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SUMMER MAGAZINE 1984
Page Z
The Status Of Blacks In Medicine:
Philosophical And Ethical Dilemmas For The 1980’s
By Louis W. Sullivan, M.D.
President and Dean
Morehouse School of Medicine
The United States was founded some
207 years ago on the principle of equal
opportunity under the law for all citizens.
This magnificent principle has been
admired and emulated by a number of
other countries around the world, most
recently by the newly-independent coun
tries in subsahara Africa, a major part of
the Third World.
However, a serious flaw has existed in
the application of this principle
throughout the history of our country.
That is, in the inclusion of black
Americans and other minority Americans
in the full enjoyment of their rights as
Americans citizens.
Even with their imperfect history,
however, the citizens of the United States
have made significant gains in their efforts
to live up to their expressed ideals. This
has been particularly so during the 1960’s
and 1970’s. However, as events of the
1980’s have shown thus far, the gains of
many years, particularly of the past two
decades are in danger of being seriously
eroded and reversed.
Of interest to those in medicine and the
other health professions is a study recent
ly completed by the Association of
Minority Health Professions Schools.
This association of eight predominantly
black health professions schools includes
Morehouse School of Medicine (Atlanta),
Charles R. Drew Medical School (Los
Angeles), Meharry Medical College,
Meharry Dental School (Nashville),
Tuskegee Institute School of Veterinary
Medicine (Tuskegee, Alabama), and
Colleges of Pharmacy at Texas Southern
University (Houston), Xavier University
(New Orleans) and Florida A&M Universi
ty (Tallahassee).
The study provides a current perspec
tive on the poor health status of blacks in
the United States. For example, it points
out that the present average life expec
tancy of black American males is five years
less than for white American males, (70.5
years vs 65.3 years), and that the infant
mortality rate for black Americans is twice
as high as that for white Americans (21.8
deaths/ 1,000 live births vs 11.4 deaths/
1,000).
However, these averages obscure some
appalling realities in some rural areas and
inner cities of our country. For example,
in Georgia today the average life expec
tancy of blacks is 8.4 years less than for
whites. And in six rural counties in
Georgia, the life expectancy for black
males ranges from 49.6 to 51.5 years,
whereas the average life expectancy of
white males in those same counties is
from 59.5 to 69.5 years. In Kenya, one of
the less developed and poorer countries
of the world, the average life expectancy
of the male population is 51.3 years,
exceeding that of some rural countries in
Georgia. In 1980, in 50 rural counties
among Georgia’s 159 counties, the infant
mortality rate for blacks was higher than
30/ 1000 live births, and in 16 counties the
rate was higher than 43.0/ 1000. Similar
realities are found in many rural areas and
inner cities all over the United States.
The Association’s study documents the
continuing shortages of black physicians
and other black health professionals. In
1950, only 2.1/ of all U.S. physicians were
black. I n spite of the efforts of the past two
decades, in 1980, black physicians in the
U.S. represented only 2.6/ of all
physicians. In 1981, less than 2/ of the
Louis W.
faculties of U.S. medical schools were
black.
In 1983, the absence of black role
models among practicing physicians and
on U.S. medical school faculties suggests
to black young people that it is not
realistic to aspire to becoming a physician.
This negative message to black youngsters
is reinforced by poor counselling in high
school and in college, where black
students are often steered into vocational
courses and less rigorous academic sub
jects, leaving many of them poorly
prepared for the study of medicine.
Compounding this long-standing
problem in medicine is the recent advent
of a severe shortage of funds for student
financial aid, documented a few weeks
ago in the Journal by Dean John Sandson
of Boston University School of Medicine.
Because most black medical students
come from families with annual incomes
of less than $20,000, the Association’s
study suggests that, unless morefundsare
made available for scholarships and low
interest loans for low income students,
there is a very real possibility that the
number of blacks enrolling in medical
schools in the future will drop
precipitously. Further, those medical
students who do graduate in future years
will be less likely to practice as primary
care physicians in poorer communities;
their need will be to earn high incomesas
specialists in affluent communities so that
they can replay their heavy debt burdens.
Because millions of Americans still reside
in rural areas and inner cities without
physicians, this projected outcome in the
distribution of new physicians would be
just the opposite of what is needed at the
present time.
