Sharrelle Barber

Transcript

Diagnosis: Racism

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SHARRELLE BARBER
We see this– what the ways in which, again, racism becomes really embedded into the brick and mortar of our cities.

MAURICE BAYNARD
Welcome to Drexel’s 10,000 Hours podcast. Our goal is to mine the stories behind our region’s innovators, inventors, and thought creators. We’ll be talking to experts in subjects from fashion to neuroscience to find out what lies behind the passion for their work, the inspiration for their ideas, and the motivation for their creativity. I’m your host, Maurice Baynard.
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Sharrelle Barber is an assistant research professor at Drexel University’s Dornsife School of Public Health. Her specialties are epidemiology and biostatistics. Sharrelle’s work focuses on the intersection of place, race, and health and examines how structural racism shapes the health of various populations.

MAURICE
So talk about the place that you grew up and where it was and what kind of community it was.

SHARRELLE
Yeah. So I grew up in eastern North Carolina. And for folks who are familiar with North Carolina, it’s near the coast. But especially the northeast is kind of considered the Black belt. And you have a series of rural towns, rural and midsize towns in that area. And yeah, so it’s a town, small town.

Goldsboro is where my family is. There’s an Air Force base there. But outside of the Air Force base, there’s not much. And so you have this small-town vibe where you can go from my house to my dad’s church and see cotton fields and tobacco and soybeans in the middle. But you do have them all. And you do have other things that make it a little bit more quote unquote urban than some of the other, the outlying towns.

MAURICE
Were there things about growing up in that community that informed either really explicitly or snuck up on you and informed what you ended up doing as a professor?

SHARRELLE
As a professor, yeah. So I’ll say, like I said before, my dad’s a pastor, small church in Goldsboro. But his orientation towards preaching and faith was very public. And so he talks a lot about bringing the Bible into the public square, meaning that we can’t live just within the four walls of a church, that our faith should inform how we treat others, but not just in a charitable way, more so in a justice and a liberation kind of way.

And so the scripture in Micah that says to do justice, love mercy, and walk humbly, that means that the work that we do and even the policies that we pass as a society, they need to be aligned with the things that are going to make more equitable conditions for everyone. He’s definitely someone who looked to folks like Dr. King. And his influence is very heavy in his preaching.

And just again, thinking about the ways in which our faith informs our practice as citizens and as a collective. And so it was rooted in that as growing up. And my family really is an activist family, where we’ve really found various ways– each of us, myself, my siblings– found different ways to live that faith out in a way that is really, again, about justice.

And I saw Bernice King on Twitter. She said, you know, justice is just love and action. It’s that communal love in action. So that– I mean, when I think about what my father’s preaching and my mom being a nurse and supporting that work and all that, it really was this idea of, how do I, as a human being, given my Christian faith, but even just as a human being, how do I live my life in such a way that has a lens towards the least of these, a lens towards those who’ve been oppressed? And Black folks in particular have been in it for so long.
So again, so take that. And then position that in the context of eastern North Carolina. Again, highest proportion of Blacks, highest rates of poverty, towns that lack industry, et cetera, and the policies that have created that. And that really informed how I thought about health, really health in context, because you can’t think about health without thinking about the broader context. And so, yeah.

MAURICE
So were you an activist kid? Were you really empathetic as a teenager in high school, doing those kinds of things?

SHARRELLE
I did things. I was involved in NAACP as a kid. But then when I, again, seeing my dad, my dad would have press conferences about different issues like education or various things and we were there. We were at the press conferences. And sometimes we were the only ones at the press conferences. But I saw the ways in which he used his voice to really shed a light and amplify the issues that affected impoverished communities, Black communities, et cetera.

And I think, again, me and my siblings– there are five of us– I think that got ingrained in all of us in different ways. And so then I went on to undergrad at–

MAURICE
Where’d you go?

SHARRELLE
At Bennett College, Bennett College for women. It’s one of two historically Black colleges for women.

MAURICE
So you’re a Bennett Belle?

SHARRELLE
Yeah, Bennett Belle.

MAURICE
You’re a freshman.

SHARRELLE
I’m a freshman.

MAURICE
What’s your major?

