tumor cells. So we know there needs to be a local and a systemic treatment. That local treatment is: OK, what are the actual policies and practices and procedures in our health care system, in our society that are causing those tumors? And we need to, of course, surgically remove them, and replace them with, with antiracist policies. And those antiracist policies thereby become almost like systemic treatment. They become almost like chemotherapy, because what they do is they simultaneously reduce the size of racial health inequities, but then they also prevent their reoccurrence, just like chemotherapy.

Dr. Abdul El-Sayed: The other powerful thing about the metaphor is we don’t usually think about disease as something that defines us, right?

Dr. Ibram X. Kendi: Exactly, exactly.

Dr. Abdul El-Sayed: Rarely do you say I’m a, I am someone who is, who has cancer. That is who I am. Rather, we say cancer has stricken me and I have excised the cancer from myself. And the power of the metaphor allows one in the narrative to say: you know what, I got to beat this thing. Rather than: I have to defend implicitly this thing from people who are saying that I have it. Right? It’d be like a crazy thing if someone with cancer said: well, you know what, don’t attack cancer, because I have it. Right? No, no, no. Cancer is maybe something you have, but we don’t want you to have it, because in the end, what happens to the disease is that it takes your life. Right?

Dr. Ibram X. Kendi: Exactly.

Dr. Abdul El-Sayed: And so I really think that’s a powerful metaphor. I personally, I trained in medicine, I don’t practice medicine. God bless your wife and all the folks on the front lines who do. But part of the reason why was because I got into health because I wanted to do something about the systemic inequities that I saw. My family is from Egypt and immigrated here and so I spent a lot of my summers with my family out there, and they’re from an extremely working class part of Alexandria. My grandmother lost two of her infants before the age of one. And, you know, I travel 15 hours and travel 10 years life expectancy. But then I could go 15 minutes into Detroit and go the same 10-year life expectancy gap. And I want to do something about that. And I realize that so much of the way that our health care system is structured is that we are left to trying to address the systemic failures of a society that has failed to prevent a lot of this disease in the first place. And there are two sides of this. There are the public health side, which is our failure to do basic things like guarantee people water and guarantee people clean air, and make sure that they have livable homes in livable communities, and great jobs that provide living wages because they’ve gone to good schools. But the other part of this is that, you know, making sure that they have a ticket into the health care system when inevitably they have to use it because we failed the first part. And I couldn’t help but in reading your book and in thinking about the health care system, which is what I spent most of my time doing, is just realizing that our health care system is fundamentally racist. It’s fundamentally in its core, it perpetuates health inequities. And if we’re defining a system based on the outcomes, then it is a racist system. And I guess my question is, what would an antiracist public health/health care system actually do? What are the things that it would take on, and how would it start thinking about the way that it values people and their bodies versus, right, a lot of the profit-making mechanisms that our health care system has been entirely wound to do right now.

Dr. Ibram X. Kendi: First an antiracist health care system, when treating individual patients, there would be an awareness of the sort of disease that that patient may be facing, or the illness that that patient may have, is not just, let’s say, the result of that person’s behavior or their parents behavior or their personal deficiencies. There would be an awareness and there would be a thinking, consistently, of the provider themselves, of the systems, whether—or I should say, the institutions— whether it’s the health care institution, whether it is the public health institution, you know, of systemic sort of issues. And so you certainly would be, when individuals present with problems, they would be treated as individuals. But there would be simultaneous, consistent and well-funded efforts to eliminate poverty which is a public health crisis, to eliminate homelessness which is a public health crisis, to eliminate food insecurity which is a public health crisis, to constantly and consistently collect many different forms of racial data that would allow us to see that a particular racial, ethnic or classed or gendered group or, you know, people with disabilities, are facing a specific health disparity. And then there would be constant consideration of: OK, what are the actual policies and practices that can be put in place to change this at a population level. So in other words, we would be treating—there would be a conceptual recognition that that poverty is an illness that we need to treat. The health care system itself needs to treat poverty as an illness, just as we’re treating colon cancer as an illness. And until we have that awareness of those social determinants of health that cause disease, that cause illness, that cause certain racial groups to be on the lower or higher end of the disparities, we’re going to continue to have those many health problems, and then we’re going to continue to blame the people. We’re going to continue to say: oh, the reason why Black folks are dying at the highest rates from COVID-19 is because they’re the most likely to be obese. But we’re not going to ask the question: well, what leads to obesity?

