We Got Our Needle! It’s a Good Time to Think about Disparities!

Thank you to everyone, near and far, who helped raise money for NE Portland to get needled via the Portland Acupuncture Project. (Check out the long list of individual contributors on the Project's website -- isn't that cool? More than half of them are WCA comrades.) This Saturday at 10 am we'll be raising the needle at Fernhill Park, at NE 42nd and Killingsworth! Expect pictures on Facebook!

Each needle-raising so far has included speakers who addressed the meaning of the site; for instance, the Public Involvement Coordinator of the EPA spoke at the Portland Harbor Superfund site when the "Remove Toxins" needle went up. Because Fernhill Park borders a site which is slated for community redevelopment, we're looking forward to hearing from some people who are involved in figuring out how the site will benefit the Cully and Concordia neighborhoods. We are also looking forward to hearing from Dr. Kim Tippens, WCA's featured speaker, about health disparities.

Dr. Tippens is a post-doctoral NIH fellow at the Helfgott Institute. Lucky for us, she is also very interested in community acupuncture; see this recent post at the Integrator Blog about her research. Since the needle-raising is outside on a Saturday morning, probably with kids and dogs running around, nobody will be speaking for very long, so I thought it would be good to have a blog post with some more background about health disparities.

Alert readers of the Integrator will note some figures summarized from Dr. Tippens' demographic study of WCA patients: " ... primarily white (87%) and female (72%); 25% of respondents are uninsured, 29% are unemployed, and 77% have an annual household income of less than $55,000". For this post, I'm just going to focus on one of those characteristics, the "primarily white" one.

A number of people, when hearing about that "primarily white" 87%, had a reaction along the lines of: well duh, it's Portland.  What did you expect?

Actually, it's a little more complicated than that. OK, a LOT more complicated.  A dozen blog posts wouldn't be enough to tackle all the complexity behind that "primarily white" percentage, but we have to start somewhere, so here goes.  

First, most of that demographic data came from our Cully clinic, 373 surveys out of 478. According to some recent statistics about neighborhoods published in Portland Monthly Magazine, 46% of Cully residents are non-white. 7% of Hillsdale residents are non-white. If WCA's data tracked along those lines, only 63% rather than 87% of our patients should have been white. Granted, I don't think that 87% figure is quite accurate, for a couple of reasons. First, the survey was only available in English; if it had been available in Vietnamese and in Spanish, a number of our patients would have been counted who weren't. Second, the survey was a survey and it looked kind of official, and some of our patients who are immigrants didn't do it because it freaked them out. But even so, 46% of our patients at Cully are not people of color. It's probably closer to 20-25%. So what's with that?

That, my friends, is a disparity.

And there are many more like it, around here. Recently, the Coalition of Communities of Color and Portland State University released a report which basically states that it really, really sucks -- on every possible level -- to be a person of color in Portland. Here's a quote from the executive summary of the report:

"This report documents the experiences of communities of color in Multnomah County. The results
are indeed unsettling, as many key insights emerge from the data. First, disparities with White
communities exist across all institutions addressed in the report. The magnitude of these disparities
is alarming. Consider some of the data findings:
• Communities of color earn half the incomes of whites, earning $16,636 per year, while white
people earn $33,095 annually. Disparities close to this magnitude exist regardless of one’s
family and household configuration.
• Poverty levels among our communities are at levels at least double those of whites. Our
child poverty rate, collectively, is 33.3%, while that of white children is 12.5%.
• Educational attainment is stratified by race. While only 7% of Whites did not graduate high
school, 30% of communities of color did not.
• Disparities exist at the preschool level. By the time children enter kindergarten, there is a
disparity that, depending on the measure, averages between 5% and 15% in readiness for
learning scores. Most children of color are unable to access preschool programs, though
they are overrepresented in Head Start initiatives.
• One-quarter of public school students of color were racially harassed in a 30-day study
period, either at school or on the way to school. The figure is constant for both students in
grade 8 and grade 11.
• Educational disparities in our local public schools are deeply entrenched and gains made
earlier in the decade have been lost, and the achievement gap is widening.
• The labor market is similarly bruised by disparities. Communities of color access
management and professional positions at half the levels of Whites. One of every two
Whites access such high status and high paid work, while less than one of every four people
of color access these positions.
• Communities of color have unemployment rates that are 35.7% higher than whites.
• Health disparities, while unevenly distributed across communities of color, average out to
result in significant disproportionality. Low birth weights among communities of color are
37% worse than for White babies.
• Child welfare disproportionately removes African and Native American children from their
homes and places them in foster care. The longer children are in care, the much greater
likelihood they are African American and Native American.
• Juvenile detention rates are much worse for children of color. They are 50% more likely to
be held than released into the community once they engage with the police.
• Even systems designed to improve the challenges facing communities of color, such as the
protected contracting practices at the City, County and Metropolitan levels fail to deliver
sufficient benefits to our communities of color. Less than one-tenth of 1% of the City of
Portland’s contracting dollars goes to minority-owned businesses.3
In every system we looked at, there are significant disparities. The breadth and depth of these
disparities is deeply unsettling. Our best understanding of this is that institutional, ideological,
behavioral and historic racism intersect to create these harrowing results. Add to this dynamic that of whiteness and white privilege, and we create the one-two punch that leads to the horrors of racism coexisting with the privileges of whiteness. Undoing such inequities must occur at all levels of every system."

