Before highlighting the contents of this edition, I must acknowledge the loss of a dear friend and mentor, Bailus Walker PhD, MPH, who transitioned April 9, 2020. Dr. Walker retired as Professor of Environmental and Occupational Medicine and Toxicology Howard University College of Medicine. His many distinguished positions including, but are not limited to the following: Professor of Environmental Health at the School of Public Health, State University of New York in Albany, Dean of the Public Health Faculty, University of Oklahoma Health Sciences Center, Commissioner of Public Health for the Commonwealth of Massachusetts and Chairman of the Massachusetts Public Health Council, State Director of Public Health for Michigan, appointed by the governors of the respective states, Director of the Occupational Health Standards Division, Occupational Safety and Health Administration (OSHA) U.S. Department of Labor, President of the American Public Health Association, Distinguished Fellow of the Royal Society of Health (London, England). Distinguished Fellow of the American College of Epidemiology, NIH Advisor on environmental and community health aspects of biodefense research, member of the Institute of Medicine, (IOM) National Academy of Sciences (NAS) member on on numerous IOM - NAS commissions/committees including the Board of Environmental Studies and Toxicology and Chairman of the Committee on Toxicology, Senior Science Advisor (Environmental Health) to the National Library of Medicine, Chairperson of the Advisory Committee, Agency for Toxic Substances and Disease Registry (Centers for Disease Control and Prevention), Editorial Board, Journal of Healthcare for the Poor and Underserved, Chairperson of the Advisory Committee, Graduate Public Health Program, College of Veterinary Medicine and Bioethics Visiting Scholar, National Bioethics Center, both at Tuskegee University. Dr. Walker has published over 100 scientific articles, and his book chapters are too numerous to name. Dr. Walker served on numerous select national and international committees. As a graduate of Kentucky State University, in my view, his commitment to implementing graduate public health programs, particularly at HBCUs is unmatched. He served on, at least, 5 MPH Advisory Committees at HBCUs, literally developing the curriculum at several of them. Global public health is better because of Bailus Walker!
I also must pause to acknowledge the murder of Mr. George Floyd, by specific members of the Minneapolis, Minnesota Police Department. The historic and continuing killing of Black men and women has spurred the world community to protest and acknowledge that structural racism is rampant globally, and Black Lives Matter. There appears to be a remerging consciousness to create, maybe for the first time, an equitable society in the United States. The manta, “I can’t breathe” symbolizes a demand for social justice.
The Fall 2019 edition of the Journal of Healthcare, Science and the Humanities includes selected articles from the Annual Public Health Ethics Forum (PHEF) 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 and commentaries address a broad array of issues from the lens of a transdisciplinary group of contributors. The first PHEF in 2015, was co-sponsored by the National Bioethics Center, CDC and the Master of Public Health, Morehouse School of Medicine honoring the 100 Year Anniversary of the death of Booker T. Washington, Founding President of Tuskegee Institute (aka. Tuskegee University). Since then, every year the National Bioethics Center and CDC have co-hosted the PHEF focusing on public health ethics considerations targeting specific vulnerable population groups. In 2019, the PHEF focused on children and youth. The Program Agenda is included this edition. The keynote address, transformed into a publishable manuscript, an extraordinary youth panel with students from Metropolitan Atlanta, Georgia and Tuskegee, Alabama and the agenda from the 2019 PHEF are included in this edition, so the reader will have a sense of the depth and breadth of the session. Other articles included in this edition have all been peer reviewed.
Dr. David Hodge, Associate Director for Education at the National Bioethics Center, provided an extraordinary keynote address to open the forum. The title of his address, “Conversation on Ethics and Theme Parks,” intertwined themes in philosophy, ethics and theology in ways that captured the attention of the audience throughout the presentation, and solicited a broad array of question when he finished. He thoughtfully, transformed the presentation into a publishable manuscript for this edition of the Journal of Healthcare, Science and the Humanities (JHSH) Dr. Hodge raised the empowering question of “what is right and what is wrong” which, can be answered philosophically, theologically and/or ethically. The question of right and wrong is particularly important when addressing the health and well-being of children and youth, especially children and youth of color. Dr. Hodge deconstructed and then reconstructed complicated terms like epistemology, utilitarianism, deontology, metaphysics, ontology and logic, in ways that were clear, non-threating, and understandable. He used the theme of theme parks, and the metaphor of a rollercoaster to help “older folk” understand the moral dilemmas that young people face. He used theme parks, rap and moral dilemmas to discuss challenges face in the 21st Center. Most youth have been to a theme park and many ride the rollercoaster. He recalled his traumatic experience on a rollercoaster with his son, who thoroughly enjoyed the experience. For me, the take home message was that while all adults had childhood and youth experiences, they cannot transfer their experiences to fully understand the experiences and perspectives of today’s children and young people. His article provides more details for the reader to explore.
