As with so many things in life, there are no single or simple answers. A number of factors conspire to contribute to these problems. As with any culture, Afro-American culture makes a powerful contribution to these problems. In some ways despite the civil rights movement and progressive attitudes of some segements of the current and next generation of white Americans, we continue to struggle with the legacy of slavery. This is reflected in a sense of powerless, diet, distrust of whites and the system, poor living standards, poor health care (substantiated by research even when factors of socio-economic status is controlled), poor schools and education, etc. Nevertheless, we are to a very large extent responsible for ourselves. There are actions we can take, hostile white society notwithstanding, to address some of these problems, at least to a significant degree. We are NOT victims. We have accomplished much with very little. Unfortunately for Dr. Poussaint, we also have a history of turning on our brothers and sisters who confront us to give up attitudes of victimhood. I strongly support Dr. Poussaint's efforts and hope he knows the silent majority of our communities stand with him.

OK, I'm not black... but I agree with Cosby.

I'm from a community that was considered almost as hopeless, mired in prejudice and identified not by color, but by accent the first time we opened our mouths... Irish-Americans. Stereotypes of ignorant drunks persist even now, and it wasn't so long ago that NINA (no Irish need apply) was printed on job applications. We were considered by most Americans to be the hopeless whites, worthy only of our big city slums and the most menial jobs.

That doesn't give me equal experience, but it does offer a glimpse that suggests that Messrs. Cosby and Poussaint are spot on. What I read in Dr. King's "I have a dream" speach would seem to agree.

It would seem to me that parts of the black community are being sold a bill of goods by the folks who insist they are less than equals. Teaching someone that you can only be a success if you're a gangsta or a sports star belittles the ones who are unwilling to settle for such and strips many of the ambitious ones of any hope. Telling someone that she is really only a valid person if she has sex early and often (and insisting that if she does and becomes pregnant that she can only be responsible if she kills her child) doesn't promote self-esteem or a wider cultural identity, it dehumanises the woman and the community (why are there so many more abortions per capita among those in the black community?).

In the Irish-American community, those who "lead" us for a long time were interested in their political empires and played every card to keep us seperate... and "oppressed" while individuals found ways to move beyond. There are still communities in this country that seem to fit the model (even Irish-American ones); helping means people need to reject the nonsense that we are less than real humans.

If we are no more than fancy animals, then there is no hope... regardless of race... for those without power. If, however, we have been "endowed by our Creator" and are something more, then building respect within a community is the real way to rise above the ugly voices that say we are pathetic and useless... it means voices like Cosby's are right and we all need to encourage them to continue to speak out.

Something I would like to know is how much of black culture involves sabotaging someone who is trying to better themselves? We hear of the "bucket of crabs" analogy, but how prevalent is it, really?

As for poor health, some of that is genetic and some of that is the kind of food that is cheap and therefore appealing to the poor. Lots of stuff that is bad for you. Quality food costs.

The key is education. The "teach a man to fish" solution. Dropping out of school should carry a heavy negative social stigma. On the flip side, our goverment must ensure a quality eduation is there for all.

I have a relative who works at a local Planned Parenthood. She informs me that many procedures and types of care at the clinics require that the patient present either their social security card, birth certificate, or passport. Who has these things easily at hand? The economically privileged. Under-resourced communities have less access to Planned Parenthood's services. I believe this to be a good example of the inequality that WE can work to take down.

Thanks for the excellent discussion!
Aaron

Its not just an educational divide. I'm a college graduate with a steady job who cannot afford health care. Out of my 10 or so college graduate comrades 2 of us are provided health care by our employers. I commute by bike everyday to save money, but one accident could ruin my good credit for life.

Dr. Poussaint: Community Choices is a non profit organization in Clark County that publishes a Report Card on the health of the community. In our next Report Card, we would like to publish health indicators that speak to health disparities and actually build awareness of these issues. Do you have advice on how to address this process?

If you haven't seen it, the report card that Multnomah County published earlier this year on health disparities might be a good place to start. If you would like me to send you the pdf, let me know. Keep up the good work!

