Journal of Healthcare, Science and the Humanities Journal of

Transcription

Journal of Healthcare, Science
and the Humanities
Volume V, Number 1
Spring 2015
National Center for Bioethics
in Research and Health Care
Looking Back to Move Forward
Journal
of
Healthcare, Science and
the Humanities
Published by the National Center for Bioethics in Research and Health Care located at Tuskegee University.
The National Center publishes the Journal in friendship with the Smithsonian Institution.
Journal of Healthcare, Science and the Humanities
Volume V, No. 1, 2015
Preface
The
General Information
The Journal of Healthcare, Science and the Humanities is published by the National
Center for Bioethics in Research and Health Care at Tuskegee University. The Journal is
published in friendship with the Smithsonian Institution Office of Sponsored Projects. The
Journal was first published in 2009 by the former Navy Medicine Institute for the Healthcare
Humanities and Research Leadership. The Journal was transferred to the new publisher in
2012 as a private publication. The publisher today continues the mission of the Journal to
benefit international academic and professional development regarding health, health care, the
humanities, the sciences, and social justice. ISSN (print): 2159-8800. ISSN (online): 2159-8819.
Correspondence
Manuscripts are to be submitted to the Editor-in-Chief. Submission of a manuscript
is considered to be a representation that is not copyrighted, previously published, or
concurrently under consideration for publishing by any other entity in print or electronic form.
Contact the JHSH Editor-in-Chief for specific information for authors, templates, and new
material. The preferred communication is through email at jhsh@cryptyictruth.com or via
voice at + 1 (334) 724-4554.
Subscriptions
Beginning in calendar year 2016, the Journal will be available through a standard
subscription service. More information will be made available for the purchase of a yearly
subscription in calendar year 2015. For all editions of the Journal prior to the year 2016,
online copies are freely available at:Jhsh.cryptictruth.com. For more information at: Tuskegee
University National Bioethics Center in Research and Health Care, John A. Kenny Hall, 1200
W. Montgomery Rd., John A. Kenny Hall 44-107, Tuskegee Institute, AL36088.
Tel: + 1 (334) 724-4554.
Copyright Information
As a private sector publication, authors retain copyright for their articles; but grant
to the Journal an irrevocable, paid-up, worldwide license to use for any purpose, reproduce,
distribute, or modify their articles in their entirety or portions thereof. Articles prepared by
employees of the US Government as part of their official duties are not copyrighted and are
in the public domain. The Journal retains the right to grant permission to third party noncommercial purposes only. Third party grantees, however, cannot further delegate their approved
usage to others etc. Third party usage must give credit to the Journal and the author (s). Opinions
expressed in the Journal represent the opinions of the authors and do not reflect official policy
of the institutions they may serve. Opinions in the Journal also do not reflect the opinions of the
publishers or the institutions served by members of the Journal Editorial Board.
ii
Table of Contents
Preface
Journal Editorial Board.................................................................................... 3
Founders Advisory Board............................................................................... 7
Contributing Authors...................................................................................... 11
From the Editor’s Desk.................................................................................. 17
Rueben C. Warren
Articles
Worldviews, Paradigms, and Liminal Spaces: Conflict and Compromise
in the Science and Spirituality Conversation................................................... 21
Shelley E. Brown
Health Optimism in the Face of Health Disparities: Exploring Self-Rated
Health and Chronic Disease Status among African American
Christian Congregants..................................................................................... 29
Alicia L. Best, Mallory A. Bembry, Rueben C. Warren
Food Deserts in Upstate South Carolina: How Do We Both Ethically
and Sustainably Feed the Region’s Food Insecure?....................................... 37
Kenneth L. Robinson
Resilience in the Face of Injustice................................................................... 53
De Fischler Herman
Public Health Injustices: “Media is the Message”............................................ 62
Joan R. Harrell
What Does One Do With a Master’s Degree in Bioethics?............................. 70
Elana Aziza, Nicole Devost, Christine McColeman, Gail A. Morris
Commemorating Legacy of Booker T. Washington................................ 83
Author Requirements..................................................................................... 93
iii
Prepared by Graphic Arts and Publishing Services
at The Henry M. Jackson Foundation
for the Advancement of Military Medicine, Inc.
JOURNAL
EDITORIAL
BOARD
Journal EditorialPreface
Board
Executive Director
Rueben C. Warren, DDS, MPH, DrPH, MDiv
The Board of Governors
Tuskegee University Council of Deans
Interim Editor
Interim Senior Associate Editor
The Rev. Joan R. Harrell, DMIN Candidate, MDiv., M.S.
Assistant Senior Associate Editor
Wylin Wilson, PhD, MDiv. MS
Associate Editors
Academic Review Committee Members
Henry Findlay, EdD
Education, Cognition Science Distance
Learning
Tuskegee University
David Anderson, DDS, MDS, MA
Oral Health, Ethics & Health Policy
Pennsylvania Dental Association
Lisa Hill, MA, PhD
American History
Tuskegee University
Moni McIntyre, PhD
Moral Theology
Duquesne University
Brendan Ozawa-de Silva, PhD, MPhil, MTS
Modern History, Philosophy, Theological Studies
Emory University
Theirmo Thiam, PhD, MA
Political Science, International Relations,
Comparative Politics
Tuskegee University
Roberta Troy, MS, PhD
Biochemistry, Molecular Biology,
Health Disparities
Tuskegee University
Malia Villegas, EdM, EdD
Culture, Community Studies, Education
National Congress of American Indians
Academic Review Committee Chair
TBA
David Baines, MD
Family Medicine, American Indian and
Alaska Native Health, Spirituality and Culture
Anchorage Neighborhood Health Center
University of Washington
Mill Etienne, MD
Neurology
Bon Secours Charity Health System
New York Medical College
Crystal James, JD, MPH
President/CEO
Crysalis International Consulting, LLC
Frederick Luthardt, MA, MA
Bioethics, Research Ethics,
Human Research Protections
John Hopkins University
George Nasinyama, BVM, MS, PhD
Epidemiology, Food Safey, Ecosystem Health
Makeree University
Michael Own, Med, PhD
History, Education, Human Research Ethics,
Research Integrity
University of Ontario Institute of Technology
Edward L. Robinson Jr, PhD, MA
Instructor
Fullerton College
Richard Wilkerson, PhD
Entomology
Smithsonian Institution
(cont.)
3
Journal Editorial Board
Preface
Manuscript Editorial Committee
Members
Jere M. Boyer, PhD, CIM, CIP, CCRP
Clinical Microbiology, Molecular Biology &
Immunology, Infectious Diseases,
Tropical Medicine
Clinical Research Management, Inc.
Copy Editing Intern
Jordan Harris
Chemical Engineering & Pre-Law
Tuskegee University
Sydney Freeman, Jr, PhD
Higher Education Administration
Thomas C. Jefferson, MD, CIP
Pediatric Medicine, Health Care Ethics,
Literature and the Humanities
United Health Group
4
FOUNDERS
ADVISORY
BOARD
Journal Founders AdvisoryPreface
Board
The Founders
The Founders is a special advisory board to the Editor of the Journal of Healthcare, Science
and the Humanities. The Founders provide continual advisement to the Editor in three key
areas of development: New Areas for Publication, New Candidate Authors, and New Areas for
Mission Expansion.
Mr. Ricky Allen
Dr. David Anderson
Mr. Garrett Anderson, Esq
Rev. Paul Anderson
Dr. L. Edward Antosek
Dr. Joshua Arthur
CDR Charmagne Beckett
Ms. Pamela Berkowsky
Dr. Bruce Boynton
Dr. Cedric Bright
Dr. Donna Burge
Dr. Fred Cecere
Ms. Mamie Clemons
Mr. Justin Constantine, Esq
Dr. Betty Neal Crutcher
Dr. Annette Debisette
Rev. Randall Ekstrom
Ms. Aynalem Etienne
Dr. Mill Etienne
Dr. Mohammed Fatoorechie and Family
Dr. Carol Fedor
Mr. Paul Finch
Mr. Mark Flores
Ms. Sharon Fullilove (In Memoriam)
Ms. Georgianne Ginder
Dr. Shirley Godwin
Mr. James Hanlon
Rev. Joan Harrell
Rabbinic Pastor De and Mr. Jan Herman
Dr. Elizabeth Holmes
Dr. Thomas Jefferson
Mr. George Jones
CAPT Marvin Jones
Dr. Anthony Junior
Dr. Patricia and Mr. Stephen Kelley
RDML (Ret) William Kiser
Mr. David Lash
RDML (Ret) Eleanor Valentin Larsen
Mr. Frederick Luthardt
Dr. Eric Marks
Dr. James Martin
Rev. Dr. Moni McIntyre
Dr. Adam McKee
Mr. David Mineo
LTC Craig Myatt
Rev. Andrew Ovienloba
RADM (Ret) Karen Flaherty Oxler
Dr. Steven Oxler
Dr. Brendan Ozawa-de Silva
Col Susan Perry
Dr. Clydette Powell
CDR James Rapley
Ms. Ann Marie Regan
Mr. Tony Richard
Dr. Thomas Roberts
CAPT Joel Roos
Dr. Margaret Ryan
Dr. Michaela Shafer
Dr. Jennifer Shambrook
Mr. J. Michael Slocum, Esq
Dr. William Kennedy Smith
Dr. Alexander Stojadinovic
BG (Ret) Loree Sutton
Mr. Shelby Tudor
Dr. Rueben C. Warren
Rev. Eric Wester
CAPT Moise Willis
Rev. Charles Wilson
Dr. Dorian Wilson
Mr. Daniel Winfield
Rev. Dr. Lorenzo York
Dr. Julie Zadinsky
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CONTRIBUTING
AUTHORS
Preface
Contributing Authors
Elana Aziza, MHSc Reg CASLPO, MHSc, (Bioethics) is a speech-language pathologist
practicing in oncology and acute care at University Health Network in Toronto. She practices
primarily with head and neck cancer patients, and includes assessment, support, treatment and
advocacy for patients who have communication and swallowing disorders. She is a lecturer
(status only) with the Department of Speech-Language Pathology, Faculty of Medicine,
University of Toronto.
Mallory Bembry, BS is currently a second year graduate student in the Master of Public
Health Program at Morehouse School of Medicine. She obtained her Bachelor of Science in
Plant Science Biotechnology at Fort Valley State University. She is currently completing her
Practicum Experience at HEALing Health Center, a federally qualified health center in MetroAtlanta. Her focus is on health education and promotion among underserved communities.
Upon graduation, Ms. Bembry plans to pursue a Doctor of Public Health degree.
Alicia Best, PhD, MPH is the Director of Research and Community Health at the HEALing
Health Center, a federally qualified health center that provides care to underserved populations
in Metropolitan Atlanta. She received postgraduate training in behavioral research with a focus
on cancer-related health disparities at the American Cancer Society and her research focuses on
understanding mechanisms through which behavioral, psychosocial, and cultural factors (e.g.
spirituality) influence health disparities among African Americans.
Shelley E. Brown, PhD, MDiv is a postdoctoral associate in the Department of Biological
Engineering at the Massachusetts Institute of Technology. Prior to MIT, Shelley received
a bachelor’s in Chemical Engineering from Stanford University, and a Masters and PhD in
Biomedical Engineering from the University of Michigan. She recently completed a Master of
Divinity from Harvard Divinity School, where she worked at the intersection of science and
religion, probing bioethical issues surrounding policy and research.
Nicole Devost MD, CCFP, FCFP, MHSc is a family physician solely practicing in Palliative
Medicine at Lakeridge Health, Oshawa, Ontario. She is an assistant professor with the adjunct
(group 1) academic staff in the Department of Family Medicine at Queen’s University for the
residency program and supervise residents for Palliative Care electives. She writes and develops
mulitple policies for the hospital in the domain of Palliative Medicine.
The Rev. Joan R. Harrell, MS, MDIV, DMin (cand) is an ordained American Baptist
clergywoman, womanist public theologian, graduate of the Columbia University Graduate
School of Journalism in New York City, award-winning broadcast journalist and television
documentary producer, and strategic external communications consultant for the National
Center for Bioethics in Research and Health Care at Tuskegee University.
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Preface
De Fischler Herman is an ordained rabbi and spiritual director from the ALEPH: Alliance for
Jewish Renewal Seminary. She serves as chaplain for Capital Caring Hospice in Washington,
DC, ministering to patients, families and caregivers. She received her Clinical Pastoral
Education (CPE) certificate from Washington Hospital Center, the Level 1 Trauma Center
for the nation’s capital. Rabbinic Pastor Herman has served as distinguish faculty at four
Smithsonian Educational Ethics courses.
Christine McColeman RRT, BA, MHSc is a registered respiratory therapist working in acute
care at the Scarborough Hospital, Birchmount Division. She has been a practicing clinician for
32 years. During her years of practice she has encountered many challenging ethical dilemmas.
It was these situations that brought her to the Master of Health Sciences Program in Bioethics at
the University of Toronto. The depth and breadth of the program provided her with the ethical
framework needed to continue advocating for her patients providing the best possible care. She
functions as an “Ethics Facilitator” at her hospital and has assisted with Policy Revisions for
CPR/No CPR documents.
