The December edition of the Journal of Healthcare, Science and the Humanities usually includes selected articles from the Annual Public Health Ethics Forum co-sponsored by the National Center for Bioethics in Research and Health Care, Tuskegee University (National Bioethics Center) and the Office of Minority Health and Health Equity at the Centers for Disease Control and Prevention (CDC). Other peer-reviewed articles, a commentary and reflections from an elders’ panel are included to commemorate National Minority Health Month, which occurs in April every year. Since 2015, the National Bioethics Center and the CDC have co-hosted this forum. This year the forum focused on elders and was held in September during Senior Citizens Month instead of April, which limited the time needed to translate and transform the excellent presentations into peer reviewed articles. Thus, there are no original articles from the 2018 Public Health Ethics Forum published in this edition. However, the Program Agenda from the forum is included, as well as a narrative from an extraordinary elders’ panel that highlighted the entire forum.
In April 2015, National Bioethics Center, CDC and the Morehouse School of Medicine co-hosted the first Public Health Ethics Forum. This first forum commemorated the 100-anniversary year of the death of Booker T. Washington (April 5, 1856—November 14, 1915), Founding President of Tuskegee University. Interestingly, in April 1915 Booker T. Washington established National Negro Health Week. In 1895, the National Negro Health News reported that, “Forty-five percent of all deaths among Negroes were preventable; there are 450,000 Negroes seriously ill all the time; the annual cost of this illness is 75 million dollars; that sickness and death cost Negroes annually 100 million dollars.” Selected articles from that forum were published in the Journal of Healthcare, Science and the Humanities ( JHSH) Volume V, No. 2, Fall 2015. Again, during April, National Minority Health Month, the 2016 and 2017 Public Health Ethics Forums took place on the main campus of CDC. The attendees from across the U.S., and participants from the Dominican Republic, focused on Hispanic/Latino Health (2016) and on Women’s Health (2017). Selected articles were published in English and Spanish in Volume VI, No. 2, Fall 2016; Volume VII, No 2, Fall 2017 published articles from the forum on Women’s Health.
This edition of the JHSH includes the agenda from the 2018 Public Health Ethics Forum, “Minority Elders and Healthy Aging.” Dave Baldridge, Executive Director of the International Association for Indigenous Aging, gave the keynote address at the opening session and highlighted some of the assets and challenges related the Native American and Indigenous Aging. That morning also included an extraordinary elders’ panel entitled, “Thriving and Aging with Dignity.” The panelists included, Councilman Chester Antone, Tohono O’odham Nation, and Chairman, Secretary’s Tribal Advisory Committee, Arizona; Mrs. Mamie H. Clemons, B.S., retired teacher, Director of Curriculum and Principal, Pittsburg, PA; Ms. Nadine Cruz, Advisory Board Member, professor, consultant, and author, Long Beach, CA; Mr. Elias Segarra, JD retired lawyer, Duluth, GA. Be sure and note the Reflections narrative from the panel that is included in this edition.
Several very exciting concurrent sessions provided engaging discussions about the lived experiences of elders of color. Ethical Dilemmas in Serving Diverse Elders, Framing Aging as a Positive Experience/Promoting a Healthy Mindset Among Minority Elders and Healthy Aging and the Built Environment/Ethics of Social Policy and Healthy Aging were the titles of the sessions. There was a diverse audience that participated in the sessions, representing CDC, academia and various advocacy groups. Each session had a speaker, discussant and lively audiences that brought a vast array of experiences and perspectives. There was time for open dialogue and discussion following the presentations.