Are you kidding me with this conspiracy hogwash about why African Americans don't acknowledge mental health. It's not necessarily oppression or repression by other people. These half-baked theories are rampant all over this country. Why does everything have to be someone else's fault? Can't things just be a confluence of circumstance? Most minorities in general don't embrace mental health. Perhaps they just have other things to worry about. African American culture seems to be quite macho so perhaps it relates to that. African Americans also are statistically very anti-gay. Is that someone else's fault too? What is the acceptance and dialogue of mental health diseases like in Africa? African Americans are also statistically quite religious---and aren't religious people in general slow to acknowledge mental illness? So how does your guest know religion is not the culprit?

I really enjoyed the program today. Health, health care and access to both are very complex issues related to so many other complex issues as was discussed today.

One concern I have is that we are looking for that "magic bullet" in terms of a solution and loose sight of the fact that the answers to complex problems require comprehensive and collaborative solutions.

We need free clinics and volunteers and sliding fee scale clinics to take care of people right NOW. We also need policy change, activism and social change to make a difference over the long haul to affect broader issues. We must be careful in our excitement about any one solution to not somehow disparage another important element of the solution.

I would like to remove the words "or" and "but" from our vocabulary around health disparities and use the word AND much more frequently.

There is so much good that is going on already in our communities - AND we can to more and better. There is a need for policy makers to pay attention to systemic issues AND to making sure people get the care they need today.

www.projectaccessnow.org has information about a relatively new collaborative effort in the Portland Metro Area designed to increase access to health care for the low income uninsured through supporting already existing safetynet clinics and involving community volunteer physicians and other health care providers.

I had the experience of having a daughter with a seizure disorder and I knew it. I was on OHP at the time my primary care physician wouldn't listen, I spent a year taking her to the ER once in not twice a month, it took seeing the same ER doctor at Emanuel Hospital for us to get a referral to see a pediatric neurologist. A couple years later we were able to get better health care coverage via my husband's work. We signed on with Kaiser, my daughter had another seizure and we were given a referral instantly to see their pediatric neurologist. The catch is I am now back on OHP but still with Kaiser and I am finding that I'm getting treated as a second class citizen again. I still see the same doctors as I did before but they don't listen and it's much harder to meet my family's health care needs.
I've watch two of my mothers friends die of cancer all because their doctors waited until it was to late to do anything about it. One was misdiagnosed for over a year before the cancer was found and by then it was to late. I see there is something very wrong with health care in this country. I feel like we are on our own.
There really needs to be a major overhaul of the health care system not just so health care is accessible but so people are treated with dignity and respect. Thoughs attitudes I'm afraid are going to have to come from the doctors and nurses them selves and how they view there patients. Part of there attitude towards their patients are do to the insurance companies and their need to make money and not really keep everyone in this country healthy.

A very important but not even mentioned way that an individual can assume some control over not only physical health, but overall health; mental environmental social,... is human lactation- breastfeeding. Define breastfeeding as continuous for 6-24 months.
Breast feeding effects on babies/ toddlers include:
*Prevention of illness including ear infections, upper/lower repiratory ailments, allergies, intestinal disorders, colds, virus', staph, strep, e coli, diabetes, juvenile rheumatoid arthritus, childhood cancers,meningitus, pneumonia, urinary tract infections, salmonella, SIDS, crohn's disease ulcerative colitus, some lymphomas, insulin diabetes, breast/ ovarian cancers.
There are also the pain reliever and emotional, mental benefits for the child.
Breastfeeding effects for mothers include:
* reduced risk of ovarian, uterine, and breast cancers
* Women with typr one diabetes priopr to pregnancy tend to need less insulin while breastfeeding
* there is eveidence that it may result in stronger bones and reduced risk of osteoporosis
* psycholocically, the release of hormones help with feelings of deprssion or blues
Obviously, legislative assistance in form of education and support starting before, during and after pregnancy and laws supporting the feeding of a baby in any place. There is also a cultural aspect in that more acceptance of extended breastfeeding/ delayed solids, and public breastfeeding...
I am afraid that I could go on, but for further reference check out the LeLeche League web site.

Interested in meeting Alvin Poussaint? He's delivering the the 18th annual Saward Lecture tonight at 7:30 pm at the Newmark Theatre in Portland (1111 SW Broadway). Tickets for the lecture are free and available by emailing sawardlecture@kpchr.org or by calling 503-335-2466