‘White Supremacy Is Bad for Health’
“I often say here in New York City that I learned almost everything I know about public health in Zimbabwe,” says Mary Travis Bassett. Before she was appointed commissioner of the New York City Department of Health and Mental Hygiene in 2014, Bassett had spent 17 years on the medical faculty at the University of Zimbabwe in Harare, working to address one of the world’s worst AIDS epidemics during the country’s first decade of independence.
“The most important thing that I learned there was how fast the health of the public can improve when you have a government that is committed to advancing the well-being of its population,” she says. “They halved the infant mortality rate, quadrupled immunization coverage—it was amazing.”
In New York City, where she joined the city’s health department as deputy commissioner of health promotion and disease prevention in 2002, Bassett applied lessons she had learned about the ability of government to improve health, and the importance of doing so in partnership with communities. She directed key initiatives including bans on smoking and trans fats in restaurants and the requirement at chain restaurants to post calorie counts. She also established the department’s District Public Health Offices in East and Central Harlem, the South Bronx, and North and Central Brooklyn to lead targeted health and communication strategies in the communities that face experiencing a disproportionate burden of disease.
But Bassett had also learned another lesson in Zimbabwe when the new country’s political climate began to change: “how vulnerable those advances can be when a government’s priorities shift,” she says.
Now, more than a year into Donald Trump’s presidency, Bassett says the policies and the political climate created by the current administration is detrimental to public health.
Bassett will be visiting the School of Public Health for the Dean’s Symposium “The Trump Administration and the Health of the Public” on May 8. Ahead of the symposium, Bassett discussed some of her concerns, the career that brought her from Harlem to Harare and back to her native city, and why government needs activists.
What do you see as the most striking effect the Trump administration has had on public health?
For me it has two parts. One is the direct effect on the delivery of health and public health services, but more important is the broader effect on the political climate in our country. His many statements regarding, really, a concession to views that we would broadly view as white supremacist are bad for health. White supremacy was bad for health and it continues to be bad for health, and this president has endorsed these kinds of views.
The Trump administration’s declared intention to reduce safety nets, to dismantle the Affordable Care Act, to seek to ban Planned Parenthood, are all very worrying. I fear that the bigger agenda is to go after public health insurance. In states like mine, which has a robust Medicaid program, the Trump administration wants to clip our wings with respect to the state’s ability to direct more funding to Medicaid. Medicaid and with it Medicare were critically important not only in providing a safety net for providing healthcare, but for having other effects on our society. Medicare, for example, should be credited with the desegregation of our hospital system in the South.
It’s not only policies. It’s the rumors, and the climate of fear that follows on declared intentions.
What keeps you motivated and hopeful in that climate?
There are the kids in Parkland, Florida, and there is the Black Lives Matter movement. I’m more hopeful than I have been in years about the ability of people to resist.
What led you to public health?
My first paying job the summer before I went to high school was as a census taker for the 1970 census. In those days the census was carried out by census takers who carried a satchel and walked door to door.
I was assigned to West Harlem, where I went door to door, sitting down at people’s kitchen tables, and talking with them. I saw how people were living and I saw people with obvious health problems that it was clear they didn’t know how to handle, that they weren’t confident in their ability to access care for. So, I decided to be the first person in my family to become a doctor
Many years later, I trained at Harlem Hospital. I still count those as some of the best years. I worked with a group of incredibly dedicated, hard-working doctors-in-training, led by experienced and committed—and visionary, inspirational—clinicians who had made the choice to work at Harlem Hospital and to train us.
I started making home visits—and in retrospect I wonder why I thought that that was OK in Harlem in the early 1980s. Many people wouldn’t have considered it safe for a young woman, wearing my whites, knocking on doors looking for my patients, but I saw people living in conditions that I hadn’t realized people were living in, people living in abandoned houses with strung up electricity from other buildings. I realized that what I was doing in the hospital was patching people up and sending them back out.
Data from years later showed that at the time that I was doing my hospital training a man in central Harlem was less likely to survive to the age of 65 than a man in Bangladesh, one of the poorest countries in the world. I didn’t think that the roots of ill health could be addressed from inside the walls of a hospital, and that’s what drove me to public health.
What led you to Zimbabwe?
Like many young, black doctors who went to medical school in the 1970s, I was interested in Africa. I supported the African liberation movement, and I had a long interest in going there. I had received invitations to work at some prestigious medical centers, but a friend of mine whose parents worked at the University of Zimbabwe arranged for me to come and interview for a job, and I leapt at the opportunity.
I thought I would be there for two years and I ended up staying for 17. I made my family there, and I became very involved in addressing the AIDS epidemic, which was one of the worst in the world. I also was involved in some work that sought to identify the deleterious impact of policies enforced by the World Bank and the International Monetary Fund.
The first decade that I was in Zimbabwe, the first decade of independence, was phenomenally exciting. It was a very heady time, and it was a privilege to have been part of it. The sorts of changes that I saw were really dependent on two pillars. One was a supportive policy environment, where there was a commitment to health for all, and Zimbabwe invested hugely in health and in education. There was also this idea that communities had to be part of the pursuit of health.
What did these two “pillars” look like in New York?
Especially with the Bloomberg administration but also now with the de Blasio administration, we’ve used the tools of government—which include taxation and regulation—to address chronic disease. Calorie posting, trans fat restrictions, sodium warning icons, tackling tobacco very robustly, and we have a whole host of laws going into effect.
But also—and this didn’t work so well when I was working in the Health Department under Mayor Bloomberg—we have to believe that the people we are seeking to serve, who are burdened by the highest load of preventable disease, want to be partners in the achievement of health. Reaching out to communities, forming partnerships, overcoming distrust, are also key.
What lessons have you learned since joining the New York City government?
I’m a big believer in the centrality of government action to advance public health, and I’m now a senior official in a progressive administration, but governments have limitations. Those of us who work in government face the reality of the fact that the people who appoint us have to go back to the public and back to the ballot box to be reappointed, so there’s always going to be a need for advocacy from people outside of government. For someone who is passionately committed to many issues embraced by advocates, it can be difficult to acknowledge the role that I play as a political appointee. I can’t always be at the barricades!
For example, the Sims statue. J. Marion Sims was a venerated obstetrician who developed techniques still in use today—by operating without anesthesia on enslaved women who obviously were not in a position to give consent. I raised concerns about this statue when I was a deputy commissioner in the Health Department. The statue was just removed this spring, and there’s now an empty plinth along Central Park where his statue used to be, but it was activists who got his statue removed. It was government response to community input.
It’s an important lesson. Government alone will never achieve its full obligation to take the steps needed for public health. We will always rely on advocacy.