Gail A. Morris, BPE, MD, CCFP, MHSc (Bioethics) is a family physician in Markham,
Ontario. She is a lecturer in the Department of Family and Community Medicine with the
University of Toronto. In affiliation with the University of Toronto, she supervises and teaches
Family Medicine Residents at Markham Stouffville Hospital in Markham, Ontario. As well, she
is a member of her hospital’s Ethics Board and Research Ethics Board. She has participated in
policy development for her hospital in the areas of Research Ethics and End-of-Life Issues.
Kenneth L. Robinson, PhD is associate professor in the Department of Sociology and
Anthropology, Clemson University. He earned his Ph.D. in Development Sociology at Cornell
University, Ithaca, NY, a Master of Public Affairs from The University of Texas at Austin,
and his bachelor’s degree in Agricultural Economics and Rural Sociology from Clemson
University. He also served as a Fulbright fellow at the University of Zululand, South Africa.
His publications include Lori A. Dickes and Kenneth L. Robinson, Rural Entrepreneurship and
Chapter 30 in Rural America in a Globalizing World, edited by Conner Bailey, Leif Jensen and
Elizabeth Ransom Morganton, West Virginia: West Virginia University Press, (In-press).
Rueben C. Warren DDS, MPH, DrPH, MDiv is professor of bioethics and director, Tuskegee
National Bioethics Center in Research and Health Care. His full professor appointments are
at the following institution: the Interdenominational Theological Center, Morehouse School
of Medicine; Emory’s Rollins School of Public Health, Schools of Dentistry and Graduate
Studies, Meharry Medical College (MMC). He is the former Associate Director for Minority
Heath, Centers for Disease Control and Prevention and directed Infrastructure Development at
the National Institute for Minority Health and Health Disparities, NIH. He is Dean Emeritus,
School of Dentistry, MMC.
12
FROM THE
EDITOR’S DESK
Preface
Message from the Interim Editor
Rueben C. Warren DDS, MPH, Dr. P.H., M.Div.
Professor and Director of the National Center
for Bioethics in Research and Health Care
Tuskegee University
Tel: (334) 724-4554
Email: warren@mytu.tuskegee.edu
The year 2015 provides an exciting array of historical and current events to celebrate the
legacy of Tuskegee University and the vision and mission of the National Center for Bioethics
Research and Health Care. Tuskegee University was founded in 1881 to provide training and
educational opportunities for Black children and adults to improve the well-being of the Black
population in the U.S. Booker T. Washington was the founding principal and president of
Tuskegee University, first known as Tuskegee Normal School, then Tuskegee Institute, and now
Tuskegee University. The National Center for Bioethics in Research and Health Care (Bioethics
Center) was mandated by President William Jefferson Clinton, as one component of the 1997
Presidential Apology for the U.S. Public Health Service Study of Untreated Syphilis in the
Negro Male at Macon County, Alabama. The U.S. Public Health Service conducted this study
at Tuskegee. The vison of the Bioethics Center is: Shaping the Future by Promoting Optimal
Health: The Future is NOW! The mission is: To enhance social justice and Optimal Health
of African American and other health disparity populations through research, education and
service in bioethics, public health ethics, health disparities and health equity. Both the vision
and mission of the Bioethics Center are 21st Century outgrowths of the Tuskegee University.
This 2015 spring edition of the Journal of Healthcare, Science and the Humanities offers peer
reviewed articles that address public health concerns within the context of the theme, “Ethics
and Social Justice.” The articles derived from lectures that were delivered at the April 1- 4, 2014
Public Health and Ethics Intensive Course and Commemoration of the Presidential Apology
for the United States Public Health Syphilis Study.
The Journal highlights the trans-disciplinary imperative that the sciences, including health
science, must collaborate with disciplines in the humanities to address the broader issues
of individual, group and community based health and well-being. The topic areas in the
peer reviewed articles published in this edition range from resilience in the face of injustice,
food deserts in upstate South Carolina, the media and social media, spirituality and science
conversations, and health optimism in the face of health disparities. One of the articles addresses
the questions of value of the master’s degree in bioethics.
The year 2015 marks the 100th year since the death of Booker T. Washington. One hundred
years ago in 1915, Booker T. Washington founded National Negro Health Week. Tuskegee
University is celebrating the many accomplishments of Booker T. Washington by hosting an
event each month during 2015. On April 17th, Tuskegee University, the Centers for Disease
Control and Prevention and Morehouse School of Medicine will partner in co-sponsoring a
15
Preface
national forum entitled, “From Negro Health Week to Minority Health Month: 100 Years of
Public Health Progress.” The forum highlights the challenges and opportunities to improve the
health of African Americans and other health disparity populations. The vision is to move from
health disparities to health equity.
The articles in this edition should be read in the broader context of social justice through
an ethics lens. For example, 2015 is the 50th anniversary of Bloody Sunday that occurred on
March 7th, and days later, Dr. Martin Luther King Jr. and many others marched from Selma to
Montgomery, nonviolently protesting for African Americans to have the right to vote in the Jim
Crow South. The year 2015 is also the 50th anniversary year of the signing of the Voting Rights
Act. As we move forward to address the issues of social justice and various spheres of ethics,
the articles have expanded traditional ways health and bioethics are viewed by challenging the
reader to find common ground and synergies between the topic areas addressed in the articles.
The ethics challenges in the 21st Century remain, however they sometimes must be researched,
investigated and critiqued within the context of a person or community’s social location such
as his or her race, ethnicity and or socio-economic class, in order to address meaningful and
long lasting resolve. Instead of focusing only on health disparities, curative care modality to
address disease, disability, dysfunction and premature death, consider a paradigm shift to health
promotion, domains of complementary and alternative medicine and health equity. Consider
physical and metaphysical constructs as complimentary, not competitive. It is important to note,
that health is one’s greatest state of aliveness; a journey, not a destination. The content of this
edition challenges the reader to embrace all dimensions of the human experience as they read
and reflect on the peer reviewed articles and resources included in this volume.
16
Preface
National Center for Bioethics in Research
and Health Care
Public Health Ethics Intensive Course Public Health Ethics aInd ntensive ourse “Ethics Social CJustice” “Ethics and Social Justice” And And Commemoration f the Presidential pology Commemoration of the o
Presidential Apology fA
or the for the Public HSealth yphilis Study U.S. PU.S. ublic Health ervice SService yphilis S
Study TUESSDAY
, APRIL 1, 2014
Schedule at a Glance Schedule at a Glance April 1-‐4, 2014 1-‐4, 2014 April Tuskegee University Tuskegee University Kellogg Hotel and Conference Center Kellogg Hotel and Conference Center TUESSDAY
, APRIL 1, 2014
8:30 am Registration and Continental Breakfast 9:15 am -‐ 9:25 am Welcome: President Matthew Jenkins, DVM 8:30 a
m Registration and Continental Breakfast 9:25 am – 9:35 am Mayor Johnny Ford -‐ a9m :25 Welcome: Paxwell resident 9:35 9:15 am – a9m :45 a m Chairman Louis M
M
atthew J enkins, D
VM – 9a:35 M
Johnny Ford M
PH, D
r. P H, M
Div 9:45 9:25 am – a1m 0:00 m a
m Overview: Rayor euben Warren, DDS, 9:35 am – 9:45 am Chairman Louis Maxwell 10:00 am a
– m 11:00 am Science Conflict r Compromise? D
DS, MPH, Dr. PH, MDiv 9:45 – 10:00 am and Spirituality: Overview: Roeuben Warren, Shelley E. Brown, PhD, MS, MDiv 10:00 am – 11:00 am Science and Spirituality: Conflict or Compromise? 11:00 am – 12:30 pm Small Group Session Shelley E. Brown, PhD, MS, MDiv 12:30 pm – 1:30 pm Lunch m p–m 12:30 pm Small Group Session J ustice C ontext Beyond 1:30 11:00 pm – 3a:00 Landscaping Global Public Health in a S ocial pm – 1:30 pm Epidemiology 12:30 Lunch Bailus Walker, Jr., PhD, MPH pm – 3:00 pm 1:30 Landscaping Global Public Health in a Social Justice Context Beyond 3:00 pm – 4:30 pm Small Group Session Epidemiology 4:30 pm – 6:00 pm Tour Bailus Walker, Jr., PhD, MPH 3:00 pm ,–A 4PRIL
:30 2,
pm WEDNESDAY
2014
4:30 pm – 6:00 pm Small Group Session Tour WEDNESDAY, APRIL 2, 2014
17
3:00 pm – 4:30 pm 4:30 pm – 6:00 pm Epidemiology Bailus Walker, Jr., PhD, MPH Preface
Small Group Session Tour WEDNESDAY, APRIL 2, 2014
7:00 am – 8:00 am 8:00am – 9:00 am 9:00 am – 10:30 am 10:30 am – 11:30 am 11:30 am – 1:00 pm 1:00 pm – 2:00 pm 2:00 pm – 3:00 pm 3:00 pm – 4:30 pm 4:30 pm – 6:30 pm Continental Breakfast Social Justice and Native Americans: The U.S. Experience David Baines, MD Small Group Session Small Group Session Lunch Small Group Session Tour Interfacing Science and Ethics as a Social Justice Construct Ralph V. Katz, DMD, MPH, PhD Justice, Food Systems and the Agricultural Black Belt Ralph Christy, PhD THURSDAY, APRIL 3, 2014
8:00 am – 9:00 am Resilience in the Face of Injustice Rabbinic Pastor De Herman, RPSD
9:00 am – 10:30 am Small Group Session 10:30 am – 12:00 pm Social Media and Social Justice: The Media is the Message Joan R. Harrell, MDiv, MS, Doctoral Candidate
12:00 pm -‐ 1:00 pm Lunch COMMEMORATION ACTIVITIES
THURSDAY, APRIL 3, 2014
1:00 PM
6:00 PM
Presenter
Reception (By Invitation Only)
FRIDAY, APRIL 4, 2014
7:30 – 8:45 AM
Breakfast (Auditorium Foyer)
9:00 – 11:30
Lecture & Panel Session (Auditorium)
COMMEMORATION KEYNOTE SPEAKER
12 NOON
Luncheon (Ballroom)
18
ARTICLES
Articles
Worldviews, Paradigms, and Liminal Spaces: Conflict and
Compromise in the Science and Spirituality Conversation
Shelley E. Brown, PhD, MDiv
Massachusetts Institute of Technology
Department of Biological Engineering
77 Massachusetts Avenue
Cambridge, MA 02139
Email: sebrown@mit.edu
Author Note
The views expressed in this article are those of the author and do not reflect the official policy
or position of the faculty, staff, administration, students or any affiliated individuals with the
Massachusetts Institute of Technology or the Department of Biological Engineering. This
subject material is a collection of ideas presented in a lecture at the 2014 Tuskegee Public
Health Ethics Intensive (PHEI) Course.
Abstract
Correlative to the tremendous growth biomedical research has experienced over the past
decade, so too have theological responses and criticisms of the research proliferated within faith
communities. The history of the competing worldviews in the science and spirituality discourse
necessitates further dialogue about whether this conflict is met with compromise. As such, this
paper aims to discuss multiple perspectives from prominent scientists whom have developed
very intellectually satisfying and spiritually keen ways to overcome the conflict with compromise
by looking at the complementarity that exists. Moving forward on the ethical journey that
is biomedical research and its particular relevance to and resonance within minority faith
communities, the various worldviews and paradigms both communities uphold provide fertile
ground for interdisciplinary dialogue about scientific discovery and faith.
Keywords: Worldviews, science, spirituality, paradigm, evolution, intelligent design,
biomedical ethics
Introduction
In his book The Language of God, Dr. Francis Collins posits an important question
that frames the science and religion debate for the purposes of this paper:
“By opening the door of my mind to its [science] spiritual possibilities, had I started a war of
worldviews that would consume me, ultimately facing a take-no-prisoners victory of one or the other?”
The conflict is one that many see as a battle between ways in which people view the
world, and is ever so present at the nexus between science and spirituality. However, I believe
there are constructive ways that both communities can explore and create this liminal space
where multidisciplinary dialogue can take place in an effort to produce a paradigm shift in
21
Articles
the way both communities respond to each other. Does it have to be an “either-or” model,
or can we have a “both-and” paradigm? We are in need of understanding, common ground,
and reconciliation in this territory of conflict. Therefore, this paper seeks to contribute to
the efforts of rethinking and assigning new meaning to scientific and spiritual worldviews,
where faith in science and faith in God don’t have to be mutually exclusively held perspectives.