Another finding of the study is the
contribution that the predominantly
black medical schools are making in the
education of black physicians. In spite of
significant expansion in the medical
education enterprise in the United States
during the past 25 years, in 1981-2, the
four predominantly black medical
schools (Morehouse, Meharry, Drew and
Sullivan
Howard) had almost 25% of the black
students in the nation’s 127 medical
schools. Six of the nation’s medical
schools had no black students and 75
medical schools (61/)- had a black student
enrollment of less than 5/, although
blacks comprise almost 12/ of the U.S.
population. These facts show the need in
the United States in 1983 for
predominantly black medical schools.
Further, studies have shown that more
than 60% of the graduates of Meharry and
Howard Medical Schools practice in
medically - underserved inner cities and
rural areas.
The predominantly "black medical
schools adhere to the same high standards
of medical education, and are measured
by the same yardsticks for accreditation of
their programs as are applied to all
medical schools. However, historically,
black medical schools have been forced
to operate with inadequate financial
resources and without access to the same
quality of clinical facilities available to
other medical schools. For example, the
historic plight of Meharry Medical
College is well known. Located in
Nashville, Tennessee and being more
than 100 years old (the same approximate
age as Vanderbilt Medical School),
Meharry has not been given access to the
two tax - supported general hospitals in its
community (the Nashville General
Hospital and the Nashville Veteran’s
Administration Hospital). Both of these
hospitals have served the Vanderbilt
Medical school for decades, providing
patients for clinical instruction, funds to
support the clinical faculty and (from the
VA hospital) funds for research programs.
These factors and a number of others
described in the Association's study, have
served to discourage and deter our black
young people from pursuing medicine as
a career. Predominantly black health
profession schools have also been
rendered financially vulnerable because
of severe retrenchment in federal support
for medical education and medical
research, and by the ravages of inflation
and recession in our nation’s economy.
Because black physicians and
predominantly black medical schools are
needed in the 1980’s, to address the
severe unmet health care needs of our
poor and minority citizens, our nation
and our profession face a philosophical
and ethical dilemma. Either we provide
the financial and other resources needed,
along with the sustained national com
mittment to implement our country’s
creed of equal opportunity, or we face the
alternative reality of a significant segment
of our population with a high incidence of
infant deaths, shortened life expectancy,
debilitating poverty, a crushing burden of
illness and disability, increasing dis
illusionment, frustration and loss of hope.
As the most affluent of nations and the
leader of the free world, we should not
allow this to happen.
Education has always served as a ladder
of upward mobility in our society, and it
still can be today — for blacks, other
minorities as well as for poor whites.
Medical education is a part of this
spectrum of opportunity and self im
provement in the United States — for
individuals and for groups. Equally impor
tant is the presence of the opportunity as a
symbol of hope and the affirmation of the
American dream.
The contribution of black institutions to
the vitality and the advancement of the
United States has never been fully ap
preciated by our larger society. For
example, more than half of the black
physicians currently practicing in the
United States today are graduates of
Meharry or Howard Medical Schools,
each more than 100 years old. Our current
deficits in the number of black physicians
would be much greater had these two
schools not existed.
The Association’s study calls for a
number of actions to address these
problems.
Black health professions schools should
be strengthened by increased financial
support for their programs — from
governmental sources (federal, state,
county, municipal), and from the private
sector (foundations, corporations,
associations and individuals). Black health
professions schools should have equal
access to tax-based municipal and
veterans administration hospitals and
other clinical facilities for their teaching
and service programs and for the oppor
tunities to contribute to the nation’s
biomedical research enterprise. The
National Institutes of Health, the National
Science Foundation and other public and
private research agencies should work
with black health professions schools to
strengthen their research capabilities,
drawing on their unique perspectives and
their ability to focus on significant health
problems of blacks and other minority
groups.
Adequate scholarship and work-study
funds and low-interest loans must be
made available to medical students from
low income and minority groups, so that
the nation can utilize the best minds
available to become our future
physicians, and so that the possibility of
becoming a physician will not be foreclos
ed to bright young people who happen to
be from minority and low income
families. Associated with the dramatic
curtailment of federal programs for
student financial aid, during the past two
years at the Morehouse School of
Medicine, we have observed a decrease
in the number of entering freshman
(Continued on page 5)