A Social and Physical Determinants of Adolescent Health Youth Panel provided an opportunity for a group of high school and college students from Metropolitan Atlanta, Georgia and Tuskegee, Alabama to share their perspectives on the salient topics that undergirded the 2019 Public Health Ethics Forum. The topics included the following: adolescent access to sexual health education and services, substance abuse and mental health challenges, access to fresh fruits and vegetables, and “what does it mean to be an adolescent?” The students’ names were removed, but their actual responses were transcribed with minor edits. The Bioethics Honors Program (BHP) students, under the leadership of Nina Hylton, President of the BHP, did an outstanding job editing the transcription of the entire panel discussion. Under the guidance of Dr. Hodge, the BPH students continue to engage in a broad array of academic, social, and community activities. The uniqueness of the BHP is that it provide opportunities for the students to take what they are learning in the classroom and translate it into engagement activities. We are very proud of the Bioethics Honors Program students.
Dr. Andrew Zekeri, Professor of Sociology, Department of Sociology and Psychology and Adjunct Professor of Sociology in the National Center for Bioethics in /Research and Health Care at Tuskegee University is a regular contributing scholar in the JHSH. His research in Alabama Black Belt counties is widely published in peer review journals throughout the U.S. Dr Zekeri article for this edition is entitled, “Household Food Insecurity Is Associated with Self-Rated Health Status among Single Mothers in Alabama’s Black Belt Counties”. He examined the association between household food insecurity and self-reported health status. He collected data from 400 households to measure household food insecurity and self-reported general health status. What seems intuitive concerning food insecurity and poor health status still needs research to influence public policy for funding and programs to address this problem. At a time when funding for federal food programs are being reduce, research to offset this trend is desperately needed.
Dr Oyoyo Egiebor-Aiwan and colleagues in the Graduate Public Health Program and other departments in the College of Veterinary Medicine, Tuskegee University completed a study entitled, “The Impact of Race and Geographical Location on the Treatment Options of Cervical Cancer in Black and White Women Living in the State of Alabama.” The Black/ White disparities in early diagnosis, treatment options, and mortality rates differ between these two groups and are consistent with national comparisons; consistently, Black women bare the greater burden. Interestingly, Black women in urban and rural areas, in their study, have better treatment options than their White women, (presumably non-Hispanic White) counterparts. Purportedly, treatment for cancer should result in better survival outcomes. However, in this study, Black women fair worse in each scenario, except for treatment options. Yet, the mortality rates are worse for Black. Why?
Dr. Elhussin, Integrative Bioscience PhD Fellow, Department of Biology at Tuskegee University and colleagues published another paper, presumably from the same dataset entitled, “Disparities in Cervical Cancer Treatment Options between African American (Black) and White Women in Alabama.” The study questioned why younger Black women, living in urban counties with advanced stages of cervical cancer were more likely to receive radiation treatment but were less likely to undergo surgical treatment options. Disadvantaged women particularly, younger Black women living in the Black Belt and other rural counties, did not receive the treatment options available to other women. Their study suggests that access to care, without assessing options provided to all women, particularly disadvantaged and Black women, may account for desperate mortality outcomes.
Dr. Brandon R. Isome, in his article, entitled, “The Paradoxical Implications of Blackness and the U.S. Constitution: The Intersectionality of King’s “I Have a Dream” Speech and Educational Inequalities”, writes continual inequities experienced by Black people in the United States the promises guaranteed to all U.S. citizens. He uses the oratorical genius Dr. Martin Luther King Jr’s use of the “promissory note” during his speech at the 1963 March on Washington for Jobs and Freedom, to emphasize the continual fight that African Americans wage for the rights and privileges purportedly, granted through “American citizenship.” The anti-black educational policies and practices that came before and after Brown v. Board of Education that King’s highlights with term “promissory note” makes clear that King’s dream has yet to be realized.
The last article by Warren and colleagues, on “Enhancing African Americans Participation in Clinical Trials” is a reprint from a 2019 edition of Journal of Medicine, Ethics and Public Health. With permission to reprint from the (JEMPH), this article documents the longstanding problems of engaging African Americans in human subjects research in the midst of bioethics and public health ethics violations. The research was funded by the Eli Lilly Company to determine how to ethically engage African Americans in human subject research, specifically, clinical trials. The article was initially published in the Journal of Ethics, Medicine and Public Health, an international journal published in English and French. The readership of the JEMPH may be different from those who read the JHSH, so we were granted permission by JEMPH to reprint the article to assure both audience have access to the findings. The primary finding in the article is trustworthiness must precede trust if equity in the research enterprise is expected.
Dr. Gwendolyn West’s Commentary, “Unsilenced and Redeemed,” challenges the audacity of others particularly, non –Hispanic White women and men, to speak for and about Black and African American women. She is intentional in distinguishing between the terms Black connotes race, and African American which designates an ethnic group within the Black race, to highlight so the reader will appreciate the difference between the two, in spite of the U.S federal government failure to distinguish between the two. Dr. West recounts the abuse that Black women experienced dating back to back to enslavement in the U.S. She also documents abuse to women of African descent in European. Reading her Commentary highlights the double jeopardy and racism and sexism experienced by women of African descent.
These are the best of times and the worst of times. The JHSH strives to provide valid and ethical information so the reader can make informed decisions about their journey towards Optimal Health. Enjoy!