There is a delicate balance that can be struck in the liminal space between the two bodies of
thought where one does not have to be anti-scientific or anti-religious, but rather can embrace
that which is scientific and that which is spiritual. This liminal space, a threshold that we can
cross and enter into, is a place in between previously held worldviews and the possibility of
a new answer. It is the place of transition into a new mode of perceiving the natural and the
supernatural – the explainable and the unexplainable. The late Stephen Jay Gould, an American
evolutionary biologist and historian of science, coined the term “non-overlapping magisteria” to
refer to science and religion as being individually legitimate magisteria, or domains of teaching
authority. Many members of both the scientific and religious communities may hold Gould’s
worldview that the two domains are non-intersecting spheres. Where the magisterium of science
explains how the universe works, and the magisterium of religion explains why the universe and
life came about. Although there may not be one clear answer on how to develop a worldview
that is just as intellectually sharp as it is spiritually open, what is clear is that society operates
within the overlapping magisteria of science and religion. Therefore, it is of great importance
that we develop effective dialogue and carve out the liminal space that produces new paradigms
and standards for addressing the conflict and compromise within the science and spirituality
conversation. As Collins states, “we need to bring all the power of both the scientific and
spiritual perspectives to bear on understanding what is both seen and unseen”.
The unique position of being a scientist and ordained minister provides me the
opportunity to investigate this matter with the hope that society can enter into the liminal space
that exists between science and spirituality. I would like to lay the foundation for depolarizing
worldviews that position science and spirituality, which will be used interchangeably with the
term “religion”, on opposite ends of the spectrum. My intention is not to present ideological
arguments about the beginning of the universe or life on this planet; nor is it my goal to present
a case for or against specific biomedical technologies or advancements. Rather, this paper can
be read as an open invitation for all invested communities to enter into a respectful and honest
discussion over these issues. As scientists, religious leaders, ethicists, policymakers and the
public so often seem to talk past one another; I aim to present ideas from scholars that have
already begun the groundwork for developing new rules of engagement that are catalysts for
the aforementioned paradigm shift. My intention is to create a space where multiple groups
with diverse histories and perspectives can fruitfully engage with one another. I put forth
the assertion that this space is not only necessary for society as a whole, but is also within the
context of biomedical ethics, theological understanding, and social justice. In addition, I believe
it is paramount that minority faith communities need to consider the importance engaging
scientific and spiritual worldviews. With the understanding that neither the scientific nor
religious communities are monoliths, prevailing sets of beliefs upheld by both communities
will be discussed.
22
Articles
BioLogos
“The need to find my own harmony of the worldviews ultimately came as the study of
genomes – our own and that of many other organisms on the planet – began to take off, providing
an incredibly rich and detailed view of how descent by modification from a common ancestor has
occurred.”
Dr. Francis Collins states this view as he addresses the topics of Darwinian evolution,
creationism, and Intelligent Design, and develops the idea of “theistic evolution”. Although
not widely referred to as such, it is the major position of scientists who are also Christians,
including Asa Gray who was a renowned 19th century botanist and chief Darwinian supporter
and colleague. Collins goes on to suggest that a modest alteration of theistic evolution is to
rename it as “Bios through Logos”, or simply “BioLogos”. Where the Greek word for life,
bios, and the Greek word for “word”, logos, are combined to express “the belief that God is
the source of all life and that life expresses the will of God.” It is the theory that “evolution
could appear to us to be driven by chance, but from God’s perspective the outcome would be
entirely specified”. Therefore, we could take on the view that God has already orchestrated
every intricate detail and that, in fact, He is intimately involved in the formation of every living
species in the universe. If we embrace the Tillichian view that faith isn’t the opposite of doubt,
but rather doubt is an essential element of faith, then one can become more comfortable in
the uncertainties that inevitably exist in life. This is the basis upon which Collins builds the
case for science and faith in harmony. Since society historically defaults to conflict instead of
peace, the uptake of BioLogos into the lexicon of the science and spirituality discourse has
been unhurried. So how can BioLogos be seriously considered without being perceived as
committing violence to faith, science, or both? BioLogos stands to be one of those ideas results
from existing in the liminal space between worldviews, thus possibly being a catalyst for major
shifts in thinking and understanding.
Dr. Thomas S. Kuhn first published The Structure of Scientific Revolutions in 1962,
and in it he first introduced the concept of paradigm shifts in science. Then in The Road Since
Structure, a book published in 2000 that revisits a collection of essays Kuhn wrote regarding
scientific revolutions, he distinguished between two types of scientific development; normal
and revolutionary. The majority of scientific achievements build a growing body of scientific
knowledge and produce the former type of change – normal. However, “revolutionary change
is defined in part by its difference from normal change, and normal change is, as already
indicated, the sort that results in growth, accretion, and cumulative addition to what was
known before.” This type of change is inherently more problematic and jolting, and includes
scientific discoveries that cannot be accommodated within the paradigm in place. It is the type
of discovery that drastically alters the way an individual views, explains, and understands a set
of natural phenomena. Examples of these types of revolutionary changes throughout history
include: (1) The shift from the Ptolemaic geocentric cosmology to Copernicus’ heliocentric
worldview; (2) The paradigm change from Aristotelian physics, where matter is almost
dispensable, to Newtonian laws of motion and physics, where a body is constituted of particles
of matter; and lastly, (3) The introduction of evolution by Darwin.
Kuhn states “violation or distortion of a previously unproblematic scientific language
is the touchstone for revolutionary change.” These examples all inspire the altering of the
language with which the natural world is described, subsequently changing the language with
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which the scientific community explains nature. This also, at first glance, appears to challenge
the worldview of the Christian community. That is why Collins asserts that BioLogos is the
synthesis of a scientifically consistent and spiritually satisfying paradigm: one which allows for
“science and faith to fortify each other like two unshakable pillars, holding up a building called
Truth.” It does not try to impose God into the gaps in knowledge of our understanding of the
universe and the evolution of life, but rather it suggests God as the answer to the “meaning of
life”. The existentialistic questions that science was never intended to solve. Moreover, from
a faith perspective, BioLogos offers a solution to the uncertainty of interpretation of certain
Scriptural passages. It is not wise for sincere believers to rest the entirety of their worldview
on evolution solely on literal interpretation that does not allow room for uncertainty. Collins
does not believe that God, the Creator of the universe, “would expect us to deny the obvious
truths of the natural world that science has revealed to us.” The conflict between scientific
observations and religious belief, and how that relates to the human condition is one that will
not disappear into the background. Both the scientific and spiritual worldviews seek to discover
something external to ourselves. To understand the sacred and the secular overlap can prove
to be quite beneficial when trying to grasp the fullness of life and its great mysteries. Collins
asserts that while discovering a scientific truth can catapult a scientist into an experience that is
void of natural properties and causes, BioLogos can allow a person with scientific and spiritual
worldviews the opportunity to seek truth on multiple levels. However, the atheist view that is
held by many to be synonymous with the scientific worldview is that this feeling or belief in
something beyond ourselves is just an expression of joy, and is fueled by a longing to invent an
answer to our human existence that we want to be true. In contrast to this, Collins believes that
for the scientist-believer “both worshiping God and using the tools of science to uncover some
of the awesome mysteries of His creation” is vital and necessary for the synthesis of the scientific
and spiritual worldviews.
As such, Collins cautions both scientists and Christians alike. His belief is that we
are on dangerous ground when we take a hardened and steadfast position on either end of the
spectrum. Whether naturalists believe that a Creator God is an outmoded superstition, or
Christians believe that technological advances threaten the existence of God, both choices are
profoundly perilous. This points to the fact that perhaps it is time to embrace the “both-and”
paradigm; it is time to make the shift from “either-or”. Collins states that “both deny truth…
both diminish the nobility of humankind…and both are unnecessary.” The same God of the
Bible is that of the genome, and He can be worshiped in a sanctuary and in a laboratory.
Evolutionary Creationism
“This is a book written by someone who is passionate about both science and the Bible,
and I hope reading it will encourage you to believe, as I do, that the ‘Book of God’s Word’ and the
‘Book of God’s Works’ can be held firmly together in harmony.”
The above is an excerpt from Creation or Evolution: Do we Have to Choose by Dr.
Denis Alexander, in which he discusses how evolution has been “used and abused for various
ideological and political reasons” throughout the past century. In response to that he probes
questions such as: (1) In what ways can we invoke the presence and works of God when it comes
to major fundamental questions about the universe?; and (2) Have we considered the possibility
that science was never intended to be able to answer such questions about the origins of the
universe, life as we know it, or the human experience after death?
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He first begins by dispelling the myth that in the Origin of Species, Charles Darwin
“unleashed a sinister plot to subvert belief in a Creator God”. Evidence actually suggests that
Darwin was not atheist and that his personal inclinations led him to believe that “there is
grandeur in this view of life, with its several powers, having been originally breathed by the
Creator into a few forms or into the one.” Alexander also points out that later in life, Darwin
was quoted to have said that is entirely possible to be ‘an ardent Theist and an Evolutionist’.
Given the “rapid baptism of evolution into the Christian doctrine of Creation in the late 19th
and early 20th centuries”, it is quite curious as to why a belief in evolution now demands atheism.
He suggests that ideological transformations of biology as it relates to the big theories such as
Big Bang cosmology and evolution have occurred because the public consciousness changes
the actual meaning of the label given to the theory itself changes. “Theory ‘X’ becomes socially
transformed into ‘Theory Y’ with all kinds of philosophical barnacles attached to it”. So much
so that the work it takes to remove these barnacles is continuous. Therefore, in an effort to
rectify this within the evolutionary debate, Alexander suggests that a better route was taken
by Bible-believing Christians such as B.B. Warfield and Asa Gray. Evolutionary creationism
provides the opportunity to “fully accept the authority of Scripture and the biblical doctrine
of creation, but [traces] God’s providential purposes and handiwork throughout the long
evolutionary process”. Although there may be gaps in our understanding of what God continues
to do in His creation, there are no gaps with God’s interaction with the world and human affairs.
If one were to look at the Genesis text as “an evolutionary narrative thread which describes
how God brought biological diversity into being and continues to sustain it all moment by
moment”, then evolution can be brought into the fold in our Christian worldview. This is not
a new concept, but rather a reintroduction of it by Alexander. He is careful to present this idea
with the disclaimer that he is not concluding that the adoption of “evolutionary creationism
resolves at a stroke all the problems”, but rather that “it provides a well-justified framework for
continuing to hold together the book of God’s Word and the book of God’s works in ways that
does justice [and not violence] to both.”
To further emphasize this point, it is prudent to visit the position that Dr. Owen
Gingerich, world renowned astronomer and historian of science at Harvard University,
presents on the cultural attitudes that help shape both scientific and religious worldviews. In
his book God’s Planet, he unfolds a compelling narrative that intertwines his Christian faith
and in depth knowledge of the cosmos. He addresses the conflict of the scientific and spiritual
worldviews by positing the idea that the magisterium of science alone is not independent, but in
fact overlaps with the magisteria of religion and culture. By addressing fundamental questions
about the planets and how life has evolved on Earth, he unearths the falsehood that science and
religion should be kept mutually exclusive and separate. He presented his argument on how the
magisteria have been repeatedly overlapped in the past few centuries by questioning whether
Copernicus correct in replacing the Earth with the sun at the center of the universe; whether
Charles Darwin was correct with his epoch-making book, On the Origin of Species; and whether
Fred Hoyle was correct with his steady-state cosmology that suggested continual creation with
no beginning and no end. Gingerich concludes that “the physical constants have been finetuned to make intelligent life in the universe possible and that this is evidence for the planning
and intentions of a Creator God.” Furthermore, it is his scientific understanding of the finetuning of physical constants in the universe that supports his theological understanding that
“the heavens declare the glory of God.” Accepting a Creator God as a final cause for “why the
universe seems so congenially designed for the existence of intelligent, self-reflective life” is not
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necessarily proof, but it propels us further into the liminal space where the explainable and the
unexplainable live in harmony. Near the conclusion of his book he states:
“And finally, I hope that in these chapters I have persuaded you that what is accepted today as science is commonly colored by personal belief, including our religious or our antireligious sentiments. If someone tells you that evolution is atheistic, be on guard.
If someone claims that science tells us we are here by pure chance, take care. And if
someone declares that magisteria do not overlap, just smile smugly and don’t believe it.”
With the arguments that Dr. Collins, Dr. Alexander, and Dr. Gingerich put forth,
society would be hard pressed to deny that the conflict that is present within the worldview
debate needs to be revisited, revamped, and reversed.
Conclusion:
The Critical Need for Paradigm Shifts of Worldviews
When biomedical research produces knowledge that raises new theological questions,
the religious community (and society as a whole) is challenged to develop definitive boundaries,
ethical paradigms, and theological responses to new medical treatments and information about
our natural world. As society forges pathways to partnership on a multitude of issues, instead
of letting failures and controversies drive reform, it is prudent to learn from past mistakes and
develop ways to collaborate on addressing salient bioethical, policy, and religious issues. The
recommendations for collaborative partnerships described here must be authentic, and they
must engender mutual trust between both communities. This is because there is a dire need
to understand the complexity of this debate not only for us as a society as a whole, but within
minority faith communities and populations. Congregational leaders are bombarded with
questions about health, health care, bioethics, and medicine in this modern biotechnological
world, and we must be able to have informed discussions and solutions.
