Dear Mr. President,
As you are certainly aware, race relations in the United States have deteriorated significantly in recent years. Much of this has to do with highly-publicized shootings of African American citizens or equally highly-publicized deaths of African American suspects in custody or during arrest. While this is certainly a topic of great concern to all Americans, of equal concern to me is the extraordinary disparity in the quality of life between white Americans and black Americans in general. The inner cities of our country have become, in many respects, not livable. While many African Americans are extraordinarily concerned with the situation governing their daily lives, the concerns and problems they face are often not specifically delineated. Neither are solutions forthcoming. In this letter, I hope to specifically delineate these extant problems and provide plausible, easily-implemented solutions for your consideration.
Education in the inner city is of paramount importance in breaking the cycle of poverty. While strides toward making African American students more competitive have been made both during your tenure in the White House and during President Bush’s, there is still roughly a 20% disparity in the high school graduation rates of white students and black students. In the meantime, many inner city communities are seeing their schools closed. Whether this decision is being made for budgetary reasons or demographics, the result is often devastating. This also has profound impact on local economies because all of the personnel at these facilities—teachers, coaches, maintenance personnel, and administrators—become unemployed. In the interim, prisons are being built at an astounding rate to house a growing population of inmates. The obvious paradox here, is that with fewer educational opportunities, more people are likely to end up on the wrong side of the law. Even if a school somewhere distant from a particular community is available, students without easy transportation are less likely to avail themselves of the opportunity for education. This is a form of erecting barriers to education. While building a prison may represent a vastly more lucrative endeavor for a contractor than repairing or rebuilding a school facility, it certainly does nothing for the future of a community. Having high quality education available to students, however, achieves several ends. It allows students to obtain higher paying jobs which, in turn, allows for economic growth in the students’ communities. It allows for a better quality of life for the student and other members of the community when he or she completes their education, especially if they choose to remain and work in that community. It can lead to an influx of professionals in communities sorely lacking in services. Finally, it leads to rising standards of achievement both academically and professionally within the community. Prisons achieve none of these things. It is easy to understand why many young black Americans view this situation and feel that nobody cares about their future. What is the solution? Federal funding for education and various educational programs should be withheld to those cities and states whose school boards choose to close schools and layoff educators while city councils and state governments choose to invest in prisons instead of education. Building prisons while closing schools actually contributes to the growth of the prison population and does nothing for the future.
There is an extraordinary lack of available healthcare facilities in the inner city. Most people in these communities are forced to seek their healthcare at whatever emergency department is available to them. This has several negative effects. First, it overburdens already overburdened emergency departments with patients who really don’t need to be there. Second, it prevents people from having a primary care physician who is familiar with their healthcare needs and past medical history. Third, it contributes to a lack of preventive medicine practices. Fourth, it contributes to a sense of hopelessness and despair. While the Affordable Healthcare Act is designed to increase percentages of insured patients, it does little to increase accessibility to high quality healthcare. Having primary care offices in modern, accessible facilities available to inner city communities would, in the long term, save money in that it would allow for preventive medicine practices to be implemented on a broad scale; it would allow for monitoring of chronic conditions among patients in the community; and it would allow for a more informed patient populace. It is easy to understand why many inner city African Americans, upon seeing the near total absence of doctors’ offices in their community, might think to themselves nobody cares about my health or whether I live or die. What is the solution? Provide low interest loans for medical practice startup to include facility construction and staffing. Allow these practices to operate tax free with reduced income taxes on the physicians and staff there. Provide for the full medicare reimbursement rate plus 10% for all medicare and medicaid patients. The federal government could pay the same rate for patients with no insurance. This would allow for growth of local economies by providing employment both during the construction of facilities and once medical practices are established. It would also save costs in the long run by allowing for early identification and treatment of treatable conditions as well as for the reasons cited above. A program as simple and relatively inexpensive as this would have an enormous positive impact on the health, well-being and liveability of inner city communities.
Many inner city communities fall into a category described by sociologists as a food desert. This is a simple way of describing a phenomenon in which a community has near total lack of access to fresh, high quality food. For many African Americans in the inner city, the only food that is available is either from fast food restaurants or convenience stores, neither of which provides good nutritional value. This might lead people in these communities to come to the conclusion that nobody cares about my community. A very simple solution is provided by co-op groceries. Using a system that entails reducing the profit motive and focusing on paying higher wages, community groceries could easily be established in inner city communities so that the people of these communities would have access to fresh, high-quality food. In a letter I sent to the Johns Hopkins Magazine which they published a number of months back, I make this case. The text of the letter follows:
I read with interest your article entitled Racial Food Deserts. I would suggest that perhaps Racial Nutrition Deserts would be more accurate based on the reported availability of junk food but not nutritious, healthy foods. At any rate, there is an undeniable societal bias against the provision of adequate services to urban poor communities that is an unintentional, unintended consequence of the social hierarchy devised by our market economy. Monied communities have extraordinary goods and services available while poor urban communities do not.
Living in Marietta, Ohio, the point of the article becomes apparent since much of the produce in our local stores is of exceptional quality and grown locally. The average annual income here is $34,000 and, as industrial jobs have grown fewer and fewer, poverty has become more widespread. Despite this, access to excellent food and nutrition is widely available to the poor at a reasonable, affordable price due to the extent of local agriculture.
The question from a public health standpoint is: How can the urban poor obtain similar access to high quality, nutritious foods at a reasonable price? The answer may lie in a later FOREFRONT article entitled, Co-op Capitalism. Worker-owned cooperatives and collectives who place greater value on mission than profit, could succeed in bringing nutritious food to the inner city by pricing items to cover costs and sustain the business model only. With the realization that there is an extraordinary community and public health benefit–an intangible but laudable goal–such an example of co-op capitalism might enlist enough support to eventually be self-sustaining.
Charles L. Levy, M.D.
Encouraging the establishment of a series of co-op businesses in the inner city community—especially for the provision of groceries—would go a long way toward improving life for the urban poor.
When I was in the Marines and an accident occurred, we undertook a process called a “safety stand-down.” This was essentially a process of stopping operations and going through an intensive review of procedures and protocols, not just to find out what happened, but to prevent a similar occurrence from happening in the future. Police are under tremendous pressure these days as they face better-armed criminals and even a routine traffic stop can lead to tragedy for an officer and his or her family. African Americans also seem to be under tremendous pressure and at risk when interacting with police. How can this volatile situation be defused? I would propose a completely voluntary two-day, scenario-driven training iteration on the appropriate use of deadly force for all federal, state, and local police officers, similar to a safety stand-down. Obviously, normal patrolling routines would have to continue, but I’m certain that all police departments could find a way to make two days of training available to their officers. Two additional days of such training could be added to all police academy curricula. In the meantime, extraordinary efforts at community relations could be made by all departments so that the current level of suspicion, distrust, and animosity between police and inner city communities could be reduced. This would make a safer environment for both citizens and police and, almost certainly, reduce violence and bloodshed.
I hope, Mr. President, that some of these suggestions make sense to you and request that you give some consideration to methods of implementation if you deem it reasonable.
Charles L. Levy, M.D.