The student poster session included several very interesting research projects. Five students displayed their posters and were well prepared to discuss their research. All the poster presentations focused on the health and well-being of elders. The students who presented had the option of transforming their poster presentations into manuscripts that would be peer reviewed and, if accepted, their manuscripts would appear in this edition of the journal. Mr. Weiwen Ng, University of Minnesota, presented a poster entitled, “Racial Disparities Among Minnesota Nursing Facility Residents Are Inextricably Linked to Serious Mental Illness: A Latent Class Regression.” Kamaria Brisco Tulane University presented “The Association of Herpes Virus Type 1 And Alzheimer’s Diseases Development.” The poster by Lan Doan, from Oregon State University, was entitled, “Health-related Quality of Life Among Asian American & Pacific Islanders Medicare Beneficiaries.” The poster by Danielle McDuffie, from the University of Alabama, Tuscaloosa, was on, “The Role of Religion and Spirituality as Protective Factors Against Depression in an African American Bereavement Populations.” The poster by Yolande Petty from the Interdenominational Theological Center in Atlanta GA, and Ashanti-Ali Davis, from Tuskegee University in Alabama, was on, “Promoting Fresh Fruits and Vegetables for Elders in a Food Desert.” The Journal of Healthcare, Science and the Humanities provides a unique opportunity for students to learn the intricacies of scientific writing and publishing.
This edition also includes several original papers. Andrew Zekeri, Ph.D., Professor of Sociology in the Department of Sociology and Psychology and Adjunct Professor in the National Bioethics Center at Tuskegee University, has two original papers in this edition. The first article is entitled, “Racial-Ethnic Disparities in HIV/AIDS” and the second is “Health Care in the United States: Evidence from a Sociological Field Research in Alabama’s Black Belt and Smoking Behavior, Demographic Factors and Smoking Cessation Among Rural and Urban Residents.” The first article examines African Americans’ belief in psychosocial factors associated with racial HIV/AIDS and health disparities using an exploratory qualitative study methodology. Dr. Zekeri focuses much of his research on health disparities among African Americans living in the Alabama Black Belt counties. In this article, he asked several empowering questions on how African Americans define their health and disease burdens, reasons for their plight, problems they face, their coping strategies for providing daily necessities of shelter, transportation, and healthcare. Dr. Zekeri argues that without hearing the voices of African Americans about issues that affect their health, well-being, and social life, health disparities will worsen. He concludes the article by writing, “Health care is a by-product of the distribution of power and the organization of the society.” His lens as a sociologist emphasizes the importance of factors outside of the health care system that have a direct impact on health care. Professionals working within the system must listen to those whom they serve. In the second article, Dr. Zekeri focuses on smoking as a persistent health problem and leading cause of morbidity and mortality worldwide. Using a telephone survey, he examined the relationship between health status, age, gender and smoking among samples of 150 rural and 150 urban adults in Pennsylvania. He also examined reasons why some respondent quit smoking and who encouraged them to quit. Dr. Zekeri’s results found male, female, and age differences in smoking behaviors. Interestingly, there is no relationship between health status and smoking. However, those who stopped smoking for health reasons did so with support of family. In these two articles, Dr. Zekeri shares the range of social issues that influence health and suggests that people have much to share about their health and health care needs, if they would only listen.
Eric Suba, M.D., Director of Clinical Laboratories, Kaiser Permanente Medical Center in San Francisco, Robert Ortega, M.S., Senior Writer, CNN in Phoenix AZ, and David Mutch M.D., Professor of Gynecologic Oncology, Washington University, School of Medicine in Missouri, use documents obtained from the US National Cancer Institute (NCI) funded 18-year randomized controlled trial in Mumbai for their article. Their clinical trial compared a discredited cervical screening test to “no-screening whatsoever.” The Mumbai trial required Indian and global health leaders to assume “no-screening whatsoever” would remain “standard care” throughout India for the duration of the trial, and thereby delayed the implementation of routine cervical screening among the general population of India for 18 years. During those 18 years, 1–2 million women died from cervical cancer in India, while Pap screening became “standard care” in developing countries such as Vietnam. Paradoxical beliefs in the non-feasibility of Pap screening in developing countries, which rationalize the staggering opportunity costs associated with the Mumbai trial, have corrupted World Health Organization policy guidelines. They recommended revising the guidelines to acknowledge that good-quality Pap screening can be implemented, even in a rural setting in a developing country, with reasonable investment. Tata Memorial Hospital and the US Office for Human Research Protections determined that the Mumbai trial was unethical. The authors suggest that the Mumbai trial was effectively covered-up by false and misleading statements from US medical leaders. They also recommend that all surviving Mumbai trial participants, from both intervention and control arms, should finally receive good-quality cervical screening tests. They argue that NCI leaders should publicly acknowledge that the Mumbai trial was unethical, and they should publicly apologize to trial participants and their families. Otherwise, the global public may reasonably conclude that conscience has died at NCI.