And, not only are people of color in Portland disadvantaged compared to white people in Portland, they are disadvantaged compared to people of color nationally AND people of color in Seattle. By all measures, Portland is a "uniquely toxic" environment for people of color.

And what about the perception that having 87% white patients is normal for an acupuncture clinic in Portland, even when that clinic is WCA? Could that perception be related to our unique toxicity? As in, we don't expect to see people of color and we don't even notice when they are not there? I can see how living in a place where people are perenially surprised that you exist could wear on a person.

We have spent a lot of time on the CAN blog looking at numbers that don't make sense, that don't add up, that point to problems that are deep and structural and hard to see unless they affect you directly. WCA's primarily white patient base, despite having been in a neighborhood that is close to 50% nonwhite (for eight years now!) has to go on that list of problematic numbers, along with only 1% of the US population getting acupuncture and 91% of acupuncturists not having jobs

Dr. Tippens recently pointed me to an article by Dr. Camara Phyllis Jones titled  "Levels of Racism: a Theoretic Framework and a Gardener's Tale".  You can read it here, and I really, really hope that you will, because it's the best explanation of institutional racism and how it works that I have ever heard or read anywhere. You can see how we arrived at all those numbers that don't add up for people of color in Portland. 

One of the things that I love about acupuncture is how it often mysteriously connects the conscious with the unconscious. My patients are constantly discovering that they know all kinds of things about themselves that they didn't know that they knew until they got acupuncture. One said to me, pointing to her favorite chair, "This recliner has solved SO MANY PROBLEMS."  My hope for the needle at NE 42nd and Killingsworth is that it works that way with the disparities in our neighborhood, that it brings them into consciousness so that we can start to work on healing them.

This story was posted on June 16 2010 by Lisafer.

Comments

  • June 16 2010 at 4:59 PM
    melissa writes:

    thanks for this post

    it’s a big issue we grapple with also and thanks for the links!i feel like this is some of the most important work we can do.

    i also loved and highly
    recommend the spring issue of YES! magazine. it’s primarily on Race in
    America which is awesome (America: the Remix) AND there’s also great
    stuff on activists for social and economic justice, the world social
    forum, an article on a co-op restaurant formed in response to 9-11
    windows on the sky not re-hiring non-white workers, and Gaviotaas,
    sustainable community in Columbia, with an interesting take on
    innovation.

    http://store.yesmagazine.org/back-issues/america-the-remixhttp://www.yesmagazine.org/

    Melissa

    Good health is not a measure of adapting to a sick society.

    When the power of love outshines the love of power, the world will know peace.

      0 likes
  • June 17 2010 at 1:28 AM
    Guest writes:

    Article:  disparities

    Thank you very very much, for this article, Lisa!

      0 likes
  • June 17 2010 at 11:17 PM
    obnicole writes:

    congratulations!

    and a fantastic post. And… somehow i didn’t even know about the project. my family would like to make a donation, tell us how.

    you’ve got the hugest heart, and all the right thinking.

    that data is overwhelming, it’s going to take a lot of porcessing, which is, i suspect, why there haven’t been many comments here yet.

      0 likes
  • June 22 2010 at 10:16 PM
    River Jordan writes:

    institutional racism - white privilege

    I am almost finished reading Howard Zinn’s, “A People’s History of the United States”, which is another excellent, painful, eye opening story of the U.S. and its legacy of racism and class stratification. It’s the history that few of us were exposed to very much in our formal education.

    Fortunately, the story is being told more (like here on CAN. The conversation is getting more air time. I am working on promoting awareness at my daughter’s private school around this, and while educated whites profess to be interested and tout their progressive credentials very easily, when the talk meets the pavement and there are calls for action, at say, bringing policy changes to the administrative and Board level, or mandating training in institutional racism, then things get eerily silent.

    For any acupuncturist running a CA clinic, I highly recommend getting more educated in this area. People’s Institute gives excellent trainings in Undoing IR nationwide.

    Until all people have access to health care, housing, education, food, water, art, employment, etc. etc.  there will be this tension in society. I think we need a revolution in compassion. I add my prayers that the Cully needle will bring greater equity to Portland and send ripples of enlightened vibrations out into the world, dismantling racism everywhere.