Dr. Abdul El-Sayed, narrating: We’ll be back for more with Dr. Ibram X Kendi after this break.

[ad break]

Dr. Abdul El-Sayed, narrating: We’re back with my conversation with Professor Kendi.

Dr. Abdul El-Sayed: It’s not enough to be curious about the pathologies that people face only after they get in your clinic and hospital. And if that’s the case, then the question becomes, you’re more interested in the service you provide than in the patient for whom you’re providing it. But the second point is that I honestly think that one of the most devastating and dangerous narratives that the public health community has foisted upon the world, is this idea of a quote unquote “healthy lifestyle, because it puts the locus of agency in the hands of a patient, and assumes that they have the same exact resources that everybody else who’s critiquing the system does. And that’s part of the problem. Right? And so, you know, you tell somebody—and this happens all the time, I used to be the health director for the city of Detroit—and people say, well: you just got to tell people that they have to exercise more. I’m like: well, that’s a nice thing if you can go to a gym that’s full of bunch of Peloton bikes and you can pick which one you want because you can afford $150 a month it takes, you know, or whatever it takes—$30, have it in your own home. It’s not that easy when you’ve worked two or three jobs, you come home after dark and you may live in a community where going and just walking around your neighborhood means that you have a higher risk of being victimized . . . [40  245]by the state itself! And/or eating healthy food, right? If I don’t eat healthy foods because I made a choice not to eat healthy food, it’s not because I couldn’t afford unhealthy food, or I couldn’t even access healthy food because it doesn’t exist in my neighborhood. And I think the point that you’re making here is that an antiracist health system has to be really concerned with the structural challenges that people have to, quote unquote “making good decisions” that rob them of a choice in the first place. I want to ask you, one of the hardest parts I think people in health care themselves have to accepting the racism that is perpetuated by the health care system, is a sense of individual agency. And one of the things that I think you do extremely well is to differentiate between individual agency on the part of a provider, versus structural and even subconscious biases. But we know that Black babies are two to three times as likely to die before the age of one. Black mothers are three times as likely to die in childbirth. And that is a function of the way that providers behave and operate in the system, let alone the way the system takes away people’s health. How do we start taking on the fact that these inequities, and the treatment that people receive in the health care system, destroys their trust in the system and perpetuates racist outcomes? How should we be engaging with health care providers themselves who want to be antiracist but whose systems and whose work creates these, these racist differences

Dr. Ibram X. Kendi: Correct me if I’m wrong, but I remember learning at some point that patients who suffer medical malpractice are more likely to not sue the medical institution if the medical institution took accountability.

Dr. Abdul El-Sayed: That’s right.

Dr. Ibram X. Kendi: If the medical institution or the medical provider apologized, you know, if the medical institution and the provider did not make that victim feel as if they were the perpetrator. Right? And the reason why I’m mentioning that is, is because I think for people who are subjected to racist practices within the medical community, to me that’s not the greater problem. And then that causes them to: OK, I’m not going to have any more children in the hospital, I’m going to have a home birth because I just don’t want, you know, someone. The issue, I don’t think is the mistake itself. The issue is the refusal of medical providers to hold themselves accountable and change. We have to recognize that the distinction between policies—a policy like because we don’t have free health care for all, it results in certain people choosing to not—you know, people who are disproportionately Black and brown—not having access to prenatal care and not having access to post sort of natal care, which then, of course, leads to greater, Black women being the most likely to die from pregnancy-related causes. But then it’s also the result of individual providers who are not listening to Black women, like Serena Williams, as wealthy as Serena Williams or as working class as other women, when they say there’s a problem. Right? And so really, it’s both and. And I think with the latter, how do we—you know, there’s no way in which we can prove that a single provider at an interpersonal level through what, it’s harder to prove that a single provider is not listening to Black women through anecdotes. Like I, you know, you tell me an anecdote, you know, especially as it relates to that, I think we should take it seriously. But what we can do is we can collect data, you know, on all of our medical providers. To me, we haven’t talked about this in relation to policing when we really should. And what I mean by that is the decisions, the interpersonal decisions and the lack of accountability and, you know, of individual medical providers, is literally leading to people dying day-in and day-out. And so, and so this is something that is very, very serious. And, and I think it’s important for the medical community themselves to get ahead of this, because once we revolutionize American policing, American medicine will be next.