Within the scientific community, there is a culture of skepticism where scientific
information is only regarded as absolute truth once a statistically significant p-value is obtained
and investigations yield repeatable results. Therefore, if one looks at the scientific community
as a producer of authoritative knowledge, the majority of the conversation about ethics takes
a very different turn from that in a religious context. Whereas, when biomedical research
produces knowledge that raises new theological questions, the religious community (and society
as a whole) is challenged to develop definitive boundaries, ethical paradigms, and theological
responses to new medical treatments and information about our natural world. As a thought
experiment, it would be interesting to introduce certain concepts into the scientific and spiritual
worldview discourse in order to raise a few thought provoking questions for secular and faithbased ethicists alike. How might minority faith communities take to the concepts of theistic
evolution, BioLogos, and evolutionary creationism? Due in part to the fact that the authority
of science is perceived to conflict with the authority of religion, where this is no compromise, we
have to begin to shift toward the liminal space where biomedical research and faith-based ethics
intersect with and inform one another. How can we begin to close the gap between the scientific
and spiritual worldviews in such a way that they are perceived as overlapping magisteria and not
in conflict with one another? How do we forge pathways to partnership as more technological
advances are introduced into society at a very rapid rate?
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As a catalyst for a paradigm shift in worldviews, I compel both the scientific and
religious communities to push beyond their normal modes of thinking in order to enter into
the liminal space that exists between science and religion. There are common goals that both
communities share as they try to make contributions to the world. Both communities endeavor
to uplift the human condition by understanding the natural world that we live in. With the
understanding that science is ever-changing and evolving, we don’t possess all of the answers
to the mysteries of the universe, life itself, and the human body. Our modes of thinking will
continue to change and we will be constantly confronted with new knowledge and truth
claims. Therefore, as discussed in the 2013 PHEI in terms of forging pathways to partnership,
how can we look forward on this ethical journey to also heal the relationship between
spirituality and scientific research? We cannot try to reconcile the scientific and spiritual
worldviews, while perceiving such actions as committing violence against either. We should
seek harmony, not discord, when it comes to all matters. The ability to respectfully disagree is
a necessity, and the capacity to understand another’s perspective is indispensible. Eliminating
the need to disprove one’s cosmology and view of the world creates a malleable situation that
allows new ethics and viewpoints to be established. As stem cell therapy, synthetic biology,
regenerative medicine, genetic testing, and personalized medicine become more of a reality for
standard practice of care for diseases that disproportionately affect minorities, how can we be
prepared to move with this shift?
Equipping our future pastors and ministers with the ability to handle these types of
questions in an ever-advancing technological world is one solution to this complex conversation
about science and spirituality. We don’t have to fall behind our majority counterparts in this
area. As the church still remains a bulwark and structure for strength, power, and participation
in society, how can we address these topics and their relation to minority faith communities as
well? I wholeheartedly put forth the assertion that our society has made huge strides in healing
and correcting the damage and pain caused by the U.S. Public Health Service Syphilis Study
at Tuskegee. However, it is always important to note that it was announced and promoted
in churches, which serves as a prime example of why religious communities needs to be
equipped and educated such that injustices and harm are never inflicted upon uninformed
and miseducated faith communities again. We must continue to explore the relationship of
health care ethics, bioethics, and research ethics with social justice, and the needs of vulnerable
populations. The tensions and opportunities for collaborative work between these spheres of
ethics, and between the scientific and spiritual worldviews, are necessary. Faith communities
are put at risk when they adopt a purely spiritual worldview that is void of scientific discussion,
and scientific research is put at risk when it adopts a purely natural worldview that is void
of the possibility of that which is unexplainable. There are many challenges that we face as
practitioners of medicine, research, public policy, and faith – and we must be able to identify
how our work is always informed by contemporary social justice issues. All of this taken together
is further proof that one cannot regard different domains of knowledge and teaching authority
as separate. The overlapping magisteria of science, religion, and ethics must coalesce and be
brought to bear on our most pressing and challenging social issues of our time. This coupled
with a shift in worldviews, leads me to believe we are heading in the right direction.
In summary, I am astounded, the National Center for Bioethics in Research and
Health Care at Tuskegee University is intentionally working within a context of “Ethics and
Social Justice” and for framing science as a social justice construct, because it is just that.
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We must consider how to best understand and utilize biomedical knowledge within our
communities, and how to develop responsible ethics (and theological responses) about the
modern medical technologies and treatments that are made available. This begins when we call
for a cease-fire from both the scientific and religious communities, and think of new ways to
coexist. So to finally offer an answer to the question posed at the beginning of the paper: we do
not have to participate in the war of the worldviews, but can rather move away from conflict
and more toward compromise with persistence and consistence, where ethically sophisticated
scientists and scientifically educated Christians endeavor to develop new paradigms for
engagement and collaboration.
References
Alexander, D. (2008). Creation or Evolution: Do We Have to Choose?. Grand Rapids:
Monarch Books.
Collins, F. (2006). The Language of God. New York: The Free Press.
Darwin, C. (1872). The Origin of Species. London: John Murray.
Gingerich, O. (2014). God’s Planet. Cambridge: Harvard University Press.
Kuhn, T. (2000). The Road Since Structure. Chicago: The University of Chicago Press.
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Health Optimism in the Face of Health Disparities:
Exploring Self-Rated Health and Chronic Disease Status
among African American Christian Congregants
Alicia L. Best, PhD, MPH, CHES
Director, Research and Community Health
HEALing Community Center
2600 Martin Luther King, Jr. Drive SW, Suite 100
Atlanta, GA 30311
Phone: 678.704.4337
Email: aliciaLbest@gmail.com
Mallory A. Bembry, BS
Master of Public Health Student
Morehouse School of Medicine
Email: mbembry@msm.edu
Director and Professor
National Center for Bioethics in Research and Health Care
Tuskegee University
Email: warren@mytu.tuskegee.edu
Authors’ Note
This study was approved by the Institutional Review Board at Morehouse School of Medicine.
The authors have no financial relationships to disclose.
Abstract
The purpose of this study was to compare chronic disease status and self-rated health (SRH)
between African American adults in the general United States (U.S.) population with a sample
of African American Christian congregants. A descriptive analysis was conducted comparing
data from the 2006 Behavioral Risk Factor Surveillance System and data collected at four
national Christian conventions. SRH and self-reported prevalence of seven chronic conditions
(hypertension, diabetes, asthma, overweight/obesity, cancer, kidney disease, and HIV/AIDS)
were compared among African American adults in the general U.S. population and African
American Christian congregants. Adults in the Christian congregant sample reported a higher
prevalence of all chronic diseases assessed, except for overweight/obesity. Additionally, 80.4%
of the Christian congregant sample rated their health as excellent or good, while approximately
79% of African Americans in the general population rated their health as excellent or good.
Although African American Christian congregants reported a greater prevalence of chronic
disease, SRH was almost identical to that of the general population of U.S. African American
adults. Findings highlight the need for public health practitioners and faith leaders to work
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together to ensure that the “health optimism” displayed among Christian congregants is
balanced with sound health care decision-making.
Keywords: Self-rated health; chronic disease; Christian congregants; health optimism;
health disparities
Introduction
Among adults in the United States (U.S.), African American populations bear a
disproportionate burden of almost every chronic disease. For example, African American
adults are twice as likely as non-Hispanic white adults to be diagnosed with diabetes, and
20% more likely to have asthma than non-Hispanic white adults (DHHS, 2013). Further,
the incidence of chronic kidney disease is approximately 2.7 times higher among African
American adults compared with non-Hispanic whites (Tarver-Carr et al., 2002). These are
just a few chronic conditions that characterize racial/ethnic health disparities in the U.S adult
population. The 1985 U.S Secretary’s Task Force on Black and Minority Health report was
assembled to help eliminate health disparities (DHHS, 1985). Unfortunately, morbidity and/
or mortality gaps have widened between African Americans and non-Hispanic whites for
many chronic conditions in recent years (Gupta, Carrión-Carire, & Weiss, 2005; Pollard &
Scommegna, 2013).
In addition to poorer objective health status, African Americans tend to report poorer
subjective health status compared to their non-Hispanic White counterparts as measured by
self-rated health (SRH) (Spencer, et al., 2009; Schootman, Deshpande, Pruitt, Aft, & Jeffe,
2010). SRH is a frequently used measure of overall health status (Layes, Asada, & Kephart,
2012) and is shown to be a consistent predictor of mortality (McGhee, Liao, Cao, & Cooper,
1999). For example, a study by Shadbolt and colleagues (2002) found that among patients with
advanced cancer, SRH predicted survival far better than many clinical indicators, appetite loss,
fatigue, and health-related quality of life measures. In general, research has found that better
SRH is predictive of better objective health outcomes, including longer survival among the
terminally ill.
Spirituality and religious practice are shown to influence health beliefs, practices,
and outcomes of African Americans (Newlin, Knafl & Melkus, 2002), and have been linked to
better SRH (Daaleman, Perera, & Studenski, 2004). Numerous population-based studies have
found that African Americans consistently report higher levels of religiosity and/or spirituality
than any other racial/ethnic group in the U.S. (Hodge & Williams, 2002; Pew Research Center,
2007). Religion has been described as “society-based beliefs and practices relating to God or
a higher power commonly associated with a church or organized group” (Egbert, Mickley, &
Coeling, 2004, p. 8), while spirituality refers more to “a belief in something greater than self
and a faith that positively affirms life” (Miller, 1995, p. 257). Given the positive influence of
spirituality and religiosity on health beliefs and outcomes, it is hypothesized that individuals
with higher levels of spirituality and religiosity would report more positive SRH, regardless of
objective health status. Thus, the purpose of this study was to assess chronic disease status and
SRH between African American adults in the general U.S. population compared to a sample
of African American Christian congregants. Christian congregants in this study are defined as
individuals of Christian faith who attend religious service on a regular basis.
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Methods
Participants
Sample participants included men and women who were: 1) age 18 years and older;
and 2) self-identified as African American. Participants representing the general population
of African American U.S. adults were sampled from the Centers for Disease Control and
Prevention’s (CDC) 2006 Behavioral Risk Factor Surveillance System (BRFSS) (CDC, 2006).
BRFSS is an annual telephone survey that assesses the health status of U.S. residents. BRFSS is
the world’s largest, on-going telephone health survey system and is run through individual state
health departments. The sample size for BRFSS is currently over 400,000.
Participants representing African American Christian congregants were sampled
from four national Christian conventions between 2005 and 2006. Specifically, congregants
consisted of men and women who attended the Joint National Baptist Convention in
January of 2005 in Nashville, Tennessee; the Church of God in Christ (COGIC) Women’s
Convention in May of 2005 in Atlanta, Georgia; the General Conference of the Christian
Methodist Episcopal (CME) Church in Nashville, Tennessee in 2006; and the African
Methodist Episcopal (AME) Leadership Conference in June of 2006 in Charleston, South
Carolina. The COGIC convention focused solely on women; therefore one hundred percent
of surveys collected during this convention were women, which results in an oversampling of
women from the COGIC denomination.
Procedures
Congregant data were collected by researchers from the Institute for Faith-Health
Leadership at the Interdenominational Theological Center (ITC) in Atlanta, Georgia.
Congregant data were collected using a survey instrument containing questions about faith,
health, and health care among African American Christian congregants. The Faith, Health,
and Health Care Survey instrument contained 80 items, divided into four sections: (1)
Demographics; (2) Health/Safety; (3) Health Care; and (4) Faith, Religion, and Health.
Some items from the Health/Safety and Health Care sections were adapted from the 2004
BRFSS questionnaire, which allowed for comparisons in this study. The questions in the Faith,
Religion, and Health section were developed by a team of researchers and consultants from the
Institute for Faith-Health Leadership at the ITC. Sample size for the congregant database was
2,959, which was achieved using a convenience sampling approach. Each congregant participant
signed an informed consent prior to completing a survey. Study participants were referenced
by unique identification numbers, and no personally identifiable information was collected
(i.e. names or addresses). All hard copies of study data were stored in a secured file cabinet in a
locked office, while electronic data were stored on a password protected computer. Hard copies
of surveys were destroyed after three years. This study was approved by the Institutional Review
Board at Morehouse School of Medicine.
Measures
SRH was measured using the single item, “In general, would you say your health
is: Excellent, Good, Fair, or Poor?” The self-reported prevalence of seven different chronic
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conditions were assessed, including hypertension, diabetes, asthma, overweight/obesity, cancer,
kidney disease, and HIV/AIDS. Chronic disease status was measured using the item, “Have
you ever been told by your doctor that you have (each chronic condition was asked separately).”
Response options included “yes” or “no.” Additional variables included self-reported sociodemographic characteristics (i.e. age, gender, Christian denomination, highest level of
education, annual household income, and health insurance status). Descriptive statistics were
analyzed using SPSS, Version 22 (IBM, 2013).
