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Ableism

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About one in five people-over six and a half million Canadians-experience a mental illness or substance use problem in their lifetime. Unfortunately, many people don't ask for help because they feel ashamed or scared. People may judge them and treat them negatively based on a mental health or substance use problem. Others have trouble finding a place to live, finding a job, maintaining relationships and other important parts of life. In fact, most people living with a mental illness say that stigma is worse than the symptoms they feel.

Stigma originally meant a physical mark of shame. Now, it's an invisible mark that sets you apart from others. The problem with the word 'stigma' is that it puts the focus on the person's difference instead of on the people who are setting them apart. Using the word stigma makes it seem different than racism, homophobia or sexism. It isn't. So it's time to talk about stigma for what it really is: prejudice and discrimination. Prejudice is holding negative attitudes or beliefs about people who are viewed as different. Discrimination is acting on these ideas or beliefs.

"Layers" of stigma

Many people don't experience stigma for just one reason. They may experience discrimination based on many different prejudices, like sexual orientation, gender, culture or physical disability. Discrimination itself can lead to mental health or substance use problems. And people who already face discrimination for any reason may be even less able to find help for mental health or substance use problems or less able to find services that meet their needs.

How bad is it?

Research shows that over half of people living with mental illnesses said that they were embarrassed about their health problems, and over half felt like they had experienced discrimination. In one recent Canadian study, researchers found that:

Just under half of Canadians thought that a mental illness was just an excuse for poor behaviour

Only about one in three Canadians would continue to be friends with someone with an alcohol use problem

Only about one in four would continue to be friends with someone with a drug use problem

Causes and effects of discrimination

Many factors lead to discrimination. Major examples include:

Fear: Such as the fear of violence and the fear of the issues themselves because they affect our mind and behaviour. Some fears may be reinforced in the media

Untrue beliefs: Such as the belief that people can't recover or the belief that people can't participate in their communities

Blame and self-blame: People may be blamed for their conditions or problem substance use and viewed as weak. People with mental illnesses or substance use problems, and their loved ones, may also deeply blame themselves

Discrimination affects all areas of living. It can prevent people from getting or having basic things that most of us take for granted, like:

Getting hired, promoted or keeping a job

Finding or keeping a place to live in a safe, accepting community

Getting proper health care

Feeling loved, needed and accepted by family and friends

Contributing to communities and feeling productive

Getting insurance

Going to school

Immigrating to another country

Feeling positive about ourselves

Discrimination may also affect families and friends. Others may dismiss their concerns. In many cultures, the entire family carries their loved one's stigma because they strongly identify as a group. As a result, family members may not confide in friends or others in their support network.

What can we do about it?

Discrimination around mental health and substance use is a human rights issue. Human rights are rights and freedoms that all people should have. The United Nations says that, "All persons with a mental illness ... shall be treated with humanity and respect for the inherent dignity of the human person." This respect and dignity is a freedom that should not be taken away by. It's also a basic human right for all people with mental health and substance use problems, no matter where they live. Everyone has the right to live without discrimination of any kind. This includes discrimination based on a mental health or substance use problem.

But when we talk about discrimination, human rights laws meant to protect people from discrimination are only part of the solution. For these laws to really work and protect people, everyone has to embrace the spirit and intent of the laws.

Health is about more than not having a disease or health problem. Health and well-being include things like human rights, community connections and access to opportunities. Discrimination promotes poor well-being because it denies human rights, prevents connections among community members and creates unequal access. When we support human rights and help everyone take part in our communities, we're also countering discrimination-and improving people's well-being. Here are some things we can do:

Address differences that prevent people from taking part in communities: Poverty, lack of affordable housing, lack of education opportunities and lack of meaningful work are a few of the social factors that affect well-being. These factors may be both a result of poor health and a cause of poor health. Addressing these inequalities among community members is good for both individuals and the community as a whole. We can challenge systems that create differences by encouraging our governments to form positive social policies and laws. We can also support people in our communities who are working to reduce differences.

Support everyone's right to work: It's no wonder that the right to employment is identified as a human right by the United Nations. Work gives us purpose and meaning. It's also tied to income, which is tied to other social factors. For example, if we have a good income, we can afford better housing and access more services. While full-time work may not be everyone's goal, we need to support people who want to find purpose and meaning through work. To do this, we need to make sure people have access to training, education or other workplace programs.

Promote direct personal contact: Meeting and interacting with people with mental health or substance use problems is one of the best ways to improve attitudes and behaviours. This works best when the people meeting each other have equal status, when there can be discussion, and when the presenters with personal experiences can counter major myths. Education efforts like this fact sheet can help us understand the challenges, but they don't change attitudes.

Look at mental health and substance use problems as a part of our shared humanity: Fear, prejudice and discrimination lessen when we talk about mental health problems as an understandable response to a unique set of circumstances-not just as biological problems.

Help people be heard: We need to encourage and empower people with experiences of mental health or substance use problems to be leaders in any efforts, such as anti-stigma programs and research. This includes supporting people and connecting them with peers. When people relate to each other's struggles and want to see changes, they're more likely to share their stories and protest when they see injustice.

Help media be a force for good: Media like TV, movies, newspapers and web sites influence how we see others. Media should be encouraged to show people for who they really are-capable and productive community members. Hearing the direct voice of people with mental health and substance use problems through the media can be incredibly powerful. And we need to challenge media that discriminates against a group of people.

5 small ways I can make a difference

1. Tell someone who doesn't know my story of mental health or substance use problems, or help others tell their story

2. Seek direct contact by volunteering for a mental health or addictions organization, or find personal stories of recovery

3. Think about the words I use. Do I use people-centered language like, "A person living with..." or do I say, "A schizophrenic" or, "An alcoholic?"

4. Think about how I personally support and treat people around me who are living with a mental health or substance use problem

5. Speak up when I see discrimination or when I see a law or policy that unfairly excludes people

Where do I go from here?

For more information about mental health and substance use issues, see the resources below:

BC Partners for Mental Health and Addictions Information
Visit www.heretohelp.bc.ca. You can read many different personal stories written by people living with a mental illness or substance use problem. You can also find fact sheets to help you get help for mental health problems and substance use problems.

Mental Health Commission of Canada's Opening Minds Campaign
Opening Minds is a ten-year anti-stigma campaign. It helps organizations across Canada create programs that counter stigma and discrimination around mental health. For more information, visit
www.mentalhealthcommission.ca

The WHO Resource Book on Mental Health, Human Rights and Legislation, World Health Organization
Mental well-being is a human rights issue, and laws can help protect people and promote well-being. The WHO Resource Book on Mental Health, Human Rights and Legislation describes the human rights approach to mental health and discusses the role of laws in protecting people and promoting health. To read this resource, visit www.who.int/mental_health.

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Stigma and Discrimination Around Mental Health and Substance Use Problems

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About one in five people-over six and a half million Canadians-experience a mental disorder or substance use problem in their lifetime. Unfortunately, many people don't ask for help because they feel ashamed or scared. People may judge them and treat them negatively based on a mental health or substance use problem.

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Racial Profiling

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"Racial Profiling" refers to the discriminatory practice by law enforcement officials of targeting individuals for suspicion of crime based on the individual's race, ethnicity, religion or national origin. Criminal profiling, generally, as practiced by police, is the reliance on a group of characteristics they believe to be associated with crime. Examples of racial profiling are the use of race to determine which drivers to stop for minor traffic violations (commonly referred to as "driving while black or brown"), or the use of race to determine which pedestrians to search for illegal contraband.

Another example of racial profiling is the targeting, ongoing since the September 11th attacks, of Arabs, Muslims and South Asians for detention on minor immigrant violations in the absence of any connection to the attacks on the World Trade Center or the Pentagon.

Law enforcement agent includes a person acting in a policing capacity for public or private purposes. This includes security guards at department stores, airport security agents, police officers, or, more recently, airline pilots who have ordered passengers to disembark from flights, because the passengers' ethnicity aroused the pilots' suspicions. Members of each of these occupations have been accused of racial profiling.

Racial profiling does not refer to the act of a law enforcement agent pursuing a suspect in which the specific description of the suspect includes race or ethnicity in combination with other identifying factors.

Defining racial profiling as relying "solely" on the basis of race, ethnicity, national origin or religion can be problematic. This definition found in some state racial profiling laws is unacceptable, because it fails to include when police act on the basis of race, ethnicity, national origin or religion in combination with an alleged violation of all law. Under the "solely" definition, an officer who targeted Latino drivers who were speeding would not be racial profiling because the drivers were not stopped "solely" because of their race but also because they were speeding. This would eliminate the vast majority of racial profiling now occurring.

Any definition of racial profiling must include, in addition to racially or ethnically discriminatory acts, discriminatory omissions on the part of law enforcement as well. For example, during the eras of lynching in the South in the 19th and early 20th centuries and the civil rights movement in the 1950's and 1960's, southern sheriffs sat idly by while racists like the Ku Klux Klan terrorized African Americans. At times, the sheriffs would even release black suspects to the lynch mobs. A recent example would be the complaint by an African American man in Maryland, who after moving into a white community, was attacked and subjected to property damage. Local police failed to respond to his repeated complaints until they arrested him for shooting his gun into the air, trying to disperse a hostile mob outside his home.

Many racial profiling victims walk away with traffic tickets, but too often for others the outcome of racial profiling is death.

Pennsylvania (Brentwood) - On October 12, 1995, Jonny Gammage, a 31 year-old African American male, was killed after being pulled over while driving the Jaguar of his cousin, Pittsburgh Steelers football player Ray Seals, in a predominately white community. Although police claimed that Gammage initiated the struggle, a tow truck driver said he saw one officer start the fight and the others join in kicking, hitting and clubbing Gammage while he lay on the pavement. Three officers were tried for involuntary manslaughter: John Vojtas was acquitted; Lt. Milton Mulholland and Michael Albert had their charges dismissed after two mistrials. Gammage's family settled a wrongful death civil rights lawsuit against the five officers involved and their police departments for $1.5 million.

New York (Bronx-New York City) - On February 4, 1999, Amadou Diallo, an unarmed 22 year-old immigrant from New Guinea, West Africa, was shot and killed in the narrow vestibule of the apartment building where he lived. Four white officers, Sean Carroll, Kenneth Boss, Edward McMellon and Richard Murphy fired 41 bullets, hitting Diallo 19 times. All four were members of the New York City Police Department's Street Crimes Unit, which, under the slogan, "We Own the Night," used aggressive "stop and frisk" tactics against African Americans at a rate double that group's population percentage. A report on the unit by the state attorney general found that blacks were stopped at a rate 10 times that of whites, and that 35 percent of those stops lacked reasonable suspicion to detain or had reports insufficiently filled out to make a determination. Thousands attended Diallo's funeral. Demonstrations were held almost daily, along with the arrests of over 1,200 people in planned civil disobedience. In a trial that was moved out of the community where Diallo lived and to Albany in upstate New York, the four officers who killed Diallo were acquitted of all charges.

Ohio (Cincinnati) - On April 7, 2001, in the early morning hours, Timothy Thomas, a 19 year-old African-American, was shot to death by police officer John Roach. Thomas had 14 outstanding misdemeanor warrants, mostly traffic violations, including failure to wear a seat belt. According to a city councilman, he was running away, holding up his baggy pants, and scaled a fence, landing in a driveway where Roach was approaching and shot Thomas. He became the fifth black male in the city to die at the hands of police in a five-month period and the fifteenth since 1995. Two nights of protests left broken windows at City Hall and fires around the city. Witnesses reported that following Thomas' funeral, six city SWAT team officers shot pellet-filled bags into a peaceful crowd. Two people hit by the pellets filed lawsuits. Under community and city council pressure, both the public safety director and city manager resigned. Officer Roach was indicted on charges of negligent homicide, and obstructing official business, resulting from differences in his version of events.

Roach was acquitted in a bench trial characterized by the judge's (a former prosecutor) open admiration for Roach, and blaming Timothy Thomas for "making" Roach kill him.

A community coalition, the Cincinnati Black United Front and the ACLU of Ohio filed suit against the city and the Fraternal Order of Police, citing a pattern and practice of discrimination by police, including issuing the type of traffic citations Thomas received to African Americans at twice their population percentage. In April 2002 the case was settled, under terms including the establishment of a civilian complaint review board and the activation of the reporting of collected traffic stop data that had been enacted by city ordinance in 2001. The Department of Justice also intervened and settled with the city, including revision and review of use of force policy.

It is significant to note that research confirms the existence of bias in decisions to shoot. A series of University of California/University of Chicago studies recreated the experience of a police officer confronted with a potentially dangerous suspect, and found that:

participants fired on an armed target more quickly when the target was African American than when White, and decided not to shoot an unarmed target more quickly when the target was White than when African American;

participants failed to shoot an armed target more often when that target was White than when the target was African American. If the target was unarmed, participants mistakenly shot the target more often when African American than when White;

shooting bias was greater among participants who held a strong cultural stereotype of African Americans as aggressive, violent and dangerous, and among participants who reported more contact with African Americans. shooting bias was greater among participants who held a strong cultural stereotype of African Americans as aggressive, violent and dangerous, and among participants who reported more contact with African Americans1.

The stories above and hundreds of others present a compelling argument that not only does racial profiling exists, but it is widespread, and has had a destructive effect on the lives of communities of color, and attitudes toward police.

Asians, who, according to the U.S. census, number 10 million, or 4 percent of the population, have been victims of racial profiling as well. Wen Ho Lee, a Taiwanese American was targeted and suspected of espionage on the basis of his race. Memos by high-ranking FBI and Department of Energy officials acknowledged that Lee was singled out because he was Chinese, and eight similarly situated non-Chinese were not prosecuted. 2

In Seattle, Washington in July 2001 a group of 14 Asian American youth were stopped by police for jaywalking, claiming that they were kept against the wall for about an hour. The Seattle Times reported that one officer told them he had visited their country while in the army, and asked them repeatedly whether they spoke English. The paper also reported that U.S. Representative David Wu (D-Oregon) was detained entering the headquarters of the Department of Energy, and repeatedly.