Dr. Abdul El-Sayed: This is a really powerful point in both circumstances. You have the either unconscious or conscious bias of people in places of authority over life and death decisions.

Dr. Ibram X. Kendi: Exactly.

Dr. Abdul El-Sayed: And whether it is in the context of a street or a hospital, either way, those choices translate bias into death. And the question I think that you pose to the health care industry is an important one. And we haven’t even touched on, you know, structural choices about how you price different drugs, or what hospitals move in or move out of different neighborhoods, and the racism inside the insurance system as it stands, the fact that 60% of Black folks are on Medicaid, while 60% of white folks are in private insurance, and private insurance reimburses at 3.7x times the value of Medicaid, which means that you’re literally valuing those bodies at 3.7x as much. But even at the level of just the care that is provided, there is a responsibility. And I think there is the beginning of a reckoning happening. One of the hard parts about trying to have this reckoning in the space of medicine and biomedical science is that we pride ourselves on our objectivity. At least we think we do, right? We say: well, we’re scientists, we’re people who are trained to understand and assess bias in circumstances, and try and remove it so, of course, we can do that for ourselves. Despite the fact that it’s like we are ignoring the obvious reams of evidence that show that we don’t do this well. And I think taking that on is, is critical culturally inside of health care, because it allows us to rethink a lot of the movement of where resources go. I want to just ask you, as we wrap up here, what is your hope for this moment? You started on a really hopeful note, what is your hope for this moment and how does that hope get realized? What’s it going to take? What are people out there going to be doing to build that kind of future where these conversations about these kinds of data no longer exist because the data themselves tell a very different story. What, what is the way forward for us? And how can people who believe in that antiracist future, how can they get involved?

Dr. Ibram X. Kendi: I think one thing that is happening in many health care systems, many hospitals and clinics and medical schools and biomedical research facilities, there are people there who are beginning to ask these types of questions, who may have already formed committees, who may have already thought about the need for changing different policies and practices. And so I would first and foremost say to those folks at those institutions, you know, public health organizations to get involved, if you aren’t already, in those individuals, with those groups of people who are possibly already starting to think about how to transform their institution, their community. And I don’t want people to think that you should just get involved and believe that you already know the answers. We all have to enter into these spaces with a certain level of humility. I am somebody who is always sort of learning and always trying to understand more and more about racism in all of its specificity. So I think as you get involved in transformational work, you have to be consistently thinking about how you’re transforming yourself. And there are so many great books and podcasts and essays and articles out there that are documenting the current nature—I should say that the current ways in which policies and practices within our current health care system are racist. But even historically, and really what this comes what this boils down to is that, you know, as early as 1890, we have known as a national community that there were racial health disparities. Before then and after then we been debating over why. And that’s largely been the position of: well it’s because a certain racial group is a biological construct, an entity, and a particular racial group is predisposed to sickle cell anemia or to heart disease or to cancer. That was the dominant perspective until the 1940s and 1950s. By the 1960s, it started shifting to the current perspective, the current dominant perspective, which is it’s the result of culture and behavior. And we’ve personalized groups. And we’ve only said: oh, if they would only—as you talked about earlier Abdul—eat better than they would be healthier. Now, that could be true for somebody like me. I can eat better. But you’re talking about Black people, you’re talking about millions of people, and you’re making a claim that a particular group would not be 25% more likely to die of cancer if they only had a better lifestyle. What you’re saying is that white people are more responsible. And what you’re saying, therefore, is white people are superior. What you’re saying is Black people are inferior. What you’re saying is a racist idea. So whenever we pinpoint biology, culture, or behavior to explain racial health disparities between groups, we are expressing racist ideas. Now we can talk about biology, culture, or behavior when trying to explain an individual case, but not when we’re talking about groups.