Results
Demographic characteristic of the Christian congregant sample are reported in
Table 1. More than two-thirds of congregant participants were women (69.2%). Only 6.9%
of congregants were under the age of 35 years,
Table 1. Demographic Characteristics of
while approximately one-third were age 35-54
Congregant Participants (N=2,959)
years (34.2%), 30.3% were 55-64 years, and
26.8% were 65 years or older. Of the congregant
Characteristic
n (%)
sample, 18.5% identified themselves as Baptist,
34.4% identified as COGIC, 5.2%% identified
Age (years)
as CME, and 41.9% identified as AME. The
18-34
199 (6.7)
majority of congregants had at least some college
35-54
1013 (34.2)
education (78.4%), with only 6.3% reporting
less than a high school diploma. Income level
55-64
896 (30.3)
was fairly evenly distributed throughout the
65+
793 (26.8)
congregant sample, with 16.8% reporting an
Gender
annual household income of less than $25,000;
Female
2049 (69.2)
28.4% reporting between $25,000 and $49,999;
22.7% reporting between $50,000 and $74,999;
Denomination
and 21.9% reporting $75,000 or more. Finally,
Baptist
546 (18.5)
almost all of congregant participants reported
COGIC
1018 (34.4)
having some form of health insurance to pay for
CME
153 (5.2)
medical care (94.7%).
First, chronic disease prevalence
among U.S. adults in the general population
was compared with that of African American
Christian congregants (Figure 1). Adults in the
congregant sample had a higher prevalence of all
chronic diseases assessed except for overweight/
obesity. Specifically, the national prevalence
of hypertension among African Americans
was 34.1% and the national prevalence of
diabetes was 11.4%, while the prevalence rate
among Christian congregants was 50.4% and
20% respectively. The national prevalence of
asthma for the general population of African
Americans was 13.4%, while the prevalence rate
in the Christian congregant sample was 15.8%.
The prevalence of overweight/obesity was
32
AME
Education Level
>High School
High School Graduate/GED
College or More
Income (US dollars)
Less than 25,000
25,000-49,999
1241 (41.9)
50,000-74,999
75,000+
Health Insurance Status
Insured
671 (22.7)
647 (21.9)
185 (6.3)
363 (12.3)
2319 (78.4)
497 (16.8)
841 (28.4)
2801 (94.7)
Notes: Due to missing data, the percentages may not add up to
100 percent; COGIC = Church of God in Christ; CME = Christian
Methodist Episcopal; AME = African Methodist Episcopal
d HIV/AIDS (30.3% versus 18.1%) compared to the general population of African Americans.
nally, SRH among Christian congregants was compared to SRH among African Americans in
e general population. Among Christian congregants, 80.4% rated their health as excellent or
ood. Similarly, 79% of African Americans in the general population rated their health as
cellent or good.
Articles
80
71
% Told by Doctor They
Have Each Condition
70
60
55.7
53.9
50
40
30
20
34.1
20
30.3
15.8
13.4
11.4
10
18.1
8.5
4.6 3.8
Christian Congregants
General Population
2.6
0
Figure 1. Self-reported chronic disease status of African American Christian congregants
compared to the general population of African American U.S. adults.
Figure 1. Self-reported chronic disease status of African American Christian
ongregants
compared
the general
population
Africancompared
American
U.S. adults
lower
among thetoChristian
congregant
sampleof(55.8%)
to African
Americans in the
general population (71%). The prevalence rate for cancer among Christian congregants (8.5%)
was almost twice the rate of the general population of African Americans (4.6%). Christian
congregants in this study also reported a higher prevalence of kidney disease (3.8% versus
2.6%) and HIV/AIDS (30.3% versus 18.1%) compared to the general population of African
90
80.4
79
% of Participants
80
70
60
50
Christian Congregants
40
19.6
30
21
General Population
20
10
0
Excellent/Good
Fair/Poor
Figure 2. Self-rated health of African American Christian congregants compared to the
Figure 2. Self-rated health
African American
congregants
generalofpopulation
of AfricanChristian
American U.S.
adults. compared
o the general population of African American U.S. adults.
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Americans. Finally, SRH among Christian congregants was compared to SRH among African
Americans in the general population. Among Christian congregants, 80.4% rated their health
as excellent or good. Similarly, 79% of African Americans in the general population rated their
health as excellent or good.
Discussion
The overall goal of this study was to describe the self-reported status of seven chronic
diseases and SRH of African American Christian congregants compared to African Americans
in the general U.S. population. The sample of African American Christian congregants reported
a greater prevalence of almost every chronic condition assessed, but almost identical SRH.
Results indicate that the positive and affirming attitudes associated with religious attendance
may lead to positive SRH among African American church-goers in spite of chronic disease.
Religious instruction may cultivate the practice of “not claiming” sickness and disease.
One of the most alarming chronic disease statistics highlighted in this study is the
prevalence of HIV/AIDS among Christian congregants compared to the general population of
African American U.S. adults (30.3% versus 18.1%, respectively). The subject of sex, sexuality,
and sexual health are often avoided in the church setting. Nonetheless, the prevalence of HIV/
AIDS is nearly twice as high among Christian congregants compared to the general population
of African American adults. The avoidance of sexual health discussions and interventions
among Christian congregants may have a negative impact on sexual health outcomes among
this population.
Health optimism is described in this study as positive SRH which may disregard
objective health measures. One reason for health optimism in the congregant sample may
involve the context in which the data were collected. Congregant data were collected at faithbased conventions, which may have prompted participants to think of health outside of the
physical realm. If data were collected in a clinical setting, it is possible that participants may
have responded based on more physical aspects of health. Health is a multifaceted phenomenon
which is comprised of physical, mental, social, and spiritual elements (Warren, 2007). Physically,
congregants had a greater proportion of chronic disease compared to African Americans in the
general population. However, consideration of other elements of health (mental, social, and
spiritual) may help explain why the congregant participants reported SRH that was comparable
to that of the general population of African Americans.
This study is strengthened by the use of such a large sample size of African American
Christian congregants (N = 2,959), which is rare within the faith-health literature. This study
is also strengthened by the sampling of participants from national Christian conventions,
which broadens the geographical and/or regional representation of study participants.
However, findings from this study must be interpreted with consideration of several important
limitations. First, the use of a nonrandom (convenience) sample limits the generalizability
of the findings of this study beyond the sample of attendees during one of the four national
Christian conventions identified. Based on self-reported income, educational level, and health
insurance status, the sample consists of a greater proportion of participants with mid to
high socioeconomic status, which is not representative of the national population of African
Americans. Also, the use of cross-sectional data limits the ability to make causal inferences
about study data. 34
Articles
Conclusion
Within Christian teaching, the most important component of a human being is
often cited as the spirit, or soul (Raboteau, 2004). African American slaves were taught that
their bodies were insignificant and that their souls would secure them a place in the afterlife
(Raboteau, 2004). African Americans have historically disregarded their physical health, placing
more emphasis on the human spirit. This phenomenon may also help explain the discordance
between chronic disease status and SRH among African American Christian congregants in
this study. Findings highlight the need for public health practitioners and faith leaders to work
together to ensure “health optimism” among Christian congregants is balanced with sound
health care decision-making.
References
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Food Deserts in Upstate South Carolina:
How Do We Both Ethically and Sustainably Feed the
Region’s Food Insecure?
Kenneth L. Robinson, PhD
Associate Professor and Extension Specialist
Department of Sociology and Anthropology
Clemson Institute for Economic and Community Development
Clemson University
132 Brackett Hall
Clemson, South Carolina 29634
Tel: (864) 656-1449
Fax: (864) 656-1252
Email: krbnsn@clemson.edu
Authors’ Note
The author is solely responsible for the contents of this article. The contents do not necessarily
reflect the policy of the U.S. Department of Agriculture. All correspondence should be directed
to Dr. Kenneth L. Robinson.
Abstract
The global food system characterized by large transnational agribusiness firms, biotech
laboratories, corporate boards and their economic advisors are “taking control of where, when,
and how food is produced, processed, and distributed” (Lyson 2004:48), with little or no regard
for the social and community level impacts on rural communities, including small farmers,
residents, workers, and even consumers, not just in the U.S., but worldwide. There is a growing
body of evidence that certain segments of the population have uneven access to healthful food
options which is associated with negative health outcomes resulting from illnesses that better
diets may delay or prevent, including high blood pressure, diabetes, and cardiovascular disease.
The goal of this paper is to shed light from a sociological perspective on the question “Can
the current food production system feed a growing population in a changing climate while
sustaining ecosystems?” and to highlight findings from a USDA sponsored research study
that seeks to support local farmers, create new food distribution and marketing channels, and
improve the quality of the food that is distributed by food assistance agencies working in local
food deserts.
Keywords: Food deserts; agriculture and Upstate South Carolina, food banks, small farmers
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Introduction
The goal of this paper is to shed light from a sociological perspective on the topic
“Social Justice, Food Systems and the Agricultural Black Belt,” and to address the big question
“Can the current food production system feed a growing population in a changing climate while
sustaining ecosystems?” as posed by our plenary speaker Dr. Ralph Christy (2014).
The literature on food security and food deserts (Nord et al. 2008, Morton and
Blanchard 2007, Blanchard and Lyson 2006) suggests that food insecurity is a pervasive
problem in certain regions across the South. The regions range from portions of the Mississippi
Delta and the Black Belt to the northern portions of Appalachia. Household access to food may
be limited by a lack of money as well as by limited access to supermarkets and the large variety
of foods needed for a healthy diet, including fresh fruits and vegetables, whole grains, fresh
dairy and meat products. Despite food and nutrition assistance programs and local hunger-relief
services such as the Growing Food Locally Program (Robinson et al 2007) designed to supply
food deserts and to increase food security by providing low-income households access to food,
a healthful diet, and nutrition education, some households still experience food insecurity
and limited access to adequate food at times during the year. For many living in the South,
in addition to hunger, the outcome is major health problems such as obesity, heart disease,
hypertension, strokes and other diet-related diseases.
The Global Food System and Food Deserts
The current restructuring of the global economy toward increased corporate
integration is premised on the assumption that core firms (i.e., large national and multinational
corporations) will be the primary engines of change and development (Barber; Harrison;
McMichael 1996). Development within this framework is what Lyson (2004) calls the
corporate community model. The objective is to keep the global engine of accumulation
running. The emphasis is on economic efficiency and productivity. Communities become
places where production and consumption are concentrated, not places where citizens are
actively engaged. But as Berry (1999:2) has noted, “The ideal of the modern corporation is to be
anywhere (in terms of its own advantage) and nowhere (in terms of local accountability).”
Rural sociologist Bill Heffernan identifies a handful of what he calls “food-chain
clusters” that are taking control of the food system from the “gene to the supermarket shelf ”
(Lyson 2004:48). Cloaked in the guise of “feeding the world,” today’s mass production food
industrial complex provides abundant quantities of cheap, standardized goods. The degree of
concentration has reached the point where the 10 largest multinational food processors control
over 60 percent of the food and beverages sold in the United States. According to geographer
Philip Hart, “Size brings economic power and this is particularly significant when set against the
structure of the farming industry with its large number of relatively small producers” (as quoted
in Lyson 2004:49), including those small producers closer to home.
For Black farmers living in the agricultural Black Belt South, the situation is not
much better. In their article The Plight of Black Farmers, Racism in the US Farm Program (The
Atlanta Constitution, October 10, 2006), Jerry Pennick and Heather Gray of the Federation of
Southern Cooperatives/Land Assistance Fund, cite that Black farmers and small family farmers
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in the United States depend on subsidies in an attempt to break even. They refer to a survey
conducted by the Federation of African-American cotton farmers throughout the Southeast.
The survey found that the subsidy program is essential for the survival of many Black farmers.
But when asked if subsidies would be as important if the farmers received a fair price for their
cotton, the answer was “no.”
Collectively, such evidence suggests that left to the private sector alone, we risk not
fully understanding “the high price of cheap food, or …[the] connection between a hamburger
and the price of oil, or between the vibrancy of life in the soil and the health of the plants,
animals and people eating from that soil” (Pollan 2009:1, 2). Moreover, there is a growing body
of evidence that certain segments of the population have uneven access to healthful food options
which is associated with negative health outcomes resulting from illnesses that better diets may
delay or prevent, including high blood pressure, diabetes, and cardiovascular disease. Areas
characterized by such uneven or low access are called “food deserts,” by the U.S. Department of
Agriculture and are defined as places where people have limited access to full-scale retail grocery
stores. Food deserts are generally considered urban neighborhoods and rural towns without
ready access to fresh, healthy and affordable food. Instead of supermarkets and grocery stores,
these communities are often served by fast food restaurants and convenience stores that offer
few healthy, affordable food options. According to the USDA’s Economic Research Service,
23.5 million people live in food deserts and more than half of them are low-income (Ver Ploeg
2010 and The Food Desert Locator). According to research by Blanchard and Lyson (2006),
256 of the 873 nonmetropolitan South counties are food deserts. The presence of food desert
counties in the Black Belt is especially important because of their high rates of poverty. For some
of these counties the average poverty rate is nearly 25 percent.
Grocery stores provide the most reliable access to healthy foods at the lowest cost.
Adults living in neighborhoods with grocery stores have the lowest rates of obesity at 21
percent, while adults living in areas that are void of these resources have the highest rates at
32-40 percent obesity. Adults living in food deserts are 25-46 percent less likely to have a healthy
diet than those living in close proximity to a grocery store (within one mile of their home).
Regarding obesity, studies have shown adults who have neighborhood access to stores
that sell fresh food have a 21 percent obesity rate, compared to a 32 to 40 percent obesity rate
among those without such access, according to the Robert Wood Johnson Foundation (2012).