Dr. Beverly Ebo, Public Private School Liaison at the National Bioethics Center, writes on, “Constructivism or Behaviorism: What is the Best Method to Teach Special Needs Students?” Consistent with her work with the Macon County Public School System, Dr. Ebo is responsible for coordinating public health ethics activities between school students in Macon County and the National Bioethics Center. Her article examines the best method(s) to teach prekindergarten, kindergarten, elementary and secondary students with special needs. She explores constructivism and/or behaviorism methods to teach students with special needs. In her paper, Dr. Ebo defines, compares, and contrasts the constructivism and behaviorism in the context of students with special needs. While some educators are unclear about which method is most effective, others are unsure and recommend integrating both. Dr. Ebo concludes that special needs students learn best when constructivism and behaviorism approaches are integrated. It is more effective to make instructional and curricular decisions based on the individual child, tasks and the setting than to use strategies representing only one theory. Moreover, the integration of components from both approaches could help special and general education teacher’s work more effectively as a team to teach children with learning disabilities.
Zanice Bond, Ph.D., Department of Modern Languages, Communication, and Philosophy at Tuskegee University completed a commentary on Mend, which is the debut collection of poetry by Kwoya Fagin Maples, a creative writing instructor at the Alabama School of Fine Arts in Birmingham. Her collection of poems honors and acknowledges several Black enslaved women by calling their names, as she describes their suffering from Dr. J. Marion Sims’ unethical, gynecological surgeries. Sims, known as “the father of modern gynecology,” acquired enslaved women to conduct his unethical research, many times without using the available anesthesia. In her book, Medical Apartheid: The Dark History of Medical Experimentation on Black Americans from Colonial Times to the Present, Harriet A. Washington writes that while Sims was a plantation doctor treating a black infant boy, he tried to “pry [the infant’s] skull bones into new positions. Bond also includes poems by Natasha Trethewey, “Miracle of the Black Leg,” and “Knowledge,” and “Dr. Samuel Adolphus Cartwright on Dissecting the White Negro,” who examines race and gender in medical transplants and dissection procedures. Poetry by Nikky Finney, “The Greatest Show on Earth,” is dedicated to enslaved Black women. Sylvia Plath’s poem, “Fever 103,” are words of advice to slave masters regarding “distinctive diseases of the negro.” The Preface to Kwoya Fagin Maples’ Mend, published in October 2018, ends with an appeal. Bond ends her book review essay with a wish written by Maples, “that you would consider how this story relates to now. Presently in 2018, Black women are three times more likely to die after childbirth than white women, regardless of ability to pay and regardless of prenatal care.” She writes about a health condition that disproportionately and adversely impacts Black women, particularly Black women with limited access to health care. She concludes by writing, “The women who are suffering from it [fistula] are often ostracized by their families and communities. Maybe, reader, you will see how you are connected to this story. Maybe you will honor what you come to know by sharing it.”
The year 2019 marks 400 years since the Middle Passage brought enslaved Africans to Virginia (1619–2019). April 9–12, 2019 the National Center for Bioethics in Research and Health Care will host the 23rd Annual Commemoration of the 1997 Presidential Apology for the United States Public Health Service Syphilis Study at Tuskegee on the historic campus of Tuskegee University. This year’s theme is, “400 Years—1619–2019: The Ethics of Reparations and Reconciliation.” Among the events during the Commemoration is the sixth Annual Public Health Ethics Intensive course. There will be keynote presentations by national scholars from across the country who will address topics ranging from Ethics of African Spirituality, to Ethics of Slavery, to Reparations and Reconciliations, ending with a presentation on Optimal Health. We invite the readers of this edition to consider attending the Commemoration Events and participating in what will be a historical event.