Dr. Abdul El-Sayed: That is a powerful point to end up with. That was Professor Ibram X. Kendi. He is the director of the Antiracism Center at Boston University, as well as author of The New York Times best-selling How to Be an Anti-racist. Professor Kendi, thank you so much for taking the time to join us and to share your wisdom on the critical topic. Thank you again.

Dr. Ibram X. Kendi: Of course. Thank you for having me.

Dr. Abdul El-Sayed: As usual, here’s what I’m watching right now: Governor, Greg Abbott of Texas—remember him from his COVID-19 follies?—yeah, well, he signed one of the country’s most restrictive abortion bills last week, restricting abortion after six weeks, which is before many people even realize they’re pregnant. What’s even more twisted is that the law’s enforcement is left to the public. People who know of a procedure in violation of the law can sue the provider, including people outside Texas. That incentivizes people looking to make a buck to be on the lookout, turning people against one another. And just as a reminder, this is not about preserving life. It’s about controlling women’s bodies. On the same day that Texas signed a fetal heartbeat law, they executed a man according to their death penalty.

Dr. Abdul El-Sayed: Doctors in India are finding an uncommon fungal infection in patients with COVID-19 mucormycosis, otherwise known as black fungus, is infecting the lungs of COVID-19 patients. So far, 41 patients with mucormycosis have been identified. But fungal infections are very rare in people unless they’re immunocompromised, suggesting possible insights into the pathogenesis of COVID-19.

[bombing sounds]

Dr. Abdul El-Sayed: That was the sound of near constant nightly bombardment of Gaza over 11 days. Fortunately, a cease-fire was brokered, ending the bombing on Thursday. But Gaza still faces a humanitarian crisis. The bombings took over 220 lives. Over 60 children were killed. The bombings killed Gaza’s top neurologist, the number two in its COVID-19 task force, and knocked out its COVID-19 testing facilities. There is open sewage on the ground and tens of thousands of people have been displaced from homes and buildings that were targeted by Israel. The news coming out of Gaza, one of the most densely populated places in the world, is limited because Israel targeted a building that housed both the AP and Al-Jazeera. As you all well know by now, public health is all about the setup and when infrastructure from homes and water facilities to clinics and hospitals to testing facilities and laboratories, is destroyed, public health suffers. Health officials in Gaza fear that a third wave of COVID-19 is about to hit them. Of course, that wouldn’t be the case if a large proportion of the population had been vaccinated, like in Israel. But in contravention of international law, Israel withheld vaccines from Gaza and the West Bank occupied territories. All of this gets to a broader question about our role in the destruction of Gaza’s infrastructure and the perpetuation of COVID-19. Our government gives 3.5 billion with a B, dollars a year of our taxpayer dollars to the Israeli military. We subsidize this. And so even though there’s a cease-fire, we have to ask about the broader responsibility we have to justice and human rights. Martin Luther King told us that injustice anywhere is a threat to justice everywhere, and that of all forms of inequality, injustice in health care is the most shocking and inhumane. The Biden administration would be wise to heed those words. And right now, Palestinians struggle to pick up the pieces after the violence in the face of another wave of COVID-19 that could have and should have been avoided.

Dr. Abdul El-Sayed: That’s it for today. Tune in next week as we discuss the World Trade Organization’s role in vaccine equity, and what our country can do to vaccinate the world. If you like our pod, tell everyone by rating and reviewing it, it helps people find the pod. So please do your part. And I just want to say a deep and profound thank you to every single person who voted in the Webby Awards, we were chosen as both the critics’ choice, and the People’s Choice for best episode in a science and education podcast. Thank you. And don’t forget to pick up your Science Always Wins caps, sweatshirts and Tees, in both adults and kids sizes, at the Crooked Media store.

Dr. Abdul El-Sayed: America Dissected is a product of Crooked Media. Our producer is Austin Fisher, our associate producer is Olivia Martinez. Veronica Simonetti mixes and masters the show. Production support from Tara Terpstra and Lyra Smith. The theme song is by Taka Asuzawa and Alex Sugiura. Our executive producers are Sarah Geismer, Sandy Girard and me: Dr. Abdul El-Sayed, your host. Thanks for listening.