In South Carolina alone, one million people live their lives without adequate access to grocery
stores, fresh food markets or transportation to get there, according to a recent South Carolina
Community Loan Fund study (as cited in Penso 2014). Statistically, according to a recent
study conducted by the Trust for America’s Health (2012) and the Robert Wood Johnston
Foundation (2012), South Carolina ranks 7th nationally for obesity among adults, 13th for
obesity among high schoolers, and 2nd for obesity among 10-17 year-olds.
The South Carolina Department of Health and Environmental Control (Simeon
2011) estimates more than one billion dollars is spent on obesity-related health expenditures
annually; this number is expected to increase to $5.3 billion dollars in 2018. If South Carolina
were able to halt the increase in the prevalence of obesity at today’s levels, it would save over $3
billion in five years.
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The author is a member of a team of researchers at Clemson University (South
Carolina) undertaking a project supported by a multi-year grant sponsored by Agriculture and
Food Research Initiative (AFRI) that seeks to address the potential of food banks for providing
a healthier food supply to low income residents as well as creating improved small-scale farm
operations and revenues.. The research project is entitled “Using Local Food Banks to Promote
Sustainability of Small and Limited Resource Farms,” and uses the institutional intelligence
gathered in an earlier Community Food Project co-sponsored by the Lowcountry Food Bank
(LCFB) of Charleston as a benchmark on how to be an effective local food system intermediary.
In addition to returns to local farmers , findings from the LCFB project suggest that the
participating agencies changed their purchasing behaviors; increased healthy food purchases by
participating agencies; purchased fewer sweets, fats, oils than regional counterparts; provided
over twice the amount of nutrition counseling as compared regionally; and increased nutrition
training opportunities.
The current AFRI project has engaged other food banks and small scale farmers
to “scale up” the benefits of local food system participation by small farms across SC and
contiguous states. Specifically, the goals of this project are: to document the potential for
local, non-profit food system intermediaries to enhance the economic sustainability for small
and limited resource farms, and to reveal the potential for these local food systems to increase
incomes in rural communities. Lessons learned should be helpful in promoting sustainability of
small farms and proximate rural communities across the State and nation. Those lessons will be
further examined in the next section.
Method
Participants and Procedure
To evaluate the effect of one food bank’s use of local foods to blend sustainable
agriculture practices with innovative community development strategies, this paper focuses on
consumer demand, supply of locally grown foods, local networks, and local impacts.
The contingent valuation framework is used to elicit South Carolina consumer
preferences for produce with the ‘‘SC grown’’ attribute (Young 2012). We use the contingent
valuation approach because it allows us to concentrate on the ‘‘SC grown’’ characteristic
in products and measure consumer willingness to pay (WTP) for this specific attribute.
Contingent valuation methods ask respondents hypothetical questions about their willingness
to pay for products with specific attributes. Current and desired demand for locally grown
products by local residents was estimated using the results of a mail survey sent to 6,000
randomly selected households in the Upstate region of South Carolina. There were two forms
of the survey: 3,000 focused on produce (fruits and vegetables) and 3,000 focused on animal
products (meat, poultry, dairy, and eggs). The counties included in the mailing were Abbeville,
Anderson, Cherokee, Chester, Greenville, Greenwood, Lancaster, Laurens, McCormick,
Oconee, Pickens, Spartanburg, Union, and York, South Carolina. This region accounts
for roughly 36.9 percent of South Carolina’s overall population. The individuals chosen to
participate were randomly selected households.
Small and medium sized farms in the upstate region with less than $100,000 in annual
sales were then identified by county extension agents in each of the upstate counties. To analyze
40
Articles
the current potential supply of locally grown products, surveys were mailed and distributed
to approximately 200 small and medium sized farmers in the upstate pre-intervention and
in year two. Questions included what production methods are used; where they sell their
products; how they promote their products; how many acres of land they have in production;
challenges they have in affiliating with brokers and direct markets; and the challenges they face
in marketing their products.
The directors of each of the three food banks serving the upstate region were recruited
to participate in the project (Robinson 2011). Figure 1 shows a map of the region. Specifically,
directors of the food bank networks were interviewed to assess the nature of issues and
challenges associated with providing food assistance, sourcing local foods, and improving client
access to nutritious and quality foods. Also, via open-ended questions, we explored any obstacles
that the food bank directors believe might be preventing greater participation by food assistance
agencies and local farmers. Based on these interviews, HHFB, Greenville was found to be in the
best position to accomplish the goals of Clemson’s research project. The regional director and
CEO are interested in an exclusive partnership with Clemson. They have all the equipment,
labor, refrigerated warehouse space and distribution systems needed to move large volumes of
produce throughout the state.
Figure 1. Map of upstate region.
Figure 1. Map of upstate region.
Thus, the goals of project are not only concerned with the farmers and the farm
but also with the broader society, hence we plan to analyze the economic and environmental
impacts of the project on the local economy and the use of local foods in the food quality and
Thus,
the goals
of project
are not
concerned
with the farmers and the farm but also
nutritional
content
of the
food offered
to only
the agencies’
clientele.
with the broader society, hence we plan to analyze the economic and environmental impacts of
the project on the local economy and the use of local foods in the food quality and nutritional
Journal of
Science
Humanities
Volume V, No. 1, 2015 41
content
of Healthcare,
the food offered
toand
thethe
agencies’
clientele.
Articles
Results
To assess if the sample of surveyed households is representative of the population of
interest, the sample population was compared to the demographics of both the overall South
Carolina census statistics as well as the Upstate population. Young (2012) reports that the ratio of
females to males was slightly higher. The educational attainment of the sample was significantly
higher, on the average, with 95% achieving some college compared to 33% in the upstate and
Table 1. Demographics of Respondents of Consumer Survey Sample Compared to Upstate SC
and Overall SC.
Demographic
Respondents
Number
%
Upstate SC
Residents
Number
%
Overall SC
Residents
Number
%
Gender
Male
Female
Education level:
Some HS or less
HS degree / GED
Some college / technical
College graduate
Graduate school
Marital status
Single
Married
Divorced or Separated
Widow
Age
Under 25
25-44
45-64
65-84
85+
Race
White / Caucasian
Black / African American
Hispanic or Latino
Asian or Pacific Islander
Am. Indian or AL native
Other
40
63
38.8
61.2
829,393
878,778
48.55
51.45
2,250,101
2,375,263
48.60
51.40
3
5
30
32
33
2.9
4.9
29.1
31.1
32.0
207,206
343,125
209,412
259,448
84,301
12.13
20.09
12.26
15.19
4.94
506,502
931,546
581,690
709,933
84,301
10.95
20.14
12.58
15.35
1.82
22
55
13
13
21.4
53.4
12.6
12.6
380,611
688,344
174,562
91,608
22.28
40.30
10.22
5.36
1,113,043
1,786,128
482,380
248,864
24.06
38.62
10.43
5.38
0
19
42
30
7
0
18.5
40.8
29.1
6.8
575,028
438,090
459,224
208,437
27,392
33.66
25.65
26.88
12.20
1.60
1,556,919
1,193,348
1,243,223
561,157
70,717
33.66
25.80
26.88
12.13
1.53
95
8
0
0
0
0
92.2
7.8
0
0
0
0
1,277,440
328,610
88,798
24,277
6,039
43,915
74.78
19.24
5.20
1.42
0.35
2.57
3,060,000
1,290,684
219,943
61,757
19,524
113,464
66.20
27.90
4.80
1.40
0.40
2.5
Note: State and County population data obtained from the U.S. Census Bureau 2010 American
Community Survey (available at: http://factfinder2.census.gov)
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28% in all of SC. The age groups were also much higher as roughly 79% of the sample was over
45 years old compared to 40% in the upstate. This skewing may be due to the summer months
during which the survey was sent out. Many younger families may have gone on vacation or
were not interested in responding. Further surveys will need to be conducted to increase rate of
response and increase variability of demographics. The race proportions were significantly off
with only 7.8% of the sample recorded non-white. Table 1 shows the comparisons.
Local product attributes do seem to be valued by consumers, when they are aware
that their products are locally grown. We find that consumers are willing to pay about, on
average, 18 percent more for local than for comparable out-of-state products. We also found
that consumers are willing to pay 5 percent more for a product with a donation to the local
food bank. This may be explained by 57 percent of respondents giving a reason why they may
not be interested in participating in a program (Young 2012:17) whereby “consumers would
be willing to “buy-in” to this proposed system by purchasing local produce at a premium. The
donation aspect could be an altruistic incentive strong enough to merit consumers to buy
local produce over out-of-state products. This price premium would then be transferred to
the food banks as a donation to be used in the efforts of sourcing from local farmers who, in
turn, support community and economic development.” Several of the highest responses were
their previous donation history (already donate to a food bank), general disinterest in paying
more to participate in the system, do not want to donate to a food bank at all, or even general
misunderstanding of the specifics of how the system would operate. They may be inclined to
donate more than 5 percent if they change their avenue of donating (via the program rather
than food or straight monetary donation), gain a greater understanding of what the program
has to offer them and their community, gain a more in depth understanding of what food
banks are and which ones in their area that would be benefiting from the program, and an
understanding of what an impact 5 percent or more could make for the participating farms
and food banks.
Table 2. Estimates for Willingness to Pay by Income Group
Income Group
Fruits and Vegetables
Local
Donation
< $19,999
21.00 %
4.80%
$20,000 - $39,999
21.17 %
4.84 %
$40,000 - $59,999
21.35 %
4.90 %
$60,000 - $79,999
21.54 %
4.92 %
$80,000 - $99,999
21.73 %
5.00 %
$100,000 - $119,999
21.92 %
5.01 %
$120,000 - $139,999
22.12 %
5.05 %
$140,000 or more
22.32 %
5.10 %
Estimates for Willingness To Pay for Total Sample (Averages)
22.90%
4.80%
Animal Products
Local
15.34 %
15.47 %
15.60 %
15.74 %
15.88 %
16.02 %
16.16 %
16.31 %
Donation
4.84 %
4.88 %
4.92 %
4.96 %
5.01 %
5.05 %
5.10 %
5.14 %
14.64%
5.08%
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A socio-economic factor that directly affects expenditures on produce is consumer
income. An increasing, positive trend was found between income and willingness to pay for
both locally grown and donation aspects indicating that consumers with higher incomes are
inclined to pay (slightly) more for these attributes. Females too are (slightly) more likely to
purchase products with these characteristics, than men. The results of this study will help the
program creators understand how to market these products effectively, how to price them
efficiently, and what types of consumers are the best to target. Tables 3 and 4 show those results.
Table 3. Estimates for Willingness To Pay by Gender and Education
Fruits and Vegetables
Animal Products
Local
Donation
Local
Donation
Female
Male
23.26 %
22.26 %
4.86 %
4.66 %
14.94 %
14.27 %
5.18 %
4.95 %
Education
College Degree(s)
No College Experience
22.40 %
23.75 %
4.69 %
4.97 %
14.34 %
15.25 %
4.97 %
5.29 %
Gender
The surveys sent out during pre-invention and in year two to local farmers were not
well received in terms of the number of responses received. Many upstate farmers were not
interested in responding. Unlike circumstances in the Lowcountry where some farmers struggle
to access markets (Robinson 2007), many upstate farmers suggests that current production is
now about ideal. Others suggested that they were unable to supply current markets and there
is no need for new markets. Some indicated current problems with water, especially high cost
per gallon. Still others indicated that providing a social safety net for low-income households
is government’s role, not farmers. Nonetheless, on a positive note, the responses did cover
a significant geographical area of the Upstate. Table 4 and Figure 2 show upstate acres in
production by crop and location. Of the approximately 200 surveys distributed, 21 farmers
responded completely or near completely to the survey questions sent out. The rate of response
was only 9.5% of the total completed surveys at the end of the two mailing periods. Of the
21 nearly 84 percent of respondents were owners of their own farms/business. 32 percent of
respondents generated less than 10 percent of their total family income from the farm while
near 16 percent generated close to 60 percent of their income from their farm. Nearly 35
percent of the respondent pool generated sales between $ 10,000 and $ 49,000 per annum.
75 percent of the respondents were farming on properties less than 50 acres. There was a
significant variety of produce farmed within the geographical area form where responses were
received. Moreover, 80 percent of farmer respondents currently donate product to emergency
relief services, food banks, or similar organizations. Nearly 55 percent farmer respondents say
“maybe” willing to dedicate a portion of their crops’ harvest for sale to food banks, depending
on price, and 90 percent farmer respondents expressed willingness to attend a meeting with
other farmers to discuss the possibilities of opening new local markets with local food bank.