SHARRELLE
I was a biology major, interestingly enough. I always–

MAURICE
Was there something that you loved about biology or were you premed or what was?

SHARRELLE
Yeah, so when I was– so from five, from the time I was five, I’m going to be a doctor. I was going to be a doctor. That was it. So we–

MAURICE
Did you know what–

SHARRELLE
–going to be a doctor. I didn’t know. I just knew I wanted to be a doctor.
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–somebody. Exactly. So smart kid, valedictorian from my high school class, always smart, always good grades. So you go, you’re a doctor, right? I also like helping people. But then I found out I wasn’t too fond of blood and that kind of thing.

MAURICE
Wow! So not so much with the blood?

SHARRELLE
Right.

MAURICE
So how do you change?

SHARRELLE
Yeah, so biology major. So a couple of things. Biology major, but I also had been, as a freshman and then into my sophomore year, started getting involved more on campus, helped to organize a March to the Polls. And we had this slogan that Dr. Alma Adams, who’s currently in the House of Representatives, she would say, Bennett Belles are voting Belles. And so under that mantra we’d march to the polls.

And I knew I’m this biology major. But I was like, I gotta connect this stuff. I gotta– what’s happening politically? What’s happening in communities? How do I connect the dots? Now, being a medical doctor could be good. I could see individual patients. But as I began to evolve, I began to say, there’s a little bit of a disconnect in medicine, just pure medicine, that I want to think more broadly.

And so sophomore year, summer, I had the opportunity to go to a summer program at Harvard, a summer program of quantitative sciences. But it was there that I found, discovered, fell in love with public health. And what it did for me is, it gave me the opportunity to marry this strong desire to be– strong core value of social justice with my love of science, with my love of thinking about health, of thinking about, but not just the health of individuals, the health of populations.

And it was there at that program that I got introduced to a wide range of literature that I had never seen before, Black epidemiologists who were doing this work, talking about health disparities in a very different way, not just what Black folks aren’t eating, that they’re not getting exercise. But there’s these larger societal issues that might actually be influencing our health. And how can we think about that and address those things and not just, it’s just individual behavior. It’s just individuals aren’t doing the things that they need to do.

MAURICE
So I’d love to dig deeper on what those disparities are. Let’s start by getting some common definitions. So when you go to a cocktail party and go, epidemiologists, and people’s eyes glaze over, how do you explain it?

SHARRELLE
I just say it’s about the health and populations. I say I talk about the fact that when you see statistics that the Black women, for example, have four times the maternal mortality rate than white women, that’s an epidemiologic statistic or that’s a statistic that we know because of epidemiologic data. So it’s really looking at the health of populations and also looking, for me as a social epidemiologist, looking at those drivers, those contextual societal systemic drivers of these patterns of health that we see within populations.

MAURICE
So your professional life then centers on these ideas, these intersections of race and place and health. So what have you found? Yeah. What are the kinds of takeaways that most people find surprising? And what should the average person know about how those things interact with one another?

SHARRELLE
Yeah. Yeah, and it’s funny because I started off saying place, race, and health. And I’ve been now very explicit with say racism, because it’s racism that has shaped the places where people live and then leads to subsequent health inequities. So my work has been, some of my work has I’ve been primarily based in two areas. One is in Jackson, Mississippi. So again, I felt doing my work in the South and it being based in the South was very essential to me.

And being able to really use the research that I do to shift the narrative, to look at these broader issues was very essential. So I’ve been using work from the Jackson Heart Study. It’s actually a study of African-Americans based in Jackson, Mississippi, the deep South.

And I’ve done a series of studies that have looked at neighborhood disadvantage, segregation. And we’ve, again, seen these patterns where you live in neighborhoods that have higher poverty, higher unemployment, lower median household incomes, et cetera. You see higher rates of allostatic load, which is– higher levels of allostatic load, which is just a marker of chronic stress. We see higher rates of cardiovascular disease. We see higher rates of stroke in these neighborhoods that have higher disadvantage.

We also, looking at explicitly racial residential segregation, also see these similar patterns where you see higher rates of cardiovascular disease, higher rates of markers of cardiovascular health in this population of Blacks. And for me, especially, looking within a population of Blacks to say, if it goes beyond race to the structure of racism and neighborhood and segregation to say, if you changed the context in which people live, you can actually change your outcomes, which counters some of the biological determinism of racial inequality.