In 2001, the Asian Freedom Project of Wisconsin issued a report that found the racial profiling of Hmong communities there, and included the testimony of adults, as well as boys and girls.

The Garden Grove (CA) Police Department settled a "gang" database racial profiling lawsuit by a group of young Asian Americans who said their civil rights were violated when officers photographed them as suspected gang members based merely on their ethnicity and clothing.

Indigenous people ( Native Americans) call it "DWI," with a new twist: "Driving While Indian." According to the National American Indian Housing Council, there are 2.4 million Indians (including Eskimos and Aleuts) in the U.S. Indians complain about stops and searches by local police and sheriffs on roads leading to and from reservations.

In South Dakota, widespread reports of racial profiling led to hearings before the state legislature, where Indians testified about their being stopped and searched not only based on race but also on religious articles hanging from rearview mirrors, and regional license plates that identified them as living on reservations.

In June 2002 scores of Indians in the state's Bennett County complained to Department of Justice attorneys, alleging racial profiling at the hands of sheriffs there, including vehicular stops in the absence of reasonable suspicion, the administration of breathalyzer tests without reasonable suspicion, warrantless searches of homes and vehicles, and demanding to see drivers licenses and vehicle registrations while inside bars.

Although "Driving While Black/Brown" traffic stops and searches are the form of racial profiling that has received the most media attention, profiling takes place off the roadways as well. Black and Latino pedestrians are regularly stopped and frisked without reasonable cause.

In New York City, the December 1999 report of the New York City Police Departments pedestrian "stop and frisk" practices by the state attorney general provided glaring evidence of racial profiling in the nation's largest city. Blacks comprise 25.6 percent of the City's population, yet 50.6 percent of all persons "stopped" during the period were black. Hispanics comprise 23.7 percent of the City's population yet, 33.0 percent of all "stops" were of Hispanics. By contrast, whites are 43.4 percent of the City's population, but accounted for only 12.9 percent of all stops. Blacks comprise 62.7 percent of all persons "stopped" by the NYPD's Street Crime Unit ("SCU").

In precincts in which blacks and Hispanics each represented less than 10 percent of the total population, individuals identified as belonging to these racial groups nevertheless accounted for more than half of the total "stops" during the covered period. Blacks accounted for 30 percent of all persons "stopped" in these precincts; Hispanics accounted for 23.4 percent of all persons "stopped."

Finally, precincts where minorities constitute the majority of the overall population tended to see more "stop & frisk" activity than precincts where whites constitute a majority of the population: Of the ten precincts showing the highest rate of "stop and frisk" activity (measured by "stops" per 1,000 residents), in only one (the 10 th Precinct) was the majority of the population white. In seven other precincts, blacks and Hispanics constituted the majority of the population. The remaining two precincts were business districts in Manhattan and Brooklyn in which the daytime racial breakdown of persons within the precinct is unknown.

In roughly half of the police precincts in New York City, the majority of the population living in the precinct is white. However, of these 36 majority-white precincts, only 13 were in the top half of precincts showing most "stops" during the period.

In Orange County California, a database containing the names and photographs of reputed gang members appeared to racially profile. 3 Latinos, Asians and African Americans were more than 90 percent of the 20,221 men and women in the Gang Reporting Evaluation and Tracking system, but made up less than half of Orange County's population. The disparity attracted the notice of the California Advisory Committee of the U.S. Commission on Civil Rights as well as the ACLU. We asked the county district attorney's office to establish a civilian oversight board to monitor what we saw as problems with the list.

Youth of color have been victims of racially-motivated bicycling stops, " In April, 2001, the ACLU joined a suit against Eastpointe, Michigan , representing 21 young African-American men who were stopped by the police while riding their bikes there. The ACLU argued that the bicyclists were stopped in this predominantly white suburb of Detroit because of their race and not because they were doing anything wrong. In a 1996 memorandum to the Eastpointe City Manager, the former police chief stated that he instructed his officers to investigate any black youths riding through Eastpointe subdivisions. Police searched many of young men and, in some cases, seized and later sold their bicycles. Police logs and reports in Eastpointe have identified over 100 incidents between 1995 and 1998 in which African-American youth were detained.

A throwback to the grainy '60's black and white television news footage of vicious police dogs attacking peaceful black civil rights protesters is the continued discriminatory use of canine units by police. These dogs, lethal weapons capable of biting at 2000 pounds pressure per square inch, and their handlers have been implicated in a vicious form of racial profiling that has led to legal action:

California (Los Angeles)- The ACLU of Southern California compiled reports on the hundreds of mostly blacks and Latinos who were bitten by Los Angeles Police Department dogs from 1990-1992, charging that the dogs trained to "attack and maul," were routinely sent out in non-violent situations. In 1997, California state highway patrol canine units stopped almost 34,000 vehicles. Only 2 percent were carrying drugs.

Maryland (Prince Georges County) - The Washington Post reported that in May 2001 federal prosecutors charged a county police officer with releasing her police dog on an unarmed Mexican immigrant as part of a pattern of using and threatening the use of the dog on people of color. Despite being the subject of four lawsuits, twice being guilty of making false statements to a supervisor, and five prior instances of releasing the dog on suspects who weren't resisting, and being flagged by a departmental "early warning" system, the officer remained undisciplined in any substantive way. In 1999 the Post reported that thirteen police dog excessive force suits had been filed in Prince Georges circuit and federal courts, in addition to five others that ended in judgement for plaintiffs or settlement. Of the total, ten alleged repeated bites of suspects once under police control, or while cuffed or on the ground.

South Dakota (Wagner)- While not involving the use of physical canine force, the issue reached a new low when school officials and police led a large German shepherd drug dog through classrooms in suspicionless drug searches of Yankton Sioux K-12 students, some as young as six years old. In July 2002, the ACLU filed suit in federal court.

Washington (Seattle) -In 1992 the ACLU alleged that police dog handlers used excessive force on suspects. Dogs were trained to attack and bite suspects regardless of their actions, even against alleged shoplifters, gasoline siphoners and jaywalkers. They also reported that in that year, 40 percent of police dog attacks were against African Americans, and that 91 people had received police dog bite injuries requiring hospitalization.

The following states appear to require independent reasonable suspicion for dog searches: Alaska, 4 Illinois, 5 Minnesota, 6 New Hampshire, New York, 8 Pennsylvania, 9 and Washington. 10

The targeting of shoppers/business patrons of color for suspicion of shoplifting by private security and other employees has disproportionately affected both working and prominent African-American women. TV talk show host Oprah Winfrey said she was refused buzz-in entry to a store even after seeing white women admitted and making a second attempt. After calling from a pay phone and being assured the store was in fact open, a third try failed as well (New York City) . U.S, Congresswoman Maxine Waters said she was followed around a store and required to show her key at a hotel, unlike whites who entered before her ( New York City) . Professional basketball player and Olympic medalist Sheryl Swoopes was kept waiting to be seated for almost an hour at a restaurant, while whites who arrived after her were seated before her (Houston, Texas).

Pauline Hampton and her niece, both African-Americans, were shopping at the Dillard Department Store in Overland Park, Kansas , a suburb of Kansas City, with their children. After making several purchases, they went to the cosmetics counter to redeem a coupon. A white security guard accused Hampton of shoplifting, took her shopping bag, and, without consent, searched it, emptying the bag onto the counter. After finding the receipt for the items, he shoved the goods and the empty bag back to her. When she complained about his actions, the guard ordered them to leave, and threatened to call the police and have them forcibly removed. Hampton eventually called her husband to the scene and the situation escalated. They sued, and were awarded a $1.2 million judgement; the U.S. Supreme Court declined to hear Dillard's appeal.

The store chain, based in Arkansas has also faced dozens of racial profiling lawsuits, claiming harassment and false arrest, in other states including Arkansas, Iowa, and Texas. Evidence produced in one case showed that although 16 percent of its shoppers were African American, 87 percent of the false arrest claims were made by them. In Texas, Dillard settled and paid money to the family of an African American customer who died at a store after being beaten and hog-tied while being detained, and has also settled discrimination suits by employees in Kansas and Missouri.

Other companies sued for racial profiling include Eddie Bauer, Avis Rent A Car, Denny's Restaurant, The Children's Place, and Holiday Spa.

Worksite Racial Profiling

The Immigration and Naturalization Service has had a history of disproportionately targeting ethnic groups of color for undocumented labor violations. Like all law enforcement, INS agents must have sufficient evidence of wrong doing to establish probable cause or reasonable suspicion to arrest or detain. They may not carry out their duties in a racially or ethnically discriminatory manner. While ethnicity or nationality are obviously critical elements in immigration violations by themselves, without additional facts there is insufficient basis for law enforcement action.

The New York Times reviewed files of INS raids released as part of the settlement of a garment workers union selective enforcement suit against the agency in New York City. The settlement included a summary that Latinos were 96 percent of the 2,907 people arrested in the 187 worksite raids carried out by the INS in the district, fat greater than their representation in the city's legal or illegal population. This occurred even where the INS acknowledged that half the workers were not Latino but Asian, including undocumented immigrants.

And while some raids were based on informant information, 80 percent were initiated by agents who cited as primary evidence subjects' appearance or language without evidence of wrongdoing. Included were skin color, speaking Spanish or English with a Spanish accent, appearing to be of South or Central American descent and wearing clothing "not typical of North Americans." Such characterizations in major American cities are common to born and naturalized citizens alike.

Undocumented workers were discovered and arrested in all but a few of the reviewed raids, but nearly everyone arrested was Latino.

Suits have also been filed in Arkansas, California, Louisiana, and Ohio claiming racial profiling by the INS. A federal court in Ohio found violations of the rights of Latinos by that states highway patrol's practice of stopping Latino drivers to question them about their immigration status, including officers even confiscated the green cards of legal migrant workers claiming they were counterfeit. In California, federal courts have found Fourth Amendment violations of Latinos in the stopping of Latinos on the basis of appearance and foreign sounding names.

The Supreme Court has held that INS agents working near the Mexican border may use Spanish ethnicity as a basis for detaining a person, but that it may not be the only basis.

A related issue is the targeting by police, first reported by the ACLU in Florida, of Latinos waiting on public sidewalks for labor employers to appear and select them for work, under the offense of being "visual clutter."

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"Racial Profiling" refers to the discriminatory practice by law enforcement officials of targeting individuals for suspicion of crime based on the individual's race, ethnicity, religion or national origin. Criminal profiling, generally, as practiced by police, is the reliance on a group of characteristics they believe to be associated with crime.

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https://thegrio.com/2019/03/25/black-college-students-handcuffed-and-racially-profiled-by-police-in-virginia-in-viral-video/

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Ashton Applewhite is the author of This Chair Rocks: A Manifesto Against Ageism, from which this essay is adapted.

I've never lied about my age - I have no problem saying "I'm 66" loud and clear - but I sure know a lot of people who do. People who've lied on résumés and on airplanes and on dates. There was the opera singer who fudged upward at the beginning of her career so she could get cast as Norma, but was holding at 39. And the woman who loved passing off her granddaughters as her kids, and who was regularly connected to her bank's fraud department because she couldn't remember what birth date she was using.

I would never have been able to keep my stories straight either - one reason I told the truth. Another was because the typical response wasn't so terrible: "You look great for your age!" I inherited my mother's no-grey-hair genes, I've always had plenty of energy and no plans to slow down, and I certainly never felt like any of the labels out there - "senior," "cougar," "woman of a certain age" - applied to me. But if I was so cool with it, why didn't "You look great for your age" feel like a compliment? The fact was that the hazy prospect of growing old filled me with something between free-floating anxiety and stomach-churning dread. I didn't want to think about it until I had to, and when it crossed my mind, I flipped the channel. Why not, as long as I could "pass" for younger, right?

That wasn't a very solid strategy. When I was a writer for the American Museum of Natural History, birthday cards circulated regularly around the charmless cubicles of the office where I worked with a guy named Ray for 15 years. Ray and I don't have much in common. He handled the accounts; I write. He lived in the suburbs; I don't own a car. He's conservative; I'm progressive. With his fringe of snow-white hair, if he gained weight and wore red, he'd make a perfect Santa Claus. He was proud of being cantankerous, was always muttering about his aches and pains, and couldn't wait to retire to Florida. So when I learned that Ray and I were exactly the same age, I panicked. I thought, "What if everyone finds out? They'll think I'm old too."

That wasn't just condescending and mean-spirited of me; it was idiotic. My museum coworkers, Ray included, were an intelligent bunch. They didn't have any trouble telling the two of us apart. Why, then, was I so flipped out about landing with Ray on the same side of some hypothetical old/young divide? Why did I imagine that this would erase our individuality, and diminish me so frighteningly? Was I driven by fear of losing my looks? Of growing frail? Of my own mortality? Wouldn't I be better off making my peace with the passage of time than waging a battle no one could ever win?

I wish I could report that I found the answers in one blinding epiphany. Instead, it's been a gradual awakening over the past twelve years. There have been many glum days at the keyboard, and some sleepless nights dictating brilliant insights into my phone, most of which were a lot less brilliant in the morning light. I had the good fortune to be able to meet several times with Dr. Robert Butler, coiner of the term "ageism," before his death in 2010. I attended seminars for journalists who cover the "age beat," inhaled countless books and articles, and started thinking out loud in blog form. I delved into a world of advertisements and movies, policies and bylaws, and products and promotions that had shaped my unconscious beliefs with one overarching message: old = no good. Or, as the Twitterverse might put it: It sucks to be old.

A chance dinner conversation in 2007 with my partner's mother, Ruth Stein, got me started on this journey. In their eighties at the time, she and her husband, Bill, were booksellers, and that night she said, "I think you should write about something people ask us all the time: 'So when are you going to retire?'" The idea of interviewing older people who remained on the job was upbeat and sound-bite friendly. I started learning about longevity, interviewing people over 80 in the workforce, and blogging about it.