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Table 4. Crops Distribution, Survey of Upstate South Carolina Farmers*
Crop
Acres
Revenue
Per Acre
Total
Source
South Carolina Agricultural Statistics,
USDA-NASS Rep. AE501
North Carolina Cooperative Extension,
1,391,181
Strawberry Operation Budget & Costs
314,284
163,790
Peaches, yellow flesh
76.9
5,323
409,433
Strawberries
46.0
30,240
Tomatoes, plum/roma
37.4
8,400
Tomato, red vine ripe
19.5
8,400
Apples
41.7
2,813
117,267
Corn, sweet
32.0
3,077
98,423
Cantaloupe
25.5
4,731
120,732
Watermelon, red flesh
seeds
23.9
3,864
92,225
Pumpkins
21.6
2,580
55,638
Beans, snap
15.8
2,734
43,234
Peas, garden
(purple hull)
9.3
6,000
56,068
Blackberries
7.7
9,085
70,337
Blueberries
7.5
15,859
119,701
Grapes, muscadine
6.1
15,855
97,103
Squash, crookneck
4.8
4,316
20,784
Squash, butternut &
Acorn
3.6
4,316
15,511
Cucumbers
2.4
4,609
11,019
Beans, Pole
2.2
2,734
5,896
Zucchini
1.1
4,316
4,653
Pecans
0.4
5,708
2,051
USDA, NASS North Carolina Field Office
Sweet Corn Production, Penn State
University
USDA, Economic Research Service,
Vegetable and Pulses Yearbook Tables
Edible-Pod Pea Production in California
USDA, Agricultural Marketing Service,
Blackberries
USDA, Economic Research Service, Fruit
and Tree Nuts Yearbook Tables
Arkansas Agricultural Experiment Station
Research Report 988 for prices; Bulletin 739,
University of Georgia, Georgia Extension
Service for yields
South Carolina Agricultural Statistics, NASS
for yields; North Carolina Department of
Agriculture & Consumer Services, Marketing
Division for price
45
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Crop
Acres
Revenue
Per Acre
Total
Honeydew melon
0.4
4,731
1,700
Asparagus
1.6
2,926
4,732
Peppers, Bell
1.3
2,730
3,583
Beans, green
2.7
2,734
7,271
Potatoes, sweet
1.4
1,138
1,637
Potatoes, Russet
0.1
1,473
212
Greens, collard
6.3
3,012
18,835
Greens, mustard
0.9
4,487
3,871
Greens, turnip
0.9
4,350
3,752
Greens, Kale
1.3
3,012
3,953
Cabbage
3.0
6,093
18,071
Broccoli (whole)
2.9
5,308
15,263
Okra
2.9
12,960
37,264
Peas, black-eyed
2.9
720
2,070
Grapes, concords
2.2
10,570
22,794
Lettuce, romaine
2.5
8,738
21,771
Bibb Lettuce
0.1
9,038
910
Leaf Lettuce
0.1
9,038
910
Peppers, finger hot
1.6
6,667
10,543
Carrots
0.7
9,355
6,725
Cauliflower
0.4
7,437
2,673
Peppers, banana hot
0.4
6,667
2,396
46
Source
USDA, Economic Research Service, F
USDA, Economic Research Service
USDA-NASS
USDA-NASS
USDA-NASS
USDA-NASS
USDA, Economic Research Service, Fruit
and Tree Nuts Yearbook Tables
Clemson University Extension Budget
Yuma Area Ag Council
Arkansas Agricultural Experiment Station
Research Report 988 for prices, Bulletin 739,
University of Georgia, Georgia Extension
Service for yields
Articles
Crop
Acres
Revenue
Per Acre
Total
Source
Spinach
0.4
3,644
1,310
Onions, white
0.2
8,077
1,893
Eggplant
1.9
8,059
15,213
USDA, Economic Research Service, Vegetable
and Pulses Yearbook Tables, for Georgia
N/A
Brussel Sprouts
1.5
8,059
12,316
N/A
Asian Pear Apples
1.1
8,059
8,690
N/A
Beets
1.0
8,059
8,400
N/A
Turnip, purple top
0.8
8,059
6,523
N/A
Pears, Bartlett
0.7
8,059
5,793
N/A
Fig
0.4
8,059
3,476
N/A
Arugula
0.4
8,059
2,897
N/A
Plums/Prunes
0.4
8,059
2,897
N/A
European Cucumber
0.2
8,059
1,738
N/A
Beans, Lima
0.1
8,059
1,159
N/A
Mushrooms
0.1
8,059
1,159
N/A
Persimmons
8,059
N/A
ure 3.1 Distribution of 3P.1 otential Sales boy f 0.1
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ood FBarm anks by Crop Type (Acres). Figure Distribution otential Sales y rea Upstate to Area Food Banks by Crop Type (Acres). *Note: As compiled by David W. Hughes, Ph.D., former Community Development Extension Program Leader, Clemson Institute for Economic
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Figure 2. Distribution of Potential Sales by Upstate Farm to Area Food Banks by Crop Type (Acres).
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Discussion Discussion
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Discussion
This research culminates in documenting the institutional characteristics of each food
bank and its operations in terms of factors such as market access, networks, leadership, and
sustainability. The results of this study, based on field notes, interviews and personal interactions,
suggest answers to whether use of food banks help to enhance the economic sustainability for
small and limited resource farms, and to reveal the potential for these local food systems to increase
incomes in rural communities, including those across the agricultural Black Belt South.
The circumstances surrounding the Upstate food bank operations are less favorable
than was present in the Lowcountry. Other direct markets may need to be more actively pursued
to accomplish the goals of this grant. Perhaps the two critical lynch pins to whether or not the
food banks servicing the upstate can be a viable direct market for small scale farm produce is
1) whether or not they are willing to operate a wholesale/retail outlet and have the profits go
toward purchase of produce made available to their affiliating agencies and 2) whether agencies
and HHFB leaders are willing to consider an increase in shared maintenance fees related to their
produce distributions. Similarly, farmer responses suggest differences between Lowcountry and
Upstate conditions, whereby some upstate farmers suggest that they are unable to supply current
markets and there is no need for new markets. Others indicate that providing a social safety net
for low-income households is government’s role, not farmers.
The findings of this study have important implications for potential changes in
knowledge: 1) County staff, market owners, and participating faculty and students know
what local consumer preferences are relative to a) willingness to pay for various types of farm
products; b) the regularity in shopping habits of current and future consumers; c) the attributes
consumers look for when purchasing local produce (of various kinds) over out-of-State produce;
d) current and future demand for local farm products. 2) Food bank, staff, university faculty
and students know who to promote locally grown to (by socio-economic characteristics; by
current and potential future consumers). 3) Farmers know more of each other’s operations,
products, challenges, needs, resources, skills and capabilities. 4) County leaders have a plan of
action for economic development of small and medium sized farms that is built on stakeholder
knowledge, commitments and participation. 5) Direct, wholesale, and retail grocers know the
extent and nature of local produce available from local region producers. 6) Market owners
know what messages to use in labeling and advertising. 7) Local food banks gain experience and
resources in servicing their clients.
While our research focuses on the Upstate of South Carolina, further research could
include the entire state and even any state or country. The basis of this study can extend to any
state or region with-in them because each has farmers markets, farm products, and food banks.
The regions could be expanded to a certain radius in miles from either the primary point of
sale locations or the primary growing locations. This would change the definition of “local” to
include not just the state the consumer is buying the product from but states that fit within this
certain mile radius. The feasibility of this system depends on the participation of food retailers
and consumers willingness to donate to local food banks in their area. For example, many
farmers from North Carolina may travel to farmers markets in South Carolina and therefore
could participate in the program because they consider “over the border” to be “local” (Young
2012: 38). Additionally, geographic information systems (GIS), which involves the combination
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of several spatial datasets, visually similar to multiple layers of maps of the same region, offer
a method for situating local distribution networks in regional and national contexts as well as
within the larger global food systems approach (Richardson 2010).
Future research should extend beyond the farmers and the farm to consider the
broader societal implications. Researchers should analyze the economic and environmental
impacts of local food systems on the local economy and the use of local foods in the food quality
and nutritional content of the food offered to the agencies’ clientele. In particular, we plan to
use IMPLAN models for each of the upstate SC counties to measure the impacts of the Food
Bank activities; added farm income for small farms and smaller “leakages” from communities in
the region will be compared with those of the mainstream marketing channels for local produce.
In addition, we are now in discussion with a local community and non-profit group regarding
a project called Feed and Seed — a multifaceted facility where farmers can sell produce, where
individuals and businesses can buy local products and where people can get culinary job training
as well. As one organizer says, “Feed and Seed would not only serve as a place to buy and sell
food, but also as an information center where farmers could learn how to get an agricultural
loan or where to find a training program; where people in the community could find out where
and how products are grown; and where job-seekers could learn culinary skills” (as quoted in
Penso 2014: 4, 5). Feed and Seed is intended to underpin what organizers hope will prove to
be a successful food system with a broad regional approach, addressing many problems ranging
from access to healthy food to sustaining local farmers.
Conclusion
Historically, the local food movement has been considered a middle or upper middle
class movement. Often communities and people of the agricultural Black Belt South have been
left out. The sustainable solutions proposed by Dr. Ralph Christy (2014) show potential and
are well meaning. However, unless the implementation approach is more balanced with an eye
towards more equitable forms of development, low-income residents, limited resource farmers,
and other economically disadvantaged groups across the Black Belt will remain particularly
vulnerable. It is certainly unrealistic to think that small farmers and the “foodie” types with their
backyard gardens can feed the world, but since the underlying principles of the free market,
global economy paradigm are economic efficiency and productivity, the challenge for us will be
to transform the global economy from one based strictly on efficiency to one that understands
communities as valued “hometowns” and residents and workers not simply as inputs in the
production process. Residents and workers should be valued as equal participants, both civically
engaged and seen as part of the community’s problem-solving capacity.
Tuskegee University’s historically rich environment is respected worldwide for
its proficiency to take on challenges and find resolve. Tuskegee University is the academic
space where noted sociologist and social justice advocate Dr. Charles Goode Gomillion was
a thorough researcher, a respected scholar educator, and an outstanding community activist.
Dr. Gomillion was a native of Edgefield County, SC, the area from which my family hails.
As president of the Tuskegee Civic Association, Dr. Gomillion was the lead plaintiff in the
landmark 1960 civil rights case Gomillion v. Lightfoot, which led the U.S. Supreme Court to
declare gerrymandering unconstitutional (Norrell 1995). Dr. Gomillion and countless others,
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during that era, dreamed of the day when local citizens of Black Belt communities like Tuskegee
could speak out against social injustices and disparities in a forum such as this one today with
the goal, in the words of President Bill Clinton, “to prevent these types of abuses from ever
happening again.” (Clinton 1997:2).
Finally, in response to Dr. Christy’s (2014) question, the answer is clear, to ethically
and sustainably feed the world, small farmers and residents of rural Black Belt and Upstate
South Carolina communities alike must not be characterized by what Berry suggests is the
modern global corporate ideal -- to be both anywhere and nowhere, depending on whether or
not it’s to their advantage. Instead, small farmers and residents of such communities must be
like those members of the Tuskegee Civic Association who, along with Dr. Gomillion, were
problem-solvers, embedded in the community and characterized by networks bound together
by place; places such as Tuskegee and the Agricultural Black Belt South.
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References
Barber, B. R. (1995). Jihad vs. McWorld. New York: Times Books.
Berry, Wendell. “The death of the rural community.” The Ecologist 29 (3): 183+. Academic
OneFile. Web. 2 Mar. 2015.
Blanchard, T. and Lyson, T. (2006). Food Availability and Food Deserts in the
Nonmetropolitan South. Food Assistance Needs of the South’s Vulnerable Population,
Number 12.
Christy, R. D. 2014. “Justice, Food Systems and the Agricultural Black Belt.” Tuskegee
University Public Health Ethics Intensive Course. Kellogg Hotel and Conference
Center, Tuskegee, AL. 2 April 2014. Plenary Address.
Harrison, B. (1994). Lean and Mean. New York: Basic Books.
Lyson T. A. (2004). Civic Agriculture: Reconnecting Farm, Food, and Community.
Massachusetts: Tufts University Press.
McMichael, P. (1996). Development and Social Change. Thousand Oaks, CA: Pine Forge Press.
Morton, L.W., and T.C. Blanchard (2007). “Starved for Access: Life in Rural America’s Food
Deserts,” Rural Realities 1 (4): 1-10.
Nord, M., M. Andrews, and S. Carlson (2008). Household Food Security in the United States,
2007, Economic Research Report 66, Economic Research Service, U.S. Department of
Agriculture.
Norrell, R. J. (1995). “Charles G. Gomillion,” Southern Changes 17 (3-4): 14-15.
Pennick, J., and Heather, G. (2006). The Plight of Black Farmers, Racism in the US Farm
Program. The Atlanta Constitution, October 10.
Penso, L. (2014). Upstate making strides in tackling food deserts. Greenville News Online,
December 2: 4, 5.
Pollan, M. (2009). Wendell Berry’s Wisdom. The Nation, September 2: 1, 2.
Richardson, K. (2010). “EXPLORING Food Environments: Assessing access to nutritious
food.” ArcUser, Fall, 50 – 52.
Robert Wood Johnson Foundation (2012). Health Policy Snapshot: Childhood Obesity Issue
Brief. December. www.rwjf.org/healthpolicy.