So there’s a whole host of literature that thinks that oh, well, the differences we see for Blacks versus whites is genetic. But if I’m looking at a fully Black population, and I see these variation, depending on where people live, that’s not genetics. That’s the structure. That’s the racism that has created these conditions that then lead to these poor health outcomes. So that’s Jackson.

And then in 2016, I begin looking at this work in Brazil, which, again, seeing Brazil being actually the country with the largest African population outside of– Afro-descendant population outside of the continent of Africa. It has 50% of their population is Afro-descendant, has a legacy of slavery that predated American US-based slavery, and also didn’t end until three years after US-based slavery, and has this really similar system of racism and oppression in that country.

And so, again, looking at where people live, their segregated neighborhood environments, and outcomes like diabetes, hypertension, obesity, we see these same patterns of where people live mattering for their health, which has implications for how we understand racial health inequalities in that context.

MAURICE
So other than a genetic pushback, I can see a novice saying, well isn’t that just really about lifestyle? Certain people live a certain way. They live sedentarily. They eat bad foods. And so they had poor health outcomes. And if they just took up yoga or maybe bought a pair of running shoes or stop eating ribs, they’d be better off.

SHARRELLE
Oh, that was when I entered into– when I became aware of public health in 2005, that was the predominant narrative. And it still exists. But what you have to ask then, you have to take it the next step. Think about where people live. Think about, what access to healthy foods, affordable foods do they have?

You got to think about the infrastructure within their neighborhoods that might preclude them from engaging in certain healthy physical activities. You have to think about just the fact that some folks in these neighborhoods are working one, two, three jobs. And their time is limited. And they’re exhausted when they get home. And they have all these other responsibilities.

So thinking about, let me go to the gym– if they can afford a gym membership– is probably the least of their worries. And so again, you go you get away from this, let’s blame the victim, because that’s really what that is, to let’s look at the context and the structures that have been created that are not conducive to health.

MAURICE
So we’ve spent a lot of time deconstructing the problems and understanding the interaction between these. So in what way does your work serve informed solutions? What are some of the answers to some of these problems?

SHARRELLE
Wow that’s a big, that’s a tough question. So I will say that part of the reason I engaged in the social epidemiologic aspect of the work is, there sometimes still is a need to shift narrative, because you’ve got to change the story about why health inequalities exist before people would even act. So it’s getting better, especially in the US, where some public health departments are declaring racism as a public health crisis. 10 years ago that wasn’t the case.

So this epidemiologic research that we’ve been doing and, again, not myself, but my colleagues and friends across the country, to just demonstrate that these structural factors are influencing health was very instrumental in just shifting the narrative. We had to first say, it’s not just this lifestyle stuff. It’s not genetics. It’s racism.

And again, we gotta shift the narrative now. When you then say, let’s step back and say, well, racism is the system. And we’ve created this system since the first enslaved individuals who came to this country, Black folks who came to this country. We’ve created a system. What are the ways that we can begin to examine the policies and the practices that have created the system so then we can begin to dismantle it?

MAURICE
This brings up the issue of racism, which we’ve been bantering around as if everybody knows what racism is. And I think people understand it if you go, I don’t like you because you’re different in this way, this specific way, this specific ethnic way. But that’s not what you’re really getting at.

SHARRELLE
Right. What I’m really getting at is, Dr. Camara Jones, who’s a physician epidemiologist, and she was really a pioneer in this area of racism and how she was talking about this in the 90s when everybody thought she was crazy. And they’re like, go sit down somewhere. Now everybody’s talking about racism. But she defines it like this. She says, it’s a system. So it gets us away from interpersonal– this I don’t like you, you don’t like me– a structuring opportunity, and assigning value based on our social interpretation of what people call race.

And so that does three things. It disadvantages some individuals and communities. It also provides an advantage to some communities and individuals. And then the final thing I think is really critical is that it saps the strength of the entire society through the waste of human resources.

The fact that we don’t invest in certain folks because of their skin color, because they’re Black or they’re Hispanic or they’re Latino or whatever–

MAURICE
Or disproportionate.