I headed to Santa Fe, where I had family to stay with. My first interview was with 88-year-old folk artist Marcia Muth on the porch of her little adobe house, shaded by a tree festooned with shiny compact disks and surrounded by her hubcap collection. Ms. Muth had been raised in Fort Wayne, Indiana, by her grandparents, to whom she was "a disappointment, because I liked classical music, I liked Shakespeare, I loved poetry. To them, work was having a store." She went on to become a law librarian, poet, publisher, and, in her fifties, a successful folk art painter and teacher. A newspaper clipping on the wall quoted Ms. Muth's advice to her Elderhostel students: "You are never too old, and it's never too late."

Embarrassed by her lack of formal training, Ms. Muth painted in secret for 10 years. When a local artist dropped by and caught her scurrying to hide her brushes, he offered her some advice: "Don't take any lessons. Just keep going." She did, and it became a way of life that she was grateful to have found in her middle years. Chronic bronchitis had ended her teaching career a few years earlier and tethered her to an oxygen tank, but "it doesn't interfere with the painting, that's the important thing," she said. "Your life does change as you get older," she told me. "You get into what's important and what's not." She and her partner went out less and moved more slowly, but her work continued to improve as she got better at listening to herself. "Don't fear old age," she advised. "Your years can be just as wonderful as you get rid of some of the anxiety people suffer from. And I find my eighties have been even more fun than my seventies were."

The possibility that life could become more fun in your eighties had never crossed my mind. Nor that growing a little shorter of breath each year would fail to terrify. Nor that an ever more circumscribed life could be an ever greater source of personal growth and specific pleasures. Nor that such joyful clarity would be rooted in awareness - not denial - that time was short and therefore to be savoured. After this first jolt of fresh old air, I kept going. From pediatricians to park rangers, people of advanced years and all stripes told me about their work behind steering wheels and desks and band saws and television cameras and how they'd gotten there. It came as no surprise that they were as different from one another as could be, not to mention from the stereotype of the doddering ancient. But something did surprise me: the discrepancy between what I'd simply assumed it was like to be 80 or 90 and what I was encountering firsthand. The more I read and the more experts I talked to, the clearer it became that these older workers were typical of a large and fast-growing cohort of older people, more of whom are working - and working longer hours - than at any time since the turn of the century.

Why the disconnect between what I had imagined about old age and the reality that was coming into view? Had I bought into some kind of party line? What were some of my assumptions about what the future held? My darkest nightmare was the possibility of ending my days drooling under a bad botanical print in some grim institutional hallway. If asked what percentage of Americans over 65 lived in nursing homes, I'd have ventured, "Maybe 30?" I'd never have arrived at the actual number: 2.5 per cent, down from 5 per cent over the last decade, during which time aging has turned from a taboo topic into a something approaching a trendy one. Even for people 85 and up, the number is only 9 per cent. (In Canada, of men and women aged 65 and over live at home)

What about being sick and helpless? I soon learned that more than half of the "oldest old" - ages 85 and up - can go about their everyday activities without any personal assistance. Probably not shovelling their driveways or doing Costco runs, but dressing, cooking and wiping their own butts. People get chronic illnesses, but they learn to live with them. The vast majority of older people live interdependently until they come down with whatever kills them.

What about the spectre of dementia? Everyone seemed to know a horror story. My memory's never been any good, so maybe I won't notice if I develop Alzheimer's disease. It's a terrifying prospect. But even as the population ages, dementia rates are dropping. The real epidemic is anxiety about memory loss. Remember the 2.5 per cent of people over 65 living in nursing homes? Ninety per cent of the remainder can think just fine. The vast majority of older people will land in the rest of the pie chart, slowed somewhat but fully capable of finding their slippers sooner or later and making their way in the world.

How about my assumption that old people no longer have sex? It's true that sexual activity tends to decrease with age. It's equally true that retirement homes are hotbeds of lust and romance, as evidenced by skyrocketing sexually transmitted disease rates in people over 50. Sex and arousal do change, but often for the better, especially for women.

I also figured that old people were depressed. After all, they were old, and they were going to die soon. Their droopy faces were all the evidence I needed. It turns out that older people enjoy better mental health than the young or middle-aged. Who knew? Here's the kicker: People are happiest at the beginnings and the ends of their lives. If you don't want to take my word for it, Google "U-curve of happiness." Even as age strips us of things we cherished - physical strength, beloved friends, toned flesh - we grow more content.

The more I learned, the better I felt about the years ahead - no small accomplishment in itself. I had to acknowledge that the goalposts were shifting, but also that I remained very much in the game. I've always loved bicycling in the city, but now I wear a helmet and stay in the slow lane. I still barrel along the sidewalk, but recently had to slow down in order to keep pace with a 74-year-old friend whose knees were killing her. Arthritis. She marvelled that time and cartilage had waylaid her in this way, and I realized that I, too, will marvel when it happens to me. Like her, I'll figure out how to deal with it. I'll buy a cane just like she did, and keep on going. Just not as fast.

Specific concerns replaced nameless dread. I was onto something. Clearly, hitting 90 was going to be different - and way better - than the inexorable slide toward depression, diapers and puffy white shoes I'd once envisioned, although I'm still worried about the shoes.

Things started looking so much rosier that I graduated to what I came to call I'm Not Ray-Stage Two: trumpet the fact that Ray and I are the same age, because see how much younger I look! Sliding happily to the other end of the spectrum, I spent several years chasing the idea that enough spinach, sudoku and positive thinking could "put old on hold." This approach goes by all kinds of peppy names, like successful aging and productive aging, and it moves a lot of product aimed at keeping us "ageless." It sounds comforting and it feels empowering.

But a question tugged at my sleeve. Was I actually coming to terms with what it meant to grow older? Or had I merely swapped my don't-want-to-think-about-it foxhole for a hamster wheel to keep uncomfortable reckonings at bay - and Ray at a distance? Replaced dread with denial, in effect?

Hitting 60 felt just fine. I knew the years were bestowing more than they took away. I knew it from my own experience, and my research continued to confirm that I was no exception and that the years ahead had even more to offer. But I had yet to internalize that knowledge, to integrate it into my beliefs and attitudes, to embed it into my sense of self and my place in the world, to make it my own. I had to acknowledge and start letting go of the prejudices about aging that had been drummed into me since childhood by the media and popular culture. Wrinkles are ugly. Old people are incompetent. It's sad to be old. Absorbing these fallacies had been effortless. Banishing them is unsettling, and infinitely harder. Present tense because I'm still at it, as I'm reminded on a regular basis.

What was the hardest prejudice to let go of? A prejudice against myself - my own future, older self - as inferior to my younger self. That's the linchpin of age denial. Whatever form it takes, from a cutesy "Just say I'm over [fill in the number]" to faces frozen by needle and knife, denial creates an artificial, destructive, and unsustainable divide between who we are and who we will become. Concealing or disavowing our age gives the number power over us that it doesn't deserve. Accepting our age, on the other hand, paves the way to acknowledging it with ease, even pride.

I am not saying that aging is easy. We're all worried about some aspect of getting old, whether it's running out of money or getting sick or ending up alone, and those fears are legitimate and real. But it never dawns on most of us that the experience of reaching old age - or middle age, or even just aging past youth - can be better or worse depending on the culture in which it takes place. And North American culture is grotesquely youth-centric. Depictions of older people tend to be extreme. At one end of the spectrum, a silver-maned dude, beloved of marketers, surfs a turquoise wave. At the other end, beloved of the aging-industrial complex, a tiny woman withers in a hospital bed. These people exist, but they are hardly typical. The vast majority of us will end up in the middle, muscles and memory slowed, but out in the world and able to enjoy our lives to the end.

I had to make my way to I'm Not Ray-Stage Three: I'm not Ray. Ray retired to Florida when he turned 65, where I bet he's happy as a clam; it's the old age he wants. I'm making my way toward the old age I want, and it won't look like his. I too left the museum at 65, in order to become a full-time activist. I'm not planning to take up pole dancing or marathon running, and I feel just fine about that. All aging is "successful" - not just the sporty version. Otherwise you're dead.

A bunch of pieces fell into place with that realization, but a fundamental, underlying question remained: Why had my vision of late life been so out of sync with the lived reality? Why had I bought into an unexamined narrative for all these years instead of taking comfort and guidance in the evidence around me? These facts were easy to come by, so why didn't more people know them? What Kool-Aid had we drunk? What was it in the culture that had me and so many others so freaked out about the prospect of living to 80 or 90? The answer, which grew into an itch that I had to scratch and ultimately a new career, is ageism - the relegation of older people to second-class citizenship, along with the disrespecting of youth. Here's the formal definition: discrimination and stereotyping on the basis of a person's age. We're ageist when we feel or behave differently toward a person or a group on the basis of how old we think they are. "Ageism" isn't a household word yet, nor a sexy one, but neither was "sexism" until the women's movement turned it into a howl for equal rights.

As with all "isms," stereotyping lies at the heart of ageism: the assumption that all members of a group are the same. It's why people think everyone in a retirement home is the same age - old - even though residents can range from 50-year-olds to centenarians. (Can you imagine thinking the same way about a group of 20- to 60-year-olds?) And the longer we live, as more experiences inform our uniqueness, the more different from one another we become. Think about it: Which group is likely to have more in common, a bunch of 17-year-olds or of 77-year-olds? As doctors put it, "If you've seen one 80-year-old, you've seen one 80-year-old."

All "isms" - ageism, racism, sexism - are socially constructed ideas. That means we make them up, and they change over time. Like all discrimination, ageism legitimizes and sustains inequalities between groups - in this case, between the young and the no-longer young. Different kinds of discrimination - including racism, sexism, ageism, ableism and homophobia - interact, creating layers of oppression in the lives of individuals and groups. The oppression is reflected in and reinforced by society through the economic, legal, medical, commercial and other systems that each of us navigates in daily life. Unless we challenge stigma, we reproduce it.

Like racism and sexism, ageism is not about how we look. It's about what people in power want our appearance to mean. Ageism occurs when a group, whether politicians or marketers or employment agencies, use that power to oppress or exploit or silence or simply ignore people who are much younger or significantly older. We experience ageism any time someone assumes we're "too old" for something - a task, a relationship, a haircut - instead of finding out who we are and what we're capable of. Or if someone assumes that we're "too young": Ageism cuts both ways, and young people experience a lot of it. That's what's going on when people grumble about lazy millennials or complain that "kids are like that."

Now I see ageism everywhere. When old pals cringe at public mention of how long they've known each other instead of happily acknowledging their shared history. When men and women feel compelled to lie about their age on online dating sites. When people bridle at being kindly offered a seat on the bus. On billboards and television, in hospitals and hotels, over dinner and on the subway. ("At age 80, who doesn't need a facelift?" a poster announcing a station renovation asks brightly.) In the incessant barrage of messages from every quarter that consigns the no-longer-young to the margins of society. In our mindless absorption of those messages and numb collusion in our own disenfranchisement.

I've learned that most of what I thought I knew about the aging process was wrong. That staying in the dark serves powerful commercial and political interests that don't serve mine. And that seeing clearly is healthier and happier. We know that diversity means including people of different races, genders, abilities and sexual orientations; why is age typically omitted? Racist and sexist comments no longer get a pass; why do eyebrows barely raise when older people are described as worthless, or "out of it," or even repulsive? As age bias bleeps onto the cultural radar, this is beginning to change. Next year, after all, people aged 65 and over will outnumber those under age five for the first time in human history.

Suppose we saw hurtful, even hateful, age stereotypes for what they are - not to mention the external policies and procedures that put the "ism" after "age." Suppose we could step off the treadmill of age denial and begin to see how ageism segregates and diminishes our prospects. Catch our breath, then start challenging the discriminatory structures and erroneous beliefs that attempt to shape our aging. Until then, ageism will pit us against each other; it will rob society of an immense accrual of knowledge and experience; and it will poison our futures by framing longer, healthier lives as problems instead of the remarkable achievements and opportunities they represent.

A good place to start is by jettisoning some language. "The elderly"? Yuck, partly because I've never heard anyone use the word to describe themselves. Also because "elderly" comes paired with "the," which implies membership in some homogeneous group. "Seniors"? Ugh. "Elders" works in some cultures but feels alien to me, and I don't like the way it implies that people deserve respect simply by virtue of their age; children, too, deserve respect. Since the only unobjectionable term used to describe older people is "older people," I've shortened the term to "olders" and use it, along with "youngers," as a noun. It's clear and value-neutral, and it emphasizes that age is a continuum. There is no old/young divide. We're always older than some people and younger than others. Since no one on the planet is getting any younger, let's stop using "aging" as a pejorative - "aging boomers," for example, as though it were yet another bit of self-indulgence on the part of that pesky generation, or "aging entertainers," as though their fans were cryogenically preserved.

It always drove me nuts when some clown called me "young lady" and expected me to feel complimented, but I didn't know why until I started thinking deeply about it. Made to our face, comments like these are disguised as praise. We tend to ignore them because the reference to being no-longer-young is embarrassing. And it's embarrassing to be called out as older until we quit being embarrassed about it. Well, I'm not any more. When someone says, "You look great for your age," I no longer mutter an awkward thanks. I say brightly, "You look great for your age too!" When it dawned on me that one of the reasons older women are invisible as older women is because so many dye their hair to cover their grey, I bleached mine white to see what it was like. When my back hurts, instead of automatically blaming it on my osteo-you-name-it, I stop to think whether shovelling or weeding could be to blame. I started a Q&A blog called Yo, Is This Ageist? where people can ask me whether something they've seen or heard or done is offensive or not.

Although we age in different ways and at different rates, everyone wakes up a day older. Aging is difficult, but few of us opt out, and the passage of time confers very real benefits upon us. By blinding us to those benefits and heightening our fears, ageism makes growing older in North America far harder than it has to be. That's why I've embarked on a crusade to overturn American culture's dumb and destructive obsession with youth, and challenge the way people at both ends of the age spectrum are devalued and disrespected.

As I've gone on this journey from the personal to the political, it's become clear that ageism is woven deeply into our capitalist system, and that upending it will involve social and political upheaval. No one gives up power without a struggle, as the backlash against the #MeToo movement attests, delivering a seat on the U.S. Supreme Court this fall to a man accused of sexual misconduct and hostile to women's rights. Yet change is both necessary and possible. What would the U-curve look like in world that values people of all ages equally? How would age equality transform the world of longer lives we now inhabit?

