A strong public hospital system and against racism in our country is crucial to the success of any national health legislative proposal

Two articles in the recent issue of American Journal of Public Health, the journal of the 50, 000 member American Public Health Association, highlight the crisis in health care for economically poor people and the national oppressed minorities, in this case Black women.

Public health doctor, Michael Cousineau and medical doctor, Robert E. Tranquada authored a crucial article that highlights the ongoing struggle for public hospitals to survive and grow in this period of privatization of public hospitals and facilities. City-based public hospitals play a crucial role on many fronts. It is widely known and understand that for trauma cases, all trauma cases, the best immediate care is in public hospital emergency rooms. And, it is widely understood that everyone in the United States uses hospitals are their primary doctors, far more than they should, but they are forced to given the office hours of physicians. Well, for people of color, those hospitals are often public hospitals. While non-profit hospital are required to NOT turn away any person in need of medical services, their practice is often not in keeping with these regulations.

LA County hospital, like their counterparts in every City in the United States, are the focus of ongoing struggles by public health care activists, especially those concerned with the civil and health rights of Black, Latin and other minority peoples.

This article documents the 150 years of service to Los Angeles residents. And, given the historic service this hospital has given to immigrants, especially in the current period, the continuation and expansion of this hospital will continue to be a source of attention.

For any national health legislative program to succeed, the public hospital systems, must be there centerpiece, with non-profit hospitals [so-called voluntary hospitals in some areas of the country], adopting the same transparency, pricing and cost structures that the publics have. Non-profit hospitals will need to cease being the cash-cows for the for-profit private interests in health care delivery.

As the authors say, "The success of the new hospital will depend on whether government leaders at all levels provide the reforms needed to help the county and its partners stabilize its funding base." "Crisis and Commitment: 150 Years of Service by Los Angeles Country Public Hospitals," AJPH, April, 2007. Vol. 97. No. 4.

The second article whose senior author is Dr. Yvette C. Cozier, from Boston University, highlights the on-going role that economics plays in determining the health status of people, in this case Black women.

The researchers found that, "The legacy of residential segregation and continued discrimination in housing and lending practices have resulted in significant difference between Black and white communities. For example, studies have shown that at the same level of personal education and income, Black persons have only one tenth the wealth of white persons and are more likely than white counterparts to live in neighborhoods marked by crime, undervalued real estate and poor schools. Our data showed that high proportions of Black women who had completed college or who had family incomes great than $50,000 lived in neighborhoods within the lowest quintile of median housing value. Unfavorable neighborhood factors, including the lack of resources such as full service supermarkets, banks, recreational spaces may serve as a source of stress and overwhelm the otherwise protective effects of individual income, education and health behaviors."

They continue, "Evidence indicates that higher education and income do not translate into the same level of financial and housing opportunity for Blacks as for white; that is, middle-class Black persons are more likely to live in poorer-quality neighborhoods than are their white counterparts and, as a result, remain exposed to the deleterious conditions associated with those neighborhoods. Furthermore, Black women report poorer health, including higher rates of hypertension, than do white women at all levels of income. Therefore, to better understand racial disparities in hypertension and other illnesses, it is important to study the effects of socioeconomic characteristics of the neighborhoods in which these women live."

In other words, the legacy of racism in our country must be attacked with the same vigor that is now taking place to enact a national health system for our country.

This article highlights the plight of Black women and hypertension given on going economic discrimination. "Relation between Neighborhood Median Housing Value and Hypertension Risk Among Black Women in the United States, " AJPH, April, 2007. Vol 97. No. 4.

The tens of thousands of people involved in struggles to save and expand public hospitals, community clinics and other facilities; and the equal numbers fighting against racism in general and in health care in particular need to be part of the struggle for national health care. This will exponentially improve the chances for a universal, system of comprehensive health care for our country.

Phil E. Benjamin