SHARRELLE
Or disproportionate.

MAURICE
In one group because–

SHARRELLE
Exactly.
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–means we’re actually doing a disservice to our whole society. And so the fact that– and you can see multiple systems– education, in housing and neighborhoods and segregation, criminal justice, all of these systems that are really interlocking and reinforce one another– have created the conditions that make health really hard for certain populations. And so when I talk about racism, I’m talking about the ways in which it’s been embedded in the very way we operate as a society– locally, statewide, and federally.

And that’s what we have to move. We have to move to be thinking about how do we address the systems that have continued. And those systems are set up on power and resources. So we’re not just talking about the lack of resources. We’re talking about the ways in which political power has also been suppressed in these communities.

MAURICE
So I’m really interested in talking about Philadelphia. We’re here in Philadelphia. Your work is currently in Philadelphia. How does all that you’ve done, especially in Jackson and in Brazil, how does it inform what you see here? What do you see here.

SHARRELLE
Yeah, yeah. Yeah. No, I think it’s really important. So there’s this report that’s really nice, well, not nice. It’s actually kind of depressing report. But the “Close to Home” report, which was done in conjunction with the Urban Health Collaborative, which is based here at Drexel and the Philadelphia Health Department. And what the “Close to Home” report did was, it divided Philadelphia into its neighborhoods and looked at different indicators or markers of health, including life expectancy by neighborhood.

And what it found was that there are these huge, striking inequalities upwards of 15-year differences in life expectancy in different neighborhoods across the city of Philadelphia.

MAURICE
That’s incredible.

SHARRELLE
15 years. You can live in one neighborhood and your life expectancy be 69 or 60. And then in another, 82 years life expectancy. And so that this report has really made visible these striking inequities that we know are the result, again, of the systems and the structures that have created the segregated neighborhoods that we see, the disinvestment that has happened over decades.

And I did a class. I’m actually currently teaching a class, an online class called Urban Inequalities in Health, where I went to different neighborhoods in Philly. I was in North Philadelphia. I was in West Philadelphia. And to be reminded of how strikingly different these neighborhoods are, from Center City, from certain parts of University City as well, it just is a reminder that there has been a lack of investment in certain communities across the city of Philadelphia.

And this has been persistent. And we see it show up in neighborhoods. We see it show up in the educational system. We see it show up in criminal justice. All of these things, these interlocking things that create these very, very different living conditions for individuals. And we see that again.

And life expectancy is one of the markers. If you want to get at what’s the real health of this population in total so to see those 15, upwards of 15 years difference, I think it’s very telling of the inequalities that exist in the city.

MAURICE
What’s your hope for the future? What do you hope students who take a course of yours take away and do in the world?

SHARRELLE
Yeah, so I hope that we as a society, we learn or we get a better what I’ve been calling in lectures that I’ve been giving over the last few months, is that we have a radical imagination. And what I mean by that is that because we’ve literally created these systems, that means we can recreate them.

And if we all collectively get the political will to just say we can’t discard certain communities, because that’s what we’ve in essence done. In here in Philadelphia we’ve said, oh North Philly doesn’t matter. West Philly doesn’t matter. That’s what we’ve done, whether or not we want to admit it or not. And that’s what we’ve done, not just as individuals, but as collective.

So can we have an imagination that says it’s not OK for certain communities to be disinvested, for certain communities not to thrive, for certain communities to literally have to struggle day in and day out literally just to survive? That’s not OK. As a collective, can we have that imagination? And that really, really requires us to see the humanity in everyone else, to see that we’re all inextricably linked.
And so what I hope that my work does and students who take my class is that they reimagine what this world looks like. And then they fight and organize and act collectively to try to make a difference and to try to change the world.

MAURICE
Dr. Sharrelle Barber, thank you for being in the 10,000 Hours.

SHARRELLE
Thank you.

MAURICE
Drexel’s 10,000 Hours podcast is hosted by me, Maurice Baynard. Our producers are Shaun Fitzpatrick and Nathan Barrick.

SHARRELLE
Drexel’s 10,000 Hours podcast is powered by Drexel University Online.
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