Ageism, unlike aging, is not inevitable. In the 20th century, the civil rights and women's movements woke mainstream North America up to entrenched systems of racism and sexism. More recently, activists have brought ableism and homophobia and transphobia to the streets and the courts of law. It is high time to add ageism to the roster, to include age in our criteria for diversity, and to mobilize against discrimination on the basis of age. It's as unacceptable as discrimination on the basis of any aspect of ourselves other than our characters.

If marriage equality is here to stay, why not age equality? If gay pride has gone mainstream, and millions of North Americans now proudly identify as disabled, why not age pride? The only reason that idea sounds outlandish is because this is the first time you've encountered it. It won't be the last. Longevity is here to stay. Everyone is aging. Ending ageism benefits us all.

Why add another "ism" to the list of oppressions when so many, racism in particular, call out for action? Here's the thing: We don't have to choose. When we make the world a better place to grow old in, we make it a better place in which to be from somewhere else, to have a disability or be queer or non-white or non-rich. Just as different forms of oppression reinforce and compound each other - that's intersectionality, a term coined by feminist and civil rights activist Kimberlé Crenshaw - so do different forms of activism, because they chip away at the fear and ignorance that all prejudice relies upon. Ageism is a perfect target for compound advocacy because everyone experiences it. And when we show up at all ages for whatever cause tugs at our sleeve - save the whales, the clinic, the democracy - we not only make that effort more effective, we dismantle ageism in the process.

What ideas about aging have each of us internalized without even realizing it? Where have those ideas come from, and what purpose do they serve? How do they play out across our lives, from office to bedroom, in muscle and memory, and what changes inside us once we perceive these destructive forces at work? What might an age-friendly world - friendly to all ages, that is - look like? What can we do, individually and collectively, to provoke the necessary shift in consciousness, and catalyze a radical age movement to make it happen?

You might not think of yourself as an activist. But I hope you'll start seeing the ageism in and around you, embrace a more nuanced and accurate view of the years ahead, cheer up - and push back.

About the artist

R.O. Blechman is an 87-year-old American illustrator, animated filmmaker, designer, and author. A pioneer of the graphic novel, his first book, The Juggler of Our Lady (1953) was, as Maurice Sendak wrote, a "blueprint for things to come." His signature nervous line is instantly recognizable and pulses throughout his work in all mediums, from his numerous New Yorker covers to his television commercials. The stark simplicity of his style seems inseparable from his sensitivity as a storyteller and from the sharp intellect he applies to his commentary on the human condition. His animated feature of Stravinsky's The Soldier's Tale for PBS earned an Emmy award. He has exhibited at the Museum of Modern Art in New York, which mounted a retrospective of his animated films in 2003. In 2012 he was inducted to the Illustrators Hall of Fame.

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Age of distinction: Don't believe the ageist myths. We only get better in our golden years

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Ashton Applewhite is the author of This Chair Rocks: A Manifesto Against Ageism, from which this essay is adapted. I've never lied about my age - I have no problem saying "I'm 66" loud and clear - but I sure know a lot of people who do.

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Cars are made for men, and do not consider boobs or pregnancy.

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https://www.benjerry.com/home/whats-new/2016/systemic-racism-is-real

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The gender pay gap varies substantially from state to state, due to factors such as:

The primary industries in the state and the opportunities they create

Demographics such as race/ethnicity, age, and education level

Regional differences in attitudes and beliefs about work and gender

Differences in the scope and strength of state pay discrimination laws and policies

Explore Your State STATE WAGE GAP DATA
The gender pay gap occurs across almost all occupations and industries:

Male-dominated industries tend to have higher wages than industries and occupations made up mostly of female workers;

In a comparison of occupations with at least 50,000 men and 50,000 women in 2017, 107 out of 114 had statistically significant gaps in pay that favored men; six occupations had no significant gap; and just one had a gap favoring women.

In some occupations, women collectively are receiving billions less than they would with equal pay; for instance, women working as physicians and surgeons are paid $19 billion less annually than if they were paid the same as men in that occupation.

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The gender pay gap varies substantially from state to state, due to factors such as: The primary industries in the state and the opportunities they create Demographics such as race/ethnicity, age, and education level Regional differences in attitudes and beliefs about work and gender Differences in the scope and strength

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the effect of ableism

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Ableism is discrimination or prejudice against people with disabilities. It can occur in many ways - some ways subtle and others overt. A person with a disability may experience ableism as unwelcome stares or a building or event being inaccessible. Though I have encountered ableism for ages, I hadn't realized there was a name for it, nor had I considered such instances to be discrimination.

I have had Charcot-Marie-Tooth (CMT) type 1A for as long as I can remember. I wear ankle-foot orthoses to help with my mobility and balance, and I use a cane when walking long distances. Recently, I have been paying more attention to the accessibility of buildings and at events. Sadly, I've found that many venues do not have accessible options for those with disabilities.

I have experienced ableism in the form of stares and rude comments. Sometimes, people do not realize their words are discriminatory. They can identify a racist remark, but fail to recognize an ableist comment. Some people do not believe that staring at a disabled person is problematic. Would you gape at an able-bodied person as they walk by or ask them, "Why do you walk like that?" Maybe people think it is OK to ask questions. However, if you wouldn't feel comfortable addressing an able-bodied person in a similar way, then it's not OK.

One example of ableism is pointing out a person's disability before introducing them or speaking about them. Putting the disability first gives the impression that it is the primary piece of information one needs to know about that person. The person with the disability should get to decide whether they want to disclose that information. There are times I feel comfortable sharing information about my CMT and others when I do not. The choice should belong to the person with the disability. Another form of ableism is expressing sympathy for a person's disability. While the words can be well-meaning, they can come across as disparaging.

Ableism is present all around us. Many who have disabilities encounter prejudice daily. I've often had to walk around a building to try to find an accessible entrance, but I had viewed that merely as poor planning and not as a form of discrimination. How often do snowplows dump snow in the handicapped parking spaces or right in front of the ramps? Where I live it happens a lot. Situations like these are extremely frustrating, and now I identify them as examples of ableism.

I have experienced many instances of ableism, but I hadn't viewed them as discrimination. I see now that they are and realize why we need to change the narrative surrounding disability and transform how we as a society treat people with disabilities. I do not want to be treated differently, but I deserve equal access and the same rights that able-bodied people enjoy.

***
Note: Charcot-Marie-Tooth News is strictly a news and information website about the disease. It does not provide medical advice, diagnosis, or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website. The opinions expressed in this column are not those of Charcot-Marie-Tooth News or its parent company, BioNews Services, and are intended to spark discussion about issues pertaining to Charcot-Marie-Tooth.

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This Is What Ableism Looks LIke to a Person with CMT

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Ableism is discrimination or prejudice against people with disabilities. It can occur in many ways - some ways subtle and others overt. A person with a disability may experience ableism as unwelcome stares or a building or event being inaccessible.

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A group of University of La Verne students say they are constantly facing microaggressions on campus - such as the time they say the director of modern languages told Latino students they don't know how to speak Spanish or when the art curator declared cultural artwork is a dumbed down version of art.

The student group is calling on administrators to address what they believe are systematic racism and gender inequality issues at the nearly 130-year-old institution.

"Every day on this campus, we have to deal with a toxic environment from students, staff and faculty that are not culturally competent and don't understand the terms of intersectionality," said Jasmine Marchbanks, a second-year graduate student.

Although the university in an email Thursday said it could not comment on specific personnel issues, there are procedures for addressing inappropriate employee conduct.

The student group, which identifies itself by using the hastag #DCULV, meaning "de-colonize the University of La Verne," has also brought to light several instances in which they say President Devorah Lieberman has made culturally-insensitive statements to them.

In an interview Wednesday in her office, Lieberman acknowledged students, faculty and staff look to the president to move the institution forward in support its core values.

"We've all made missteps in saying something, in not recognizing something, and I believe I am among the all - that I have had some missteps," she said. "In those missteps, our job is to learn to be better. I'm one of the learners."

A list of demands

Students first broached the issue in October, giving administration a list of demands to improve what they believe is the lack of cultural competency at the campus. The students said they want to see the university's "Eurocentric and patriarchal" curriculum replaced with one that reflects the diversity on campus.

They have asked the president, provost and president's executive board to come up with a curriculum and co-curricular plan that address the issues and ensure diversity training be part of the tenure evaluation process.

Then in November, the student group presented another set of demands to the Faculty Senate. Among the items requested was that the employee handbook be updated to include "training for diversity, inclusion, neurodiversity, mental health, gender, disabilities, sexuality and socioeconomics."

The group said faculty members want to add culturally relevant information and resources to their courses but don't want audit all of the general education curriculum. They also asked to create a minority postdoctoral fellowship program to recruit and retain more faculty of color, Marchbanks said.

Both letters from the students conclude by stating: "Discrimination and prejudice are systematic at La Verne. The lack of awareness and microaggressions students face on campus create a toxic academic and social environment." They sign it without names, using only Students With a Voice.

After the first demonstration in October, Lieberman said she and the provost met with the group 24 hours later. Their goals was to listen more and address every single demand, she said. The university then took out an ad in the campus publication with a list of the demands and the university's plan of action, Lieberman said.

Pointing to university figures, Marchbanks said more needs to be done improve the retention rate of black students on campus.

Associate Provost Daniel Byrd, who leads institutional research for the university, acknowledged the average four-year graduation rate for African-American students was 39 percent compared to 51 percent for white students, reflecting a 12 percentage point performance gap. Byrd said in an email Thursday he was referring to statistics from the university's Factbook, based on a seven-year period, from 2008-2014, of traditional-aged undergraduates.

But Byrd also noted that if using the last three years of available data, from 2012-2014, the average performance gap is only 5 percentage points. He cautioned that "drawing inferences from any single year given the small co-hort of African-American students can contribute to high year-to-year variation in percentages, hence the focus on comparison across multiple years."

The provost office is very supportive, Lieberman said, of the idea of looking at programs so there is inclusivity and diversity - a core value at the university - in the curriculum across the board.

For example, the board of trustees has approved the creation of a faculty position that will support the Culture and Critical Studies program that will launch in fall 2020. That position will also oversee leadership and equity-related courses for first-year students.

Other diversity, equity and inclusivity measures taken by the university since the student demands:

An internal portal that chronicles recent efforts as well as channel for questions.

Diversity, equity, inclusion/cultural competency training for all employees.

Student leadership training as well as listening sessions were conducted.

An external expert conducted a two-hour dialogue with board of trustees. The board request additional training for this fall.

A policy requiring diversity, equity, inclusion/cultural competency training for employees should be implemented by July.

The president's 12-member executive cabinet has also received in-depth diversity, equity and inclusivity/cultural competency training.

Liebermen said the university acted immediately to respond but noted it already had implemented other initiatives to improve the campus culture, such as creating the Office of Diversity and Inclusivity and hiring a chief diversity officer.

"The change is here and the change is happening," she said.

Presidential example

At an on-campus protest Wednesday morning, more than a dozen students gave examples of offenses that came from faculty, fellow students and most of all Lieberman herself. The group addressed more than a dozen onlookers of students, faculty and staff.

History graduate student Paril Patel said Lieberman referred to him as "an exotic human being" during an encounter last year. It left him a little dumbfounded.

During her freshman and sophomore years, Marchbanks said the president would try to touch her hair, and when she would tell her no, Lieberman would just laugh off the incident.

"This problem that what we're talking about isn't just at the presidential level. Most of the president's executive committee ignore all the students who are up here," Marchbanks said during the protest.

Last year, when Liebermen reportedly began to culturally appropriate a Spanish term used to refer to a strong Latina who fights for her community, it bothered Anayeli Dominguez, who approached Lieberman to share her concern.

"I told her 'No disrespect, but you have not done anything for the Latino community. You claim to be a Latino institution but Latino students don't feel the help. I would appreciate it if you stop calling yourself chingona,'" she said. "'If you were more culturally aware, you'd know you have done a lot of macro- and microagressions against the students on campus.'"

Lieberman, who got a bit emotional addressing the student's concerns, said: "As an individual who believes so deeply in this mission and believes in the success of every student, faculty and staff - if, and when offended anybody - I feel that pain. It pains me that I may have offended anybody."

The university is a federally-designated Hispanic Serving Institution, according to the university.

Since then, Dominguez said Lieberman has ignored her.
EDITOR'S NOTE: This article has been edited to correct the spelling of a surname.

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University of La Verne students say racism and gender inequality issues are systemic, demand change

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A group of University of La Verne students say they are constantly facing microaggressions on campus - such as the time they say the director of modern languages told Latino students they don't know how to speak Spanish or when the art curator declared cultural artwork is a dumbed down version of art.

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In 2018, women earned 85% of men, showing that overtime the gap is narrowing. In addition, many women are discriminated against due to their taking care of children, as women are more likely to take time off. Therefore, mothers are twice as likely as fathers to be negatively impacted by taking a leave on their job/ career.

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The gender gap in pay has remained relatively stable in the United States over the past 15 years or so. In 2020, women earned 84% of what men earned, according to a Pew Research Center analysis of median hourly earnings of both full- and part-time workers. Based on this estimate, it would take an extra 42 days of work for women to earn what men did in 2020.

As has been the case in recent decades, the 2020 wage gap was smaller for workers ages 25 to 34 than for all workers 16 and older. Women ages 25 to 34 earned 93 cents for every dollar a man in the same age group earned on average. In 1980, women ages 25 to 34 earned 33 cents less than their male counterparts, compared with 7 cents in 2020. The estimated 16-cent gender pay gap among all workers in 2020 was down from 36 cents in 1980.

The gender pay gap measures the difference in median hourly earnings between men and women who work full- or part-time in the U.S. Historically, men have earned more on average than women, but the gap has slowly closed over time. The most recent data is from 2020 Current Population Survey Merged Outgoing Rotation Group (MORG) files. To understand how we calculate the gender pay gap, see our 2013 post, " How Pew Research Center measured the gender pay gap."

The U.S. Census Bureau has also analyzed the gender pay gap, though its analysis looks only at full-time workers (as opposed to full- and part-time workers). In 2019, full-time, year-round working women earned 82% of what their male counterparts earned, according to the Census Bureau's most recent analysis.

