by Myra J. Christopher, Director of PAINS

pathologies-of-powerI live in Kansas City, 239 miles due west of Ferguson, Missouri, which in 2015 became the epicenter of racial tension in our country. When I learned last week that the Justice Department is bringing charges against the City of Ferguson for blatant discrimination in policing, I thought about physician/anthropologist Paul Farmer’s work on “structural violence.”  In his book on suffering and structural violence, Pathologies of Power: Health, Human Rights and the New War on the Poor, Farmer defined structural violence as:

social arrangements that put individuals and populations in harm’s way… The arrangements are structural because they are embedded in the political and economic organization of our social world; they are violent because they cause injury to people … neither culture nor pure individual will is at fault; rather, historically given (and often economically driven) processes and forces conspire to constrain individual agency. Structural violence is visited upon all those whose social status denies them access to the fruits of scientific and social progress.”

Black history month is quickly passing, and I feel that, as Director of PAINS, I would be remiss not to make note of the irrefutable disparities that exist in the treatment of pain among African Americans. Under-treatment of this population, including pain, was well documented in the 2003 Institute of Medicine report, Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. Tragically, for African Americans, these differences occur from the beginning of their lives to the end. For example, a 2011 study by Zempsky, et al. found that children with sickle-cell anemia who presented to the ER with pain were far less likely to have their pain assessed than were white children with long-bone fractures. Another earlier study found that, among nursing home residents who reported daily cancer pain, African Americans had a 63% greater likelihood of receiving no pain medications than whites – not even a Tylenol.  (emphasis added)

What will it take to change this situation?  I think the first step, as is true with other major problems, is to own it. I know it is not popular to argue for this, but it is my opinion that until healthcare professionals acknowledge racism in healthcare delivery and take responsibility—individually and collectively—for it, this unconscionable problem will not change. Before the month is over, I ask all those who receive this update to stop for just a moment and have a conversation with a colleague about disparities in pain management.