    As a footnote and tangent, recently, I attended a meditation retreat southeast of Portland. We combined meditation on Tara, the female Buddha of enlightened activity, with recitation of her mantra - Om tare tutare ture mama ayer punya jana pushtim kuru soha. I think collectively we recited ~ 500,000 mantras and after each session, we each took turns blowing on a bowl of saffron water being passed around.

    The water was collected and poured into a local creek (flowing into the Clackamas River), in order to bring greater health to that watershed. A sort of spiritual homeopathy if you will. Some of the water will soon be going with a friend of mine to the Gulf of Mexico to bring healing there. The power of mind - internal revolution - is what is ultimately going to get us there. Meanwhile, lots of action in the manifest physical realm is needed. Thanks for all your work Lisa.

      0 likes
  • June 22 2010 at 10:18 PM
    River Jordan writes:

    yes

    this was a great issue - second your recommendation here. Sonja, if you are reading this, we want a report from the Detroit Social Forum when you return.

      0 likes
  • July 7 2010 at 1:28 AM
    River Jordan writes:

    deafening silence

    Okay, I’ll confess that - as is not unusual - in my last comment I wandered a little bit off topic, and, perhaps I must take some responsibility for closing off conversation on this topic, but I refuse to take it all.

    Do we as a community really have nothing more to say about this topic? I find that somewhat incredible, given that one of the main goals of the CAN movement (I think I remember three from the first workshop)...is to broaden access to acupuncture.

    Yes, white privilege is difficult to talk about, and perhaps a public internet blog isn’t the safest place to open up and be vulnerable…but on the other hand, why not just be transparent (teaching moment for the world), risk a little bit, and see what we can learn together?

    I’ll be the first to admit that as a white male, I’m only a little bit - intellectually - aware of these disparities Lisa is writing about. I always thought that Portland was a more progressive city than Seattle for some unexamined reason…but according to the data above, that does not seem to play out when it comes to racial equity. Why did I assume that? It’s easy - as a person of privilege - to assume things based on specious subjective data (like Portland having a better light rail system), and then feel no need to follow through with a more rigorous examination. The consequences of errant assumptions are likely minimal - in the short term - when one already occupies a place of privilege.

    But I digress…I am interested to know how you did your survey Lisa. Was it a paper survey that you handed out to clients? Would something like that be advisable for other clinics as a way to gather more data on the proportional racial representation of our patients - with the intent to see how well our clinics as a whole are serving people of color?

    A former patient suggested a few months ago that I submit a proposal to the Seattle Race Conference (not about jogging) which is happening on August 28-29 at South Seattle Community College in Seattle.  The conference focus this year is on racial disparities in health care. I frankly don’t remember exactly what I put on the application - I know I was pretty brief - but I talked a little bit about the CAN model and possibly my experiences in New Orleans in Haiti - and, to my surprise and mild horror, my application was accepted.  Actually, I am excited…I like being at my edge…and clearly I’ve found a new one in white privilege/anti-racism work.

    So, I am now reaching out for ideas -  I do have Dr. Tippens article bookmarked and will carefully read it - I’m wondering if she knows about the conference and has been invited?

    A new friend who also happens to be one of the conference organizers suggested to me that it might be beneficial if I had a co-presenter, perhaps someone of a different race and gender, as that can make the presentation more dynamic, and more inviting to a diverse audience. Which led me to the realization (duh!) of how white our profession is generally, which leads back to the dysfunction in the profession..(Aside: Of course, lots of Asians in our profession, but how many black acupuncturists do you know? What’s with that?)

    I believe that one of the central cogs in the dysfunction of the acupuncture “profession” is how we are conditioned by the schools to emulate the medical profession and become little white coated “experts”...and of course…so called experts need to command a high salary…and that justifies the push for an Acupuncture doctorate, which jacks up tuition, and stratifies students and prospective students, and ultimately, practitioners, by race…it’s all a vicious circle (kind of like institutional racism) which leads to exclusivity, elite status and objectification of a profession of experts, and barriers of access.  Round and round we go, rich get richer, those without get stiffed more brazenly (I’m thinking of Congress not approving an extension of unemployment benefits for millions of people right now). Not to mention the intellectual snobbery that goes along with expertism which creates its own sort of racist overtones not dissimilar from colonialism or paternalism.

    So, perhaps I should talk some about all of this…however, I don’t want to spend all my time dwelling on the negative…but spend some time empowering….maybe talk for half the time, then whip out the needles and say “okay, the rest of the presentation will be done in silence”, and pop in 5NP in everyone!

    I’m thinking to invite one of my patients to co-present with me (female, person of color), and have her share what it is like both to try to access health care generally, as a person of color, and the experience of community acupuncture…

    Well, there it all is - a whirlwind of thoughts spinning around my mind.  I’m open for constructive criticism and positive feedback and ideas.

     

      0 likes
  • July 7 2010 at 2:45 AM
    River Jordan writes:

    Institutional Racism is

    “inaction in the face of need”...from Dr. Tippens article (see Lisa’s original post).

      0 likes

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