Why does a gender pay gap still persist?

Much of this gap has been explained by measurable factors such as educational attainment, occupational segregation and work experience. The narrowing of the gap is attributable in large part to gains women have made in each of these dimensions.

Even though women have increased their presence in higher-paying jobs traditionally dominated by men, such as professional and managerial positions, women as a whole continue to be overrepresented in lower-paying occupations relative to their share of the workforce. This may contribute to gender differences in pay.

Other factors that are difficult to measure, including gender discrimination, may also contribute to the ongoing wage discrepancy. In a 2017 Pew Research Center survey, about four-in-ten working women (42%) said they had experienced gender discrimination at work, compared with about two-in-ten men (22%). One of the most commonly reported forms of discrimination focused on earnings inequality. One-in-four employed women said they had earned less than a man who was doing the same job; just 5% of men said they had earned less than a woman doing the same job.

Motherhood can also lead to interruptions in women's career paths and have an impact on long-term earnings. Our 2016 survey of workers who had taken parental, family or medical leave in the two years prior to the survey found that mothers typically take more time off than fathers after birth or adoption. The median length of leave among mothers after the birth or adoption of their child was 11 weeks, compared with one week for fathers. About half (47%) of mothers who took time off from work in the two years after birth or adoption took off 12 weeks or more.

Mothers were also nearly twice as likely as fathers to say taking time off had a negative impact on their job or career. Among those who took leave from work in the two years following the birth or adoption of their child, 25% of women said this had a negative impact at work, compared with 13% of men.

Once women become mothers, juggling family caregiving responsibilities and work can be a challenge. Mothers, even those who are married and work full time, tend to carry a larger load at home than fathers when it comes to these tasks. In a 2019 survey, mothers with children younger than 18 were more likely than fathers to say they needed to reduce their work hours, felt like they couldn't give full effort at work and turned down a promotion because they were balancing work and parenting responsibilities. Roughly one-in-five mothers said they had been passed over for an important assignment or a promotion at work, while 27% said they had been treated as if they weren't committed to their work.

Overall, Americans see equal pay as central to gender equality. In a 2020 survey, 45% of those who said it's important for women to have equal rights with men volunteered equal pay as a specific example of what a society with gender equality might look like. This response trumped other items such as women not being discriminated against for their gender or women being equally represented in leadership positions.
Note: This is an update of a post originally published on March 22, 2019. Former Pew Research Center staff Nikki Graf and Eileen Patten contributed to this analysis.

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Gender pay gap in U.S. held steady in 2020

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The gender gap in pay has remained relatively stable in the United States over the past 15 years or so. In 2020, women earned 84% of what men earned, according to a Pew Research Center analysis of median hourly earnings of both full- and part-time workers.

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causes of systemic racism

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October 2, 2023

Your waffle cone just got even sweeter! From Oct. 3 to 17, we're donating $1 for every waffle cone purchased in Scoop Shops to Advancement Project, a national civil rights organization working to progress human rights and build power in local communities.

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Yes, systemic racism is real. And people of color - African Americans, Latinos, Asians, and other minorities - face it every day. We still have a lot of work to do, America. The good news: by speaking up about it, you can be part of the solution.

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First-person essays and interviews with unique perspectives on complicated issues.

When news broke this week that only seven black students were accepted into New York City's Stuyvesant High School, an elite public school that supposedly only takes the most advanced students in the city, I wasn't surprised. In my 14-year career as a middle school math teacher in Manhattan with majority black or Latinx students, I've had thousands of kids who were rejected from magnet public schools like Stuyvesant. It breaks my heart every time.

Every year, sometime in March, thousands of New York City adolescents receive a letter that tells them which high school selected them. That school day is always a tough one. Some students run up and down the halls, excitedly telling their friends about where they will be spending the next four years. Others, disappointed in their placement, sit solemnly or find a comforting shoulder to lean on.

I've had to console far too many brilliant students who didn't get chosen for the high school they wanted to go to. They checked off all the proverbial boxes: great attendance, high grades, strong work ethic, and had positive relationships with adults and peers. They studied hard for the Specialized High School Admission Test - an assessment given to eighth or ninth graders for entry into eight of the elite magnet public schools in New York City - for months. Because a student's score on that test is the only criterion for high school admissions, the stressful three hours spent taking this exam could determine a student's future.

As a teacher, I try to assure my students that they will be fine regardless of which school they attend. But I often wonder if we educators are doing a disservice - and perpetuating the lie of meritocracy - by continuing to tell kids that if they work hard and excel then they can get what they want in life.

School segregation in New York City is reaching emergency levels

Make no mistake: New York City is burning. But unlike the literal and metaphorical burning of the Bronx in the 1970s, the latest fire is happening in our education system as schools continue to segregate at alarming rates. Only 190 of the 4,798 slots, or 3 percent, in the eight major specialized high schools went to black students. This is in a city where a quarter of NYC's public-school students are black.

None of this is by accident. Some forty years after Stuyvesant High School opened, New York State passed the Calandra-Hecht Act in 1971 which stated that "admissions to [these specialized high schools] shall be solely and exclusively by taking a competitive, objective and scholastic achievement examination." The bill was passed to preempt city investigations as to whether these institutions were racially discriminatory.

Essentially, these schools enshrined into law the right to ignore school performance, grades, interviews, standardized state exams, or any other qualification in favor of a test that rarely aligns with the standards they learn in school, tacitly keeping these schools out of reach for under-resourced students and schools. The specialized high schools continue to exemplify why New York City has the most segregated school system in the country.

The Specialized High School Admission Test, much like the IQ tests of yore and the SAT or ACT of the present, has been gamed since its inception. Everything from expensive test prep centers concentrated in specific neighborhoods to private tutors who spend hours with students across the city helps exacerbate admissions, and with it racial disparity.

Any number of initiatives may provide free resources for students to improve their scores. But the history of schooling suggests this will only push the already privileged to seek more advantages. Even if we buy the premise that the test is a valid assessment, which it isn't, we already see how the multimillion dollar test prep industry makes the prospect of taking this test daunting for black and brown children in our city.

In Nicolas Lehman's The Big Test: The Secret History of the American Meritocracy, he argues that "the study of human intelligence had always attracted people with a certain cluster of beliefs, even before there were IQ tests around for use as evidence." In the early 1900s, our country had become fascinated with the study of eugenics. IQ tests became a tool for pundits to argue that people of darker skins were intellectually inferior.

Standardized testing is a tool for structural racism, not a way to eliminate it

These days, standardized tests don't just create inequitable conditions for schools; they also bolster arguments of those who already preferred to consolidate education to the privileged few. In historian Horace Mann Bond's 1924 paper "Intelligence Tests and Propaganda," Bondbrings this point home: "[T]o claim that the results of the tests given to such diverse groups, drawn from such varying strata of the social complex, are in any wise accurate, is to expose a fatuous sense of unfairness and lack of appreciation of the great environmental factors of modern urban life."

In other words, standardized testing is a tool for structural racism, not a way to eliminate it.

A single test determines the future of our children. That is unacceptable.

Especially tragic is that so much of this debate ignores the brilliance that I get to witness on a daily basis from my students of color. I've seen the ways my students master scientific notation and systems of equations better than I could at their age. I hear them debate each other - often in vociferous ways - on whether a set of relations determines a function. I, and so many of their teachers, believe in their present and future.

My students deserve high-level academic experiences regardless of whether their school is specialized or not. That starts with abolishing this test, which simply does not reflect a student's true academic potential. (Mayor Bill de Blasio has said he wants to end the SHSAT, which was met with opposition.) We need to support programs that reserve a set of seats for disadvantaged kids, such as Mayor Bill de Blasio's Discovery Program. We need a multi-faceted approach that tends to years' worth of work, not just one exam that's not even aligned to the standards students get taught in school.

As a middle school teacher, I long for the day when students can say, "Maybe I didn't get into the school I wanted to attend, but I got into a school that loves me back."

Jose Vilson is a New York City public school teacher. He is the author of This Is Not A Test: A New Narrative on Race, Class, and Education. He has spoken about education, math, and race for a number of organizations and publications, including the New York Times, The Guardian, TED, El Diario / La Prensa and the Atlantic. He's a National Board Certified teacher, a Math for America Master Teacher, and the executive director of EduColor, an organization dedicated to race and social justice issues in education.

First Person is Vox's home for compelling, provocative narrative essays. Do you have a story to share? Read our submission guidelines, and pitch us at firstperson@vox.com.

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The New York City school controversy shows why standardized testing is broken

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First-person essays and interviews with unique perspectives on complicated issues. When news broke this week that only seven black students were accepted into New York City's Stuyvesant High School, an elite public school that supposedly only takes the most advanced students in the city, I wasn't surprised.

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cause --> perpetuation of systemic inequality

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diverse executives at fortune 500 companies

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women executives at fortune 500 companies

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White Men Account for 72% of Corporate Leadership at 16 of the Fortune 500 Companies

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Among the 16 Fortune 500 companies that share diversity data, 72% of their senior executives are white men.

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I'm a tenured, deeply qualified New York City teacher, but some only see my disability. At least my students know the impact I can make in the world.

The morning of my job interview brought excitement and anxiety. At the same time, I felt prepared and confident. It was the beginning of 2017 and already I had gone through three rounds of phone interviews, all rigorous, yet fair. This final interview would be our first face-to-face meeting. After passing through such an extensive interview process, backed by my impeccable credentials, I felt this meeting would be a formality.

A 14-year veteran New York City public school teacher, I was applying for a literacy coach position to train new teachers. The interviews had gone so well, I was certain a job offer would soon follow.

I met my interviewer for the first time at Starbucks. Soon after we started, I saw the sparkle leave her eyes. I noticed the fidgeting, a symptom of her sense of discomfort. Instead of asking about my pedagogical philosophy or leadership style, she asked me this: How am I able to get the students to listen to me?

The implication behind her question was clear: She didn't think my students pay attention to me. Despite 14 years of exemplary performance evaluations, including high ratings for classroom management, somehow she believed my skills were wanting.

Later, I was informed that I was not selected for the position. After sailing through every stage of the application process, something had changed. Suddenly, she seemed to lose all enthusiasm for my candidacy.

What happened?

Disabled in a city not made for me

Meeting me for the first time, my interviewer saw a woman in a motorized wheelchair. She didn't see a black woman. She didn't even see a capable professional. What she saw was a disabled person.

I am a tenured, New York City teacher with a master's degree in School Leadership from New York University. At my school, I held four leadership positions: English Department chair, testing coordinator, grade level chair and professional development committee member. The next step in my career would be educational administration.

I also have spinal muscular atrophy type II, a neural disease that occurs in 1 in every 6,000 children. It leads to decreased motor skills and deteriorating muscles. In 2008, I survived a risky surgery in which my spine was exposed, untwisted, and reinforced with titanium, possibly adding as many as 20 years to my life.

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Despite my professional qualifications, there have been some programs I am unable to take full advantage of because of a lack of disability access. I was accepted to the CUNY-NYC Leadership Academy Program for Future Middle School Principals. The program was extremely rigorous. The reality of living with a disability means that my physical needs had to be met before I could work toward any goal. I had to consider whether the "reasonable accommodations" that employers are required to provide under the 1990 Americans With Disabilities Act - certain protections are guaranteed by law - would allow me to participate.

Classes were held from 4 to 8 p.m. once a week in Queens. The journey from my school in the Bronx began right after work. In a society where the infrastructure is designed for able-bodied individuals, most people can't conceptualize how challenging it can be for people with physical disabilities. A small thing we take for granted - going to the bathroom in a public place - can present a serious problem when there are no bathrooms that are wheelchair accessible.

Of course, if I had to use the bathroom during the school day, I couldn't because I could not enter with my wheelchair. I had to wait until I got home to relieve myself. Under this program, I would not make it home until 10 pm. My doctor had warned me to consider the long-term impact of this schedule on my kidneys and overall health.

To further complicate the matter, the only wheelchair access to the building where the class was being held was on a side street that required me to pass through a parking lot. When I arrived at the door, I would have to wait for security to let me in.

After arriving late for the first three sessions because I had to wait outside at the entrance, I made peace with the fact that this program was not the best option for me. While I valued the program and felt supported by the administrators, there wasn't a protocol for the program to deal with a situation like mine.

Showing up every day for my students

The Starbucks meeting showed me that no matter how accomplished I am, people's limited understanding of the capacity of people with disabilities proves to be a major impediment to my career advancement.

It is disheartening to see how my future is totally at the mercy of individuals who might have their own mistaken assumptions about people with disabilities. The job of literacy coach does not require much more physical skill than just showing up. There is so much more to fostering educational success - the ability to communicate, to motivate, to encourage and inspire while keeping abreast of current research and best professional practices. For my entire career this has been my passion, so I have no doubt that I would be an asset in this position.

I was not able to change my interviewer's unfounded notion about my abilities. But since the door closed on that job opportunity, I delved deeply into my role as a teacher. I thought of how my students could grapple with Ursula Le Guin's fiction. I obsessed about how I could teach students to analyze the impact of the author's use of symbolism. I planned a one-on-one conference with a student who had already given up, searching for the right words to convey that I believe in his potential.

It is with great pride that I leave home each day to serve my community, my colleagues and my students with dignity, resourcefulness, intelligence and professionalism.

My role, as I see it now, is to show how much of an impact a person with a disability can have in the world. I want people to see what we can do.
Dayniah Manderson is a 38-year-old veteran public school educator and single mother. She served as Ms. Wheelchair New York 2017 and is an advocate for people with disabilities.
Read or Share this story: https://www.usatoday.com/story/opinion/voices/2018/10/08/disability-access-job-interview-teacher-discrimination-ada-ableism-accommodation-column/1501095002/

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Does my wheelchair make you uncomfortable? How my disability may have cost me a job.

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I'm a tenured, deeply qualified New York City teacher, but some only see my disability. At least my students know the impact I can make in the world. The morning of my job interview brought excitement and anxiety. At the same time, I felt prepared and confident.

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Income inequality happens by design. We can’t fix it by tweaking capitalism | Steven W Thrasher

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The poorest Americans have no realistic hope of achieving anything that approaches income equality. They still struggle for access to the basics

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Effect

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Executive Summary

Systematic discrimination against women in medicine constitutes a potential threat to patient safety and public health. Accumulating evidence shows that women deliver superior care. For example, one study of over 1.5 million Medicare patients found that those who were treated by a female physician were less likely to die or be readmitted to the hospital within 30 days than those patients treated by a male physician. A separate study of over 100,000 surgical patients found the same effect: Patients who were operated on by a female surgeon were significantly less likely to die within the next 30 days. While the underlying mechanisms driving these differences have yet to be fully explored, evidence suggests that female physicians bring unique perspectives to their practice that can improve care. Barriers restricting the access and development of women's careers in medicine need to be removed, and the field must do a better job of promoting, supporting, and rewarding female physicians.

James Boast/Getty Images

In August 2018 officials from Tokyo Medical University admitted to systematically altering medical school admission test scores to disadvantage female applicants. Since 2006 the university had been subtracting points from all exam scores, then adding up to 20 points to those of male applicants, with the explicit goal of reducing the percentage of women entering medical school. (The percentage of enrollees who were women had reached 40% in 2010, and now stands at approximately 30%.)

This systematic discrimination against female medical school applicants is not only sexist and scandalous in its own right - not to mention devastating for the women denied access to the profession they desired - but it constitutes a potential threat to patient safety and public health.

Accumulating evidence shows that women deliver superior care. For example, one study of over 1.5 million Medicare patients found that those who were treated by a female physician were less likely to die or be readmitted to the hospital within 30 days than those patients treated by a male physician. A separate study of over 100,000 surgical patients found the same effect: Patients who were operated on by a female surgeon were significantly less likely to die within the next 30 days.

Other research has demonstrated that these differences in outcomes may be particularly pronounced for female patients. A recent study of over 500,000 patients who experienced a sudden heart attack found evidence that any patient treated by a female physician was more likely to survive, compared with those treated by a male physician. But the researchers also found strong evidence that the effect was particularly pronounced for female patients.

What accounts for the differences in outcomes achieved by female and male physicians? The underlying mechanisms have yet to be fully explored, but evidence suggests that female physicians bring unique perspectives to their practice that can improve care. For instance, female physicians tend to engage in more preventative care and more-effective doctor-patient communication. Research has also found that female physicians engage in more evidence-based care practices and score higher on medical school examinations, relative to their male colleagues, factors that may account for their better outcomes.

But there are other issues at play. A recent study of surgeons and other operating room (OR) team members revealed that the percentage of women in the OR team was directly associated with more cooperative behavior (critical for effective, safety-focused OR team performance), with a substantial drop in cooperation when the number of men on the OR team exceeded 50%.

In light of this evidence, it is reasonable to conclude that any practice, bias, or treatment that keeps women from entering and advancing in medicine is actually denying patients opportunities to receive higher-quality care. While overt sex-based discrimination like that observed at Tokyo Medical University is uncommon, pernicious attitudes and systemic pressures exist throughout medicine that inhibit the inclusion and development of female physicians.

The underrepresentation of women in medicine is well-documented, with women making up more than half of medical school entrants but fewer than 35% of all active physicians in the U.S. (and far lower percentages of senior leadership positions). This underrepresentation is driven by a range of factors, from different preferences and gendered attitudes about certain medical specialties to persistent wage gaps and biases in hiring or promotion decisions.

Biases that disadvantage women are observable even within the clinical components of medical training, resulting in different experiences for men and women during medical school and residency training. For instance, having autonomy during surgical residency is important for developing skills and preparing for a successful future career. In a clever study of thoracic surgery training, Shari Meyerson and colleagues observed differences in the autonomy given to male and female residents. The researchers sent both residents and faculty surgeons mobile alerts immediately after the completion of a surgery, asking both to independently report the degree of autonomy provided to the resident in the case. Both the faculty and the resident ratings agreed that female surgical residents were given significantly less autonomy in the OR, even after adjusting for a variety of factors related to the case, the faculty surgeon, and the resident's level of experience.

The obvious conclusion is that these barriers restricting the access and development of women's careers in medicine need to be removed, as many have already called for. The field is routinely under-promoting, under-supporting, under-rewarding, and under-training female physicians. And yet, despite these implicit and systematic barriers, female physicians continue to persist and achieve better outcomes than their male colleagues.

A second implication is that male physicians can learn from their female colleagues. In the study of heart attack patients we described earlier, male physicians who had more exposure to female physician colleagues were better able to treat female patients. This suggests that not only will women benefit from having more female physicians in leadership positions, but men will benefit from the education they receive from these women as well.

Allowing things to continue as they have for women in medicine is accepting a system where potentially higher-quality care is denied to patients due to sexism and bad practices. In fact, the difference in patient mortality observed in studies of male and female physicians is approximately the same magnitude as the improvement in mortality that can be attributed to the last decade of scientific improvement in patient care. This means that excluding female physicians in the health care system sets our society back not only in gender equality but also in terms of the progress we should be making in medical care.

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How Discrimination Against Female Doctors Hurts Patients

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Executive Summary Systematic discrimination against women in medicine constitutes a potential threat to patient safety and public health. Accumulating evidence shows that women deliver superior care. For example, one study of over 1.5 million Medicare patients found that those who were treated by a female physician were less likely to die or be readmitted to the hospital within 30 days than those patients treated by a male physician.

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Unequal Access to Education caused by system of funding for schools

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Unequal Opportunity: Race and Education | Brookings

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Brookings Review article by Linda Darling-Hammond (Spring 1998)

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Simone Landrum getting a prenatal massage. Credit... LaToya Ruby Frazier for The New York Times

Feature

The answer to the disparity in death rates has everything to do with the lived experience of being a black woman in America.

Simone Landrum getting a prenatal massage. Credit... LaToya Ruby Frazier for The New York Times

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W hen Simone Landrum felt tired and both nauseated and ravenous at the same time in the spring of 2016, she recognized the signs of pregnancy. Her beloved grandmother died earlier that year, and Landrum felt a sense of divine order when her doctor confirmed on Muma's birthday that she was carrying a girl. She decided she would name her daughter Harmony. "I pictured myself teaching my daughter to sing," says Landrum, now 23, who lives in New Orleans. "It was something I thought we could do together."

But Landrum, who was the mother of two young sons, noticed something different about this pregnancy as it progressed. The trouble began with constant headaches and sensitivity to light; Landrum described the pain as "shocking." It would have been reasonable to guess that the crippling headaches had something to do with stress: Her relationship with her boyfriend, the baby's father, had become increasingly contentious and eventually physically violent. Three months into her pregnancy, he became angry at her for wanting to hang out with friends and threw her to the ground outside their apartment. She scrambled to her feet, ran inside and called the police. He continued to pursue her, so she grabbed a knife. "Back up - I have a baby," she screamed. After the police arrived, he was arrested and charged with multiple offenses, including battery. He was released on bond pending a trial that would not be held until the next year. Though she had broken up with him several times, Landrum took him back, out of love and also out of fear that she couldn't support herself, her sons and the child she was carrying on the paycheck from her waitress gig at a restaurant in the French Quarter.

As her January due date grew closer, Landrum noticed that her hands, her feet and even her face were swollen, and she had to quit her job because she felt so ill. But her doctor, whom several friends had recommended and who accepted Medicaid, brushed aside her complaints. He recommended Tylenol for the headaches. "I am not a person who likes to take medicine, but I was always popping Tylenol," Landrum says. "When I told him my head still hurt, he said to take more."

High blood pressure and cardiovascular disease are two of the leading causes of maternal death, according to the Centers for Disease Control and Prevention, and hypertensive disorders in pregnancy, including pre-eclampsia, have been on the rise over the past two decades, increasing 72 percent from 1993 to 2014. A Department of Health and Human Services report last year found that pre-eclampsia and eclampsia (seizures that develop after pre-eclampsia) are 60 percent more common in African-American women and also more severe. Landrum's medical records note that she received printed educational material about pre-eclampsia during a prenatal visit. But Landrum would comprehend the details about the disorder only months later, doing online research on her own.

When Landrum complained about how she was feeling more forcefully at the appointment, she recalls, her doctor told her to lie down - and calm down. She says that he also warned her that he was planning to go out of town and told her that he could deliver the baby by C-section that day if she wished, six weeks before her early-January due date. Landrum says it seemed like an ultimatum, centered on his schedule and convenience. So she took a deep breath and lay on her back for 40 minutes until her blood pressure dropped within normal range. Aside from the handwritten note, Landrum's medical records don't mention the hypertensive episode, the headaches or the swelling, and she says that was the last time the doctor or anyone from his office spoke to her. "It was like he threw me away," Landrum says angrily.

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In 1850, when the death of a baby was simply a fact of life, and babies died so often that parents avoided naming their children before their first birthdays, the United States began keeping records of infant mortality by race. That year, the reported black infant-mortality rate was 340 per 1,000; the white rate was 217 per 1,000. This black-white divide in infant mortality has been a source of both concern and debate for over a century. In his 1899 book, "The Philadelphia Negro," the first sociological case study of black Americans, W.E.B. Du Bois pointed to the tragedy of black infant death and persistent racial disparities. He also shared his own "sorrow song," the death of his baby son, Burghardt, in his 1903 masterwork, "The Souls of Black Folk."

From 1915 through the 1990s, amid vast improvements in hygiene, nutrition, living conditions and health care, the number of babies of all races who died in the first year of life dropped by over 90 percent - a decrease unparalleled by reductions in other causes of death. But that national decline in infant mortality has since slowed. In 1960, the United States was ranked 12th among developed countries in infant mortality. Since then, with its rate largely driven by the deaths of black babies, the United States has fallen behind and now ranks 32nd out of the 35 wealthiest nations. Low birth weight is a key factor in infant death, and a new report released in March by the Robert Wood Johnson Foundation and the University of Wisconsin suggests that the number of low-birth-weight babies born in the United States - also driven by the data for black babies - has inched up for the first time in a decade.

Black infants in America are now more than twice as likely to die as white infants - 11.3 per 1,000 black babies, compared with 4.9 per 1,000 white babies, according to the most recent government data - a racial disparity that is actually wider than in 1850, 15 years before the end of slavery, when most black women were considered chattel. In one year, that racial gap adds up to more than 4,000 lost black babies. Education and income offer little protection. In fact, a black woman with an advanced degree is more likely to lose her baby than a white woman with less than an eighth-grade education.

This tragedy of black infant mortality is intimately intertwined with another tragedy: a crisis of death and near death in black mothers themselves. The United States is one of only 13 countries in the world where the rate of maternal mortality - the death of a woman related to pregnancy or childbirth up to a year after the end of pregnancy - is now worse than it was 25 years ago. Each year, an estimated 700 to 900 maternal deaths occur in the United States. In addition, the C.D.C. reports more than 50,000 potentially preventable near-deaths, like Landrum's, per year - a number that rose nearly 200 percent from 1993 to 2014, the last year for which statistics are available. Black women are three to four times as likely to die from pregnancy-related causes as their white counterparts, according to the C.D.C. - a disproportionate rate that is higher than that of Mexico, where nearly half the population lives in poverty - and as with infants, the high numbers for black women drive the national numbers.

Monica Simpson is the executive director of SisterSong, the country's largest organization dedicated to reproductive justice for women of color, and a member of the Black Mamas Matter Alliance, an advocacy group. In 2014, she testified in Geneva before the United Nations Committee on the Elimination of Racial Discrimination, saying that the United States, by failing to address the crisis in black maternal mortality, was violating an international human rights treaty. After her testimony, the committee called on the United States to "eliminate racial disparities in the field of sexual and reproductive health and standardize the data-collection system on maternal and infant deaths in all states to effectively identify and address the causes of disparities in maternal- and infant-mortality rates." No such measures have been forthcoming. Only about half the states and a few cities maintain maternal-mortality review boards to analyze individual cases of pregnancy-related deaths. There has not been an official federal count of deaths related to pregnancy in more than 10 years. An effort to standardize the national count has been financed in part by contributions from Merck for Mothers, a program of the pharmaceutical company, to the CDC Foundation.

The crisis of maternal death and near-death also persists for black women across class lines. This year, the tennis star Serena Williams shared in Vogue the story of the birth of her first child and in further detail in a Facebook post. The day after delivering her daughter, Alexis Olympia, via C-section in September, Williams experienced a pulmonary embolism, the sudden blockage of an artery in the lung by a blood clot. Though she had a history of this disorder and was gasping for breath, she says medical personnel initially ignored her concerns. Though Williams should have been able to count on the most attentive health care in the world, her medical team seems to have been unprepared to monitor her for complications after her cesarean, including blood clots, one of the most common side effects of C-sections. Even after she received treatment, her problems continued; coughing, triggered by the embolism, caused her C-section wound to rupture. When she returned to surgery, physicians discovered a large hematoma, or collection of blood, in her abdomen, which required more surgery. Williams, 36, spent the first six weeks of her baby's life bedridden.

The reasons for the black-white divide in both infant and maternal mortality have been debated by researchers and doctors for more than two decades. But recently there has been growing acceptance of what has largely been, for the medical establishment, a shocking idea: For black women in America, an inescapable atmosphere of societal and systemic racism can create a kind of toxic physiological stress, resulting in conditions - including hypertension and pre-eclampsia - that lead directly to higher rates of infant and maternal death. And that societal racism is further expressed in a pervasive, longstanding racial bias in health care - including the dismissal of legitimate concerns and symptoms - that can help explain poor birth outcomes even in the case of black women with the most advantages.

"Actual institutional and structural racism has a big bearing on our patients' lives, and it's our responsibility to talk about that more than just saying that it's a problem," says Dr. Sanithia L. Williams, an African-American OB-GYN in the Bay Area and a fellow with the nonprofit organization Physicians for Reproductive Health. "That has been the missing piece, I think, for a long time in medicine."

After Harmony's death, Landrum's life grew more chaotic. Her boyfriend blamed her for what happened to their baby and grew more abusive. Around Christmas 2016, in a rage, he attacked her, choking her so hard that she urinated on herself. "He said to me, 'Do you want to die in front of your kids?' " Landrum said, her hands shaking with the memory.

Then he tore off her clothes and sexually assaulted her. She called the police, who arrested him and charged him with second-degree rape. Landrum got a restraining order, but the district attorney eventually declined to prosecute. She also sought the assistance of the New Orleans Family Justice Center, an organization that provides advocacy and support for survivors of domestic violence and sexual assault. Counselors secreted her and her sons to a safe house, before moving them to a more permanent home early last year.

Landrum had a brief relationship with another man and found out in March 2017 that she was pregnant again and due in December. "I'm not going to lie; though I had a lot going on, I wanted to give my boys back the sister they had lost, " Landrum said, looking down at her lap. "They don't forget. Every night they always say their prayers, like: 'Goodnight, Harmony. Goodnight, God. We love you, sister.' " She paused and took a breath. "But I was also afraid, because of what happened to me before."

Early last fall, Landrum's case manager at the Family Justice Center, Mary Ann Bartkowicz, attended a workshop conducted by Latona Giwa, the 31-year-old co-founder of the Birthmark Doula Collective. The group's 12 racially diverse birth doulas, ages 26 to 46, work as professional companions during pregnancy and childbirth and for six weeks after the baby is born, serving about 400 clients across New Orleans each year, from wealthy women who live in the upscale Garden District to women from the Katrina-ravaged Lower Ninth Ward and other communities of color who are referred through clinics, school counselors and social-service organizations. Birthmark offers pro bono services to these women in need.

Giwa, the daughter of a white mother and a Nigerian immigrant father, took her first doula training while she was still a student at Grinnell College in Iowa. She moved to New Orleans for a fellowship in community organizing before getting a degree in nursing. After working as a labor and delivery nurse and then as a visiting nurse for Medicaid clients in St. Bernard Parish, an area of southeast New Orleans where every structure was damaged by Katrina floodwaters, she devoted herself to doula work and childbirth education. She founded Birthmark in 2011 with Dana Keren, another doula who was motivated to provide services for women in New Orleans who most needed support during pregnancy but couldn't afford it.

"Being a labor and delivery nurse in the United States means seeing patients come in acute medical need, because we haven't been practicing preventive and supportive care all along," Giwa says. Louisiana ranks 44th out of all 50 states in maternal mortality; black mothers in the state die at 3.5 times the rate of white mothers. Among the 1,500 clients the Birthmark doulas have served since the collective's founding seven years ago, 10 infant deaths have occurred, including late-term miscarriage and stillbirth, which is lower than the overall rate for both Louisiana and the United States, as well as the rates for black infants. No mothers have died.

A scientific examination of 26 studies of nearly 16,000 subjects first conducted in 2003 and updated last year by Cochrane, a nonprofit network of independent researchers, found that pregnant women who received the continuous support that doulas provide were 39 percent less likely to have C-sections. In general, women with continuous support tended to have babies who were healthier at birth. Though empirical research has not yet linked doula support with decreased maternal and infant mortality, there are promising anecdotal reports. Last year, the American College of Obstetricians and Gynecologists released a statement noting that "evidence suggests that, in addition to regular nursing care, continuous one-to-one emotional support provided by support personnel, such as a doula, is associated with improved outcomes for women in labor."

In early November, the air was thick with humidity as Giwa pulled up to Landrum's house, half of a wood-frame duplex, for their second meeting. Landrum opened the door, happy to see the smiling, fresh-faced Giwa, who at first glance looked younger than her 23-year-old client. Giwa would continue to meet with Landrum weekly until her Dec. 22 due date, would be with her during labor and delivery and would make six postpartum home visits to assure that both mother and baby son remained healthy. Landrum led Giwa through her living room, which was empty except for a tangle of disconnected cable cords. She had left most of her belongings behind - including her dog and the children's new Christmas toys - when she fled from her abusive boyfriend, and she still couldn't afford to replace all her furniture.

They sat at the kitchen table, where Giwa asked about Landrum's last doctor visit, prodding her for details. Landrum reassured her that her blood pressure and weight, as well as the baby's size and position, were all on target.

"What if. ..." Landrum began tentatively.

"I'm keeping a backup doula informed of everything," Giwa said. "Just in case."

"I think everything's going to be O.K. this time," Landrum said. But it sounded like a question.

When the black-white disparity in infant mortality first became the subject of study, discussion and media attention more than two decades ago, the high rate of infant death for black women was widely believed by almost everyone, including doctors and public-health experts, to affect only poor, less-educated women - who do experience the highest numbers of infant deaths. This led inevitably to blaming the mother. Was she eating badly, smoking, drinking, using drugs, overweight, not taking prenatal vitamins or getting enough rest, afraid to be proactive during prenatal visits, skipping them altogether, too young, unmarried?

At Essence magazine, where I was the health editor from the late '80s to the mid-'90s, we covered the issue of infant mortality by encouraging our largely middle-class black female readers to avoid unwanted pregnancy and by reminding them to pay attention to their health habits during pregnancy and make sure newborns slept on their backs. Because the future of the race depended on it, we also promoted a kind of each-one-teach-one mentality: Encourage teenagers in your orbit to just say no to sex and educate all the "sisters" in your life (read: your less-educated and less-privileged friends and family) about the importance of prenatal care and healthful habits during pregnancy.

In 1992, I was a journalism fellow at the Harvard T.H. Chan School of Public Health. One day a professor of health policy, Dr. Robert Blendon, who knew I was the health editor of Essence, said, "I thought you'd be interested in this." He handed me the latest issue of The New England Journal of Medicine, which contained what is now considered the watershed study on race, class and infant mortality. The study, conducted by four researchers at the C.D.C. - Kenneth Schoendorf, Carol Hogue, Joel Kleinman and Diane Rowley - mined a database of close to a million previously unavailable linked birth and death certificates and found that infants born to college-educated black parents were twice as likely to die as infants born to similarly educated white parents. In 72 percent of the cases, low birth weight was to blame. I was so surprised and skeptical that I peppered him with the kinds of questions about medical research that he encouraged us to ask in his course. Mainly I wanted to know why. "No one knows," he told me, "but this might have something to do with stress."

Though I wouldn't learn of her work until years later, Dr. Arline Geronimus, a professor in the department of health behavior and health education at the University of Michigan School of Public Health, first linked stress and black infant mortality with her theory of "weathering." She believed that a kind of toxic stress triggered the premature deterioration of the bodies of African-American women as a consequence of repeated exposure to a climate of discrimination and insults. The weathering of the mother's body, she theorized, could lead to poor pregnancy outcomes, including the death of her infant.

After graduating from the Harvard School of Public Health, Geronimus landed at Michigan in 1987, where she continued her research. That year, in a report published in the journal Population and Development Review, she noted that black women in their mid-20s had higher rates of infant death than teenage girls did - presumably because they were older and stress had more time to affect their bodies. For white mothers, the opposite proved true: Teenagers had the highest risk of infant mortality, and women in their mid-20s the lowest.

Geronimus's work contradicted the widely accepted belief that black teenage girls (assumed to be careless, poor and uneducated) were to blame for the high rate of black infant mortality. The backlash was swift. Politicians, media commentators and even other scientists accused her of promoting teenage pregnancy. She was attacked by colleagues and even received anonymous death threats at her office in Ann Arbor and at home. "At that time, which is now 25 or so years ago, there were more calls to complain about me to the University of Michigan, to say I should be fired, than had happened to anybody in the history of the university," recalls Geronimus, who went on to publish in 1992 what is now considered her seminal study on weathering and black women and infants in the journal Ethnicity and Disease.

By the late 1990s, other researchers were trying to chip away at the mystery of the black-white gap in infant mortality. Poverty on its own had been disproved to explain infant mortality, and a study of more than 1,000 women in New York and Chicago, published in The American Journal of Public Health in 1997, found that black women were less likely to drink and smoke during pregnancy, and that even when they had access to prenatal care, their babies were often born small.

Experts wondered if the high rates of infant death in black women, understood to be related to small, preterm babies, had a genetic component. Were black women passing along a defect that was affecting their offspring? But science has refuted that theory too: A 1997 study published by two Chicago neonatologists, Richard David and James Collins, in The New England Journal of Medicine found that babies born to new immigrants from impoverished West African nations weighed more than their black American-born counterparts and were similar in size to white babies. In other words, they were more likely to be born full term, which lowers the risk of death. In 2002, the same researchers made a further discovery: The daughters of African and Caribbean immigrants who grew up in the United States went on to have babies who were smaller than their mothers had been at birth, while the grandchildren of white European women actually weighed more than their mothers had at birth. It took just one generation for the American black-white disparity to manifest.

When I became pregnant in 1996, this research became suddenly real for me. When my Park Avenue OB-GYN, a female friend I trusted implicitly, discovered that my baby was far smaller than her gestational age would predict, even though I was in excellent health, she put me on bed rest and sent me to a specialist. I was found to have a condition called intrauterine growth restriction (IUGR), generally associated with mothers who have diabetes, high blood pressure, malnutrition or infections including syphilis, none of which applied to me. During an appointment with a perinatologist - covered by my excellent health insurance - I was hounded with questions about my "lifestyle" and whether I drank, smoked or used a vast assortment of illegal drugs. I wondered, Do these people think I'm sucking on a crack pipe the second I leave the office? I eventually learned that in the absence of a medical condition, IUGR is almost exclusively linked with mothers who smoke or abuse drugs and alcohol. As my pregnancy progressed but my baby didn't grow, my doctor decided to induce labor one month before my due date, believing that the baby would be healthier outside my body. My daughter was born at 4 pounds 13 ounces, classified as low birth weight. Though she is now a bright, healthy, athletic college student, I have always wondered: Was this somehow related to the experience of being a black woman in America?

Though it seemed radical 25 years ago, few in the field now dispute that the black-white disparity in the deaths of babies is related not to the genetics of race but to the lived experience of race in this country. In 2007, David and Collins published an even more thorough examination of race and infant mortality in The American Journal of Public Health, again dispelling the notion of some sort of gene that would predispose black women to preterm birth or low birth weight. To make sure the message of the research was crystal clear, David, a professor of pediatrics at the University of Illinois, Chicago, stated his hypothesis in media-friendly but blunt-force terms in interviews: "For black women," he said, "something about growing up in America seems to be bad for your baby's birth weight."

On a December morning three days before her due date, Landrum went to the hospital for her last ultrasound before the birth. Because of the stillbirth the previous year, her doctor did not want to let the pregnancy go past 40 weeks, to avoid the complications that can come with post-term delivery, so an induction had been scheduled in 48 hours.

She hadn't read the chart.

"Yes, I've had three babies, but one died," Landrum explained warily, for the third time since she had arrived at the hospital that day. Her voice was flat. "I had a stillbirth."

She asked Landrum to close her eyes and imagine the color of her stress.

"Red," Landrum snapped, before finally laying her head onto the pillow.

"What color is really soothing and relaxing?" Giwa asked, massaging her hand with lotion.

"Lavender," Landrum replied, taking a deep breath. Over the next 10 minutes, Landrum's blood pressure dropped within normal range as the baby's heart rate stabilized.

At 1 a.m., a team of three young female residents bustled into the room; the labor and delivery nurse followed them, flipping on the overhead light. They were accompanied by an older man Landrum had never seen. He briefly introduced himself as the attending physician before plunging his hand between Landrum's legs to feel for the baby. Landrum had been told that her OB-GYN might not deliver her infant, but a nurse had reassured her earlier in the day that if her doctor was not available, her doctor's husband, also an OB-GYN, would cover for her. This doctor, however, was not the husband, and no one explained the switch. Giwa raised an eyebrow. The Listening to Mothers Survey III, a national sampling of 2,400 women who gave birth in 2011 and 2012, found that more than a quarter of black women meet their birth attendants for the first time during childbirth, compared with 18 percent of white women.

"He's ready," the doctor said, snapping off his gloves. "It's time to push."

One resident stepped forward and took his place, putting her hand into Landrum's vagina, feeling for the baby. Landrum gripped the side of the bed and closed her eyes, grimacing. "You're a rock star," Giwa said. The nurse, standing at her side, told Landrum: "Push! Now. You can do it." After about 20 minutes of pushing, the baby's head appeared. "This is it," the nurse told her. "You can do this," Giwa whispered on her other side.

Landrum bore down and pushed again. "You're doing amazing," Giwa said, not taking her eyes away from Landrum. The attending physician left the room to put on a clean gown. Landrum breathed in, closed her eyes and pushed. More of the infant's head appeared, a slick cluster of black curls. The senior resident motioned to the third and most junior of the women, standing at her shoulder, and told her, "Here's your chance." The young resident took the baby's head and eased the slippery infant out. Landrum was oblivious to the procession of young residents taking turns between her legs or the fact that the attending physician wasn't in the room at all. She was sobbing, shaking, laughing - all at the same time - flooded with the kind of hysterical relief a woman feels when a baby leaves her body and emerges into the world.

The resident lay the infant, purple, wrinkled and still as a stone, on Landrum's bare chest. "Is he all right? Is he O.K.?" Landrum asked, panicking as she looked down at the motionless baby. A second later, his tiny arms and legs tensed, and he opened his mouth and let out a definitive cry.

"He's perfect," Giwa told her, touching her shoulder.

"I did it," Landrum said, looking up at Giwa and laying her hands on the baby's back, still coated with blood and amniotic fluid. She had decided to name him Kingston Blessed Landrum.

"Yes," Giwa said, finally allowing herself a wide smile. "You did."

In 1995, a pregnant African-American doctoral student had a preterm birth after her water broke unexpectedly at 34 weeks. Her baby was on a ventilator for 48 hours and a feeding tube for six days during his 10-day stay in the neonatal intensive-care unit.

The woman was part of a team of female researchers from Boston and Howard Universities working on the Black Women's Health Study, an ongoing examination, funded by the National Institutes of Health, of conditions like preterm birth that affect black women disproportionately. The team had started the study after they noticed that most large, long-term medical investigations of women overwhelmingly comprised white women. The Black Women's Health Study researchers, except for two black women, were also all white.

What happened to the doctoral student altered the course of the study. "We're thinking, Here's a middle-class, well-educated black woman having a preterm birth when no one else in our group had a preterm birth," says Dr. Julie Palmer, associate director of the Slone Epidemiology Center at Boston University and a principal investigator of the continuing study of 59,000 subjects. "That's when I became aware that the race difference in preterm birth has got to be something different, that it really cuts across class. People had already done some studies showing health effects of racism, so we wanted to ask about that as soon as possible."

In 1997, the study investigators added several yes-or-no questions about everyday race-related insults: I receive poorer service than others; people act as if I am not intelligent; people act as if I am dishonest; people act as if they are better than me; people act as if they are afraid of me. They also included a set of questions about more significant discrimination: I have been treated unfairly because of my race at my job, in housing or by the police. The findings showed higher levels of preterm birth among women who reported the greatest experiences of racism.

The bone-deep accumulation of traumatizing life experiences and persistent insults that the study pinpointed is not the sort of "lean in" stress relieved by meditation and "me time." When a person is faced with a threat, the brain responds to the stress by releasing a flood of hormones, which allow the body to adapt and respond to the challenge. When stress is sustained, long-term exposure to stress hormones can lead to wear and tear on the cardiovascular, metabolic and immune systems, making the body vulnerable to illness and even early death.

Though Arline Geronimus's early research had focused on birth outcomes mainly in disadvantaged teenagers and young women, she went on to apply her weathering theory across class lines. In 2006, she and her colleagues used government data, blood tests and questionnaires to measure the effects of stress associated with weathering on the systems of the body. Even when controlling for income and education, African-American women had the highest allostatic load scores - an algorithmic measurement of stress-associated body chemicals and their cumulative effect on the body's systems - higher than white women and black men. Writing in The American Journal of Public Health, Geronimus and her colleagues concluded that "persistent racial differences in health may be influenced by the stress of living in a race-conscious society. These effects may be felt particularly by black women because of [the] double jeopardy of gender and racial discrimination."

People of color, particularly black people, are treated differently the moment they enter the health care system. In 2002, the groundbreaking report "Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care," published by a division of the National Academy of Sciences, took an exhaustive plunge into 100 previous studies, careful to decouple class from race, by comparing subjects with similar income and insurance coverage. The researchers found that people of color were less likely to be given appropriate medications for heart disease, or to undergo coronary bypass surgery, and received kidney dialysis and transplants less frequently than white people, which resulted in higher death rates. Black people were 3.6 times as likely as white people to have their legs and feet amputated as a result of diabetes, even when all other factors were equal. One study analyzed in the report found that cesarean sections were 40 percent more likely among black women compared with white women. "Some of us on the committee were surprised and shocked at the extent of the evidence," noted the chairman of the panel of physicians and scientists who compiled the research.

In 2016, a study by researchers at the University of Virginia examined why African-American patients receive inadequate treatment for pain not only compared with white patients but also relative to World Health Organization guidelines. The study found that white medical students and residents often believed incorrect and sometimes "fantastical" biological fallacies about racial differences in patients. For example, many thought, falsely, that blacks have less-sensitive nerve endings than whites, that black people's blood coagulates more quickly and that black skin is thicker than white. For these assumptions, researchers blamed not individual prejudice but deeply ingrained unconscious stereotypes about people of color, as well as physicians' difficulty in empathizing with patients whose experiences differ from their own. In specific research regarding childbirth, the Listening to Mothers Survey III found that one in five black and Hispanic women reported poor treatment from hospital staff because of race, ethnicity, cultural background or language, compared with 8 percent of white mothers.

Researchers have worked to connect the dots between racial bias and unequal treatment in the health care system and maternal and infant mortality. Carol Hogue, an epidemiologist and the Jules & Uldeen Terry Chair in Maternal and Child Health at the Rollins School of Public Health at Emory University and one of the original authors of the 1992 New England Journal of Medicine study on infant mortality that opened my own eyes, was a co-author of a 2009 epidemiological review of research about the association between racial disparities in preterm birth and interpersonal and institutional racism. Her study, published by the Johns Hopkins School of Public Health, contains an extraordinary list of 174 citations from previous work. "You can't convince people of something like discrimination unless you really have evidence behind it," Hogue says. "You can't just say this - you have to prove it."

Lynn Freedman, director of the Averting Maternal Death and Disability Program at Columbia University's Mailman School of Public Health, decided to take the lessons she and her colleagues learned while studying disrespect and abuse in maternal care in Tanzania - where problems in pregnancy and childbirth lead to nearly 20 percent of all deaths in women ages 15 to 49 - and apply them to New York City and Atlanta. Though the study is still in its preliminary phase, early focus groups of some 50 women who recently delivered babies in Washington Heights and Inwood, as well as with doulas who work in both those areas and in central Brooklyn, revealed a range of grievances - from having to wait one to two months before an initial prenatal appointment to being ignored, scolded and demeaned, even feeling bullied or pushed into having C-sections. "Disrespect and abuse means more than just somebody wasn't nice to another individual person," Freedman says. "There is something structural and much deeper going on in the health system that then expresses itself in poor outcomes and sometimes deaths."

Two days after the birth of Landrum's baby, she had moved out of labor and delivery and into a hospital room, with the butterfly-decorated, crayon-drawn affirmations taped above her bed. She'd had a few hours of sleep and felt rested and cheerful in a peach-colored jumpsuit she brought from home, with baby Kingston, who had weighed in at a healthy 6 pounds 13 ounces, napping in a plastic crib next to her bed. But over the next hours, Landrum's mood worsened. When Giwa walked into her room after leaving for a few hours to change and nap, Landrum once again angrily recounted the mishap with the epidural and complained about the nurses and even the hospital food. Finally, Giwa put her hand on Landrum's arm and asked, "Simone, where are the boys?"

"I understand," Giwa said, stroking her shoulder. "You need the boys to see their brother, to know that he is alive, that this is all real." Landrum nodded. She made several phone calls from her hospital bed but could find no one to get the boys, so I left to drive across town and pick them up. It took Giwa's attentive eyes, and the months of building trust and a relationship with Landrum, to recognize a problem that couldn't be addressed medically but one that could have emotional and physical consequences.

The doula consumer market has been largely driven by and tailored for white women, but the kind of support Giwa was providing to Landrum was actually originated by black women, the granny midwives of the South. Inspired by that historic legacy and by increasingly visible reproductive-justice activism, dozens of doula groups like Birthmark in New Orleans have emerged or expanded in the past several years in Brooklyn, Los Angeles, Atlanta, Dallas, Memphis, Miami, Washington and many other cities, providing services to women of color, often free or on a sliding scale.

The By My Side Birth Support Program in New York City, administered by the city's Department of Health, offers free doula services during pregnancy, labor and delivery and postpartum for mothers in central and eastern Brooklyn's predominantly black and brown neighborhoods where maternal and infant mortality are highest. A team of 12 doulas has served more than 800 families since 2010, and an analysis of the program showed that from 2010 to 2015, mothers receiving doula support had half as many preterm births and low-birth-weight babies as other women in the same community.

Interventions that have worked to bring down maternal- and infant-mortality rates in other parts of the world have been brought back to the United States. Rachel Zaslow, a midwife and doula based in Charlottesville, Va., runs a program in northern Uganda, where a woman has a one-in-25 lifetime chance of dying in childbirth, through her nonprofit organization, Mother Health International. In Zaslow's program, community health workers - individuals selected by the community and given medical training - link local pregnant women to trained midwives and nurse-midwives. Since 2008, a mother has never died in Zaslow's program, and the infant-mortality rate is 11 per 1,000, compared with 64 per 1,000 for the country at large.

Three years ago, when she became aware of high rates of infant and maternal mortality in pockets of Virginia, Zaslow decided to take her Ugandan model there: a collective of 45 black and Latina doulas in Charlottesville, called Sisters Keeper, that offers birthing services free to women of color. "The doula model is very similar to the community health worker model that's being used a lot, and successfully, throughout the global South," Zaslow says. "For me, when it comes to maternal health, the answer is almost always some form of community health worker." Since 2015, the Sisters Keeper doulas have attended about 300 births - with no maternal deaths and only one infant death among them.

"It is really hard for American health care professionals to get their heads around that when you have an organized community-based team that connects technical clinical issues with a deep, embedded set of relationships, you can make real breakthroughs," says Dr. Prabhjot Singh, the director of the Arnhold Institute for Global Health at the Icahn School of Medicine at Mount Sinai, who studies community health worker models and how they can be used in the United States. "In the U.S., doulas can't do it by themselves, but based on work that's taken place globally, they can help reduce infant and maternal deaths using what is essentially a very simple solution."

An hour and a half after Giwa noticed that Landrum needed to have her sons with her, Caden and Dillon burst through the door of the hospital room. Holding Kingston in her lap, Landrum lit up at the sight of the boys. Caden, who is 4, ran to his new brother, gleefully grabbing at the infant. "Calm down," Landrum said, smiling and patting the side of the bed. "Put out your arms, strong, like this," she told him, arranging his small arms with her free hand. Gently, she lay Kingston in his brother's outstretched arms. "It's my baby," he said excitedly, leaning down to kiss the infant all over his cheeks and forehead. "I luh you, brother."

Dillon, 7, was more cautious. He stood near the door, watchful. "Don't you want to meet your brother, Dillon?" Landrum asked. He inched closer, looking at the floor. "Come on, boy, don't be shy. This is Kingston." He sat on the other side of his mother, and she took the baby from Caden and placed him in Dillon's arms. He looked down at the newborn, nervous and still hesitant. "It's a real baby," he said, looking up at his mother and finally smiling. "Mommy, you did it."

"At that moment, I felt complete," Landrum said later, tearing up, "seeing them all together."

On a cool, sunny afternoon in March, Landrum led me into her living room, which now held a used couch - a gift from a congregant of her church, where she is an active member. A white plastic Christmas tree strewn with multicolored Mardi Gras beads, left up after the holidays, added a festive touch. Landrum handed me Kingston, now 3 months old, dressed in a clean onesie with a little blue giraffe on the front. Plump and rosy, with cheeks chunky from breast milk and meaty, dimpled thighs, he smiled when I sang him a snippet of a Stevie Wonder song.

Landrum had lost the baby weight and looked strong and healthy in an oversize T-shirt and leggings, wearing her hair in pink braids that hung down her back. There was a lightness to her that wasn't apparent during her pregnancy. One word tumbling over the next, she told me that the new baby had motivated her to put her life in order. She had been doing hair and makeup for church members and friends out of her house to earn money to buy a car. She had applied to Delgado Community College to study to be an ultrasound technician. "I love babies," she said. "When I look at ultrasound pictures, I imagine I see the babies smiling at me."

Latona Giwa had continued to care for Landrum for two months after Kingston's birth. The C.D.C. measures American maternal mortality not just by deaths that occur in pregnancy or childbirth, or in the immediate days afterward, but rather all deaths during pregnancy and the year after the end of pregnancy - suggesting the need for continued care and monitoring, especially for women who are most at risk of complications.

It was Giwa who drove Landrum and the baby home from the hospital, moving her own 2-year-old daughter's car seat from the back of her Honda and replacing it with a backward-facing infant seat, when Landrum had no other ride. It was Giwa who ushered the new mother into her home and then surprised her by taking a bag of groceries and a tray of homemade lasagna, still warm, from the back of the car. And it was Giwa who asked her, six weeks after childbirth, if she had talked to her doctor about getting a contraceptive implant to avoid pregnancy. When Landrum told her that her doctor had never called her about a checkup, Giwa was livid. "High-risk patients with complicated maternal histories often have an appointment two weeks after they've been discharged," she said later, after insisting that Landrum call to make an appointment. "Her life is hectic; she's at home with three children. Luckily she's fine, but at minimum someone should've called to check on her."

For Giwa's work with Landrum, from October to February, she earned just $600. Like the other Birthmark doulas, Giwa can't make ends meet just doing doula work; she is employed as a lactation consultant for new mothers both privately and at a "latch clinic" in a New Orleans office of the federal Women, Infants and Children Food and Nutrition Service that supports low-income pregnant and postpartum women.

"We need to recognize that there is actual medical benefit to having doula support - and make the argument that insurance should pay for it," says Williams, the Bay Area OB-GYN. "It is a job. People do have to be paid for that work." Insurance would mean some standardization; Williams notes that many programs securing public funding or grants to provide doula support to lower-income women can't match the kind of money that private doulas can command. These programs often have "all black women who are doulas," she says. "Yes, it's fantastic that these women are training to be doulas and supporting other black women - but they're not making as much as these other doulas." If, she asks, "doula support is important and can have this beneficial outcome for women, especially black women, how can we actually move forward to make that more accessible to everybody?"

In her home on that March afternoon, Landrum put Kingston into a baby carrier. He fell asleep as we walked five blocks to meet Dillon and Caden, who were due home from school at two different bus stops. The boys jumped off their buses, dressed in identical red polo shirts, their hair freshly cut, each dragging a large backpack, and ran to their mother. Dillon could hardly wait to pull out his report card and show his mother his grades; he had received four out of six "exceptional" marks. "He's smart," Landrum said, and he gave her a huge, gaptoothed smile.

Then he raced ahead, his backpack lurching as he leapt over bumps in the sidewalk full of pent-up little-boy energy; Caden was right behind him, doing his best to keep up with his brother's longer strides. "Hey, y'all, you be careful!" Landrum called, keeping her eyes trained on them. "You hear me?!"

Kingston stirred when he heard his mother's voice. He lifted his head briefly and looked into Landrum's face. Their eyes met, his still slightly crossed with new-baby nearsightedness. Landrum paused long enough to stroke his head and kiss his damp cheek. The baby sighed. Then he burrowed his head back into the warmth and safety of his mother's chest.

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Why America's Black Mothers and Babies Are in a Life-or-Death Crisis (Published 2018)

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Feature The answer to the disparity in death rates has everything to do with the lived experience of being a black woman in America. Simone Landrum getting a prenatal massage. Credit... LaToya Ruby Frazier for The New York Times Send any friend a story As a subscriber, you have 10 gift articles to give each month.