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Robinson, K.L., K. Wilson, C.E. Carpio and D. Hughes (2007). “Linking Sustainable
Agriculture and Community Development: The Lowcountry Food Bank’s Use of
Locally Grown Foods,” Journal of the Community Development Society, 38 (3): 76-88.
Robinson, K. K. (2011). The Potential of Food Banks as a Direct Market for Upstate Smallscale Farm Produce. Clemson University, South Carolina.
Robinson, K. L., K.K. Robinson, C. Carpio, and D. Hughes. (2007). Linking Sustainable
Agriculture and Community Development: The Lowcountry Food Bank’s Use of
Locally Grown Foods. Journal of the Community Development Society, 38, 77-89.
Schafft, K. A., E. B. Jensen, and C. C. Hinrichs. 2009. Food Deserts and Overweight
Schoolchildren: Evidence from Pennsylvania. Rural Sociology 74 (2): 153-177.
Simeon, R. (2011). 2011 South Carolina Obesity Burden Report. Columbia: South Carolina
Department of Health & Environmental Control, Division of Nutrition, Physical
Activity & Obesity.
The Food Desert Locator http://www.ers.usda.gov/data/fooddesert/Trust for America’s
Health. (2012). Health Data About South Carolina. http://healthyamericans.org/stat
es/?stateid=SC#section=1,year=2012,code=undefined
The White House. (1997). Remarks by The President in Apology for Study Done in Tuskegee.
Washington, DC: Office of the Press Secretary.
Ver Ploeg, M. 2010. “Access to Affordable, Nutritious Food Is Limited in “Food Deserts”,
Amber Waves 6 (5), USDA, Economic Research Service. Available at http://ers.usda.
gov/AmberWaves/March10/Features/FoodDeserts.htm
Young, E. (2012). “Finding Upstate South Carolina’s Consumers’ Willingness to Pay for Local
Food with a Price Premium Donation to Local Food Banks.” Unpublished thesis.
Clemson, SC: Clemson University Graduate School.
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Resilience in the Face of Injustice
De Fischler Herman, RP, SD
Chaplain, Capital Caring Hospice
50 F Street, NW Suite 3300
Washington, DC 20001 USA
Tel: 202-244-8300
Fax: 202-244-1413
E-mail: dherman@capitalcaring.org
Author Note
The opinions expressed here are those of the author alone and do not necessarily reflect those
of Capital Caring Hospice. The author has no financial conflicts of interest. The author
acknowledges Eva Mozes Kor and Ginni Stern for their first person accounts.
Introduction
This article is not about resolving all the injustice in the world. Nor is it about slavery,
United States Public Service Syphilis Study in the Untreated Negro Male in Macon County,
Alabama, the Holocaust, genocide, rape in wartime, baseless hatred, or the countless other
horrors human beings, intentionally or unintentionally, inflict on each other, on other sentient
beings, on the Earth.
This article IS about how human beings, after suffering trauma from injustice of any
kind, can meet new life circumstances with their humanity intact. And not only intact, but
perhaps from a new place where it is possible to bear witness to the trauma and, in the process,
become resilient, teach others, and help move humanity toward collective healing.
Healing is Not Limited to the Physical
The word “heal”, by definition, means to make sound or whole, patch up or restore to
health or integrity. Healing, or wholeness, is not limited to the physical realm. Human beings
are made up of much more than a physical body. Chinese medicine offers the five elements:
Earth, Wood, Fire, Water, Metal. From Ayurvedic medicine: Earth, Air, Fire, Water and Aether.
Traditional African medicine is based on the belief that psycho-spiritual issues should be
addressed before or simultaneously with medical aspects. Native American medicine is based on
the understanding that humanity is part of nature and health is a matter of balance and includes
body, mind, spirit, emotions, social group, and lifestyle. It requires a relationship between a
skilled, compassionate healer and a committed patient. Corresponding with Earth, Water, Air
and Fire, Jewish mystical tradition speaks of the four worlds: physical, emotional, intellectual
and spiritual. All these ancient traditions spring from a holistic view, looking at dis-ease and
healing as involving the whole human being.
The greatest teachers and mentors emphasize the need to pause in the midst of busily
“doing” and allowing oneself to spend time simply “being.” It’s only when one can reflect on life
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and its meaning that individuals can make course corrections and respond to the soul’s longing.
One way to prepare for self-reflection is to focus on the breath for several minutes, which can
help quiet the noisy mental chatter.
The ramifications and fallout from acts of injustice and trauma affect not only
individuals, but also families and the ever widening circles of community, nation, and
humanity. Some people, like World War II Polish resistance officer Witold Pilecki, display
unimaginable inner strength and challenge the threat, risking life to halt the injustice. Many
cannot succeed without the encouragement and inspiration from family, friends, trusted
elders, healers, clergy, teachers. Many pathways foster healing from trauma and build resilience:
experiencing loving relationships and caring communities, belief in God or a higher power,
praying, caring for others in distress, communing with nature, engaging in physical exercise,
playing, making music or art, laughing.
What, exactly, is resilience? And how is it that some people who survive trauma from
injustice show resilience and go on to live life well? What tools can help heal and transform
traumatic experience from victim to survivor to victor? Examining the lives of Holocaust
survivors and their children, as well as others who have suffered grave injustice, may shed light
on the characteristics and protective factors that foster resilience. The aim of this presentation is
to teach how to cultivate resilience and pay it forward.
French neuropsychiatrist and psychoanalyst Boris Cyrulnik defines resilience as “the
ability to succeed, to live and to develop in a positive and socially acceptable way, despite the
stress or adversity that would normally involve the real possibility of a negative outcome.”
In his memoir 12 Years a Slave, Solomon Northup, bolstered by his [mental map] of
family, home, and vocation, struggled against the brutality of his slavemaster and declared, “I
want to live!” His will, determination, and resilience strengthened Solomon’s resolve to survive,
despite the terrible circumstances of his kidnapping and enslavement. When he finally found
someone he could entrust with his truth, he was able to affect the shift that helped him regain
his freedom.
Dr. Viktor Frankl, while a prisoner of the infamous Nazi concentration camp
Auschwitz, discovered his theory of logo therapy, a positive method for working with the
mentally and spiritually disturbed. In his classic book Man’s Search for Meaning he describes
how a person can choose one’s attitude and find meaning in one’s life no matter what the
circumstances. Dr. Frankl posed these existential questions:
What about human liberty? Is there no spiritual freedom in regard to behavior and
reaction to any given surroundings? Is that theory true which would have us believe
that man is no more than a product of many conditional and environmental factors-be they of a biological, psychological or sociological nature? Is man but an accidental
product of these? Most important, do the prisoners’ reactions to the singular world
of the concentration camp prove that man cannot escape the influences of his
surroundings? Does man have no choice of action in the face of such circumstances?
After much observation, Dr. Frankl concluded, “The sort of person the prisoner
became was the result of an inner decision, and not the result of camp influences alone.”
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Etty Hillesum, a Dutch Jew, Holocaust diarist, and spiritually gifted woman who
perished in the death camp, showed remarkable depth and wisdom in her short life. Her nonJewish friends reached out to protect her from deportation to the death camps. She could have
lived, but having witnessed her own family’s arrest, she chose to go with them to certain death.
She wrote, “Ultimately, we have just one moral duty: to reclaim large areas of peace in ourselves,
more and more peace, and to reflect it toward others. And the more peace there is in us, the
more peace there will also be in our troubled world.”
A story: Natalia [a pseudonym], a prisoner in a Nazi concentration camp barrack, was
sitting on her bed of straw when it began to rain. A hole in the barrack roof allowed the rain to
fall on the young woman. An object on the floor nearby caught her eye. Curious, she picked it
up and realized it was, of all things, an umbrella. As she opened it she saw it was full of holes. As
more raindrops landed on her, she saw the irony in the ridiculous scenario and began to laugh.
And so did her fellow prisoners.
When the concentration camp was liberated, Natalia was sent to a displaced persons
(DP) camp. Once there, the camp commander treated the liberated as if they were still
prisoners, feeding them little and forcing them to stand for roll call each morning despite their
grave and weak condition. Natalia, unwilling to endure this injustice and deprivation, decided to
act by initiating a hunger strike. In order for her action to be taken seriously by the commander,
she needed a second participant and persuaded a friend to join her. The commander called them
to his office where her friend collapsed in a chair. One did not sit in front of the commandant,
and he barked at her to get up. But Natalia met his eye, looking at the human being behind the
facade of his power. She stated the truth of their inhumane treatment and proclaimed they were
not prisoners, they needed to be treated with dignity, and they needed more food. The man
softened, motioned for her to sit, and promised to stop roll call and to get them more food.
Natalia lived to tell her story to her daughter who carries her mother’s resilient spirit in her own
life, and who shares this story as an important life lesson.
Another strength that helps people survive the trauma of injustice is helping someone
else. Clearly this was one of the characteristics possessed by Dr. Ferdinand Berley, a US Navy
doctor, who was imprisoned in several Japanese prison camps in Manila for most of WWII.
Despite the horrid conditions of his captivity, Dr. Berley found a purpose in living each day by
aiding his fellow prisoners in staying alive. Dr. Berley not only survived his incarceration, he
went on to live a full and rewarding life.
Early in his POW experience, Dr. Berley knew who would survive and who would
not. Those who fell into despair and refused to eat the meager rice ration had caught what he
called “give-up-itis” and soon succumbed. He declared his intention to go home at the end of
the ordeal—and live! He bore witness to his wartime experiences by returning to the Philippine
prison at 92 and giving his oral history testimony to teach the next generation. He died in 2013
just shy of his 101st birthday.
Resilience is possible even if the eventual outcome is negative. One of the stories told
at the Zen Peacemakers Bearing Witness Retreat to Auschwitz illustrates this point: Edek, a
Polish man, and Mala, a Jewish woman, both imprisoned in Auschwitz, fell in love. Instead of
being sent to the gas chambers, each was found fit for labor--Edek as a handyman, and Mala as
a translator. With the help of other prisoners, the pair found a way to share intimate moments.
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Edek had access to the women’s side because he had to make repairs. One day he got a Nazi
uniform and a gun and the lovers planned their escape. As Mala held a sink over her head to
hide her face, she and Edek simply walked out of the camp. They were free for a couple of weeks
until they were recognized as escapees by the Gestapo. Sent back to Auschwitz, never revealing
how they’d obtained the uniform and gun, they were tried and sentenced to death by hanging.
Rather than letting the Nazis kill them, they each took the initiative. One of them ran into the
electric fence and was electrocuted. The other kicked away the chair at the gallows before the SS
executioner could do so.
One rule of survival is get organized or die. Ginni, one of the Zen Peacemakers, told
about her father who survived the concentration camp. In his crammed cattle car transport to
Auschwitz, the “passengers” who were Orthodox Jews, organized themselves-- the men stood on
one side and the women on the other. They all took turns holding up the babies so the infants
wouldn’t suffocate. No one in that transport died.
Ginni, now on the Zen Peacemakers staff, has made this pilgrimage to Auschwitz
every year since its inception in 1995. It may be hard enough to go once, but what motivates
someone to return again and again to that place of unspeakable horror? Is it some sort of sadistic
punishment? One hundred pilgrims, from many countries and many walks of life, make the
journey each November. The youngest participant in 2013 was a college student from Germany
making her second trip, this time without her family. Asked what inspired her, she echoed what
others shared, that Auschwitz was her teacher and she had much more to learn.
Auschwitz does offer deep teachings when one bears witness to that place. There is, in
each and every human being, the capacity for good and the capacity for evil. The perpetrators
of the massive killing factory that was Auschwitz were human beings. That, if given the right
circumstances, any person might choose to “follow orders” and do unspeakable things to
others. One hopes to have the inner strength to rebel against such perpetrators. When the
slavemaster commanded Solomon Northup to whip his fellow slave Patsey, what other choice
might he have made?
Eva Mozes Kor, now 81 years old, is a “poster elder” for resilience. A tireless activist
and recognized speaker on the Holocaust, human rights, and medical ethics, Eva’s life mission
is to educate the world about the need for forgiveness in order to heal from trauma. She was
one of the twin subjects Dr. Josef Mengele experimented on in Auschwitz from 1944 to
1945. Miraculously, and through her resilience, she and her twin sister Miriam, survived the
experiments and were liberated just before their 11th birthday. In 1993 Eva traveled to Germany
and met with a Nazi doctor from Auschwitz, Dr. Hans Munch. She says, “Surprisingly, he was
very kind to me. Even more surprising, I found that I liked him. I asked him if he knew anything
about the gas chambers in Auschwitz. He said what he knew had been fueling the nightmares
he lived with every single day.” Dr. Munch bore witness to Eva Kor of what he saw in those gas
chambers and what he did, signing mass death certificates with no names on them. Eva invited
Dr. Munch to accompany her to Auschwitz in 1995 to commemorate the 50th anniversary of
liberation. She also asked him to sign an affidavit about what he had said and seen and done and
to do so at the site of those killings. He agreed.
It meant so much to Eva Kor that she would have an original document witnessed and
signed by a Nazi--a participant, not a survivor and not a liberator. She felt so grateful, she wanted
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to find a way to thank Dr. Munch. But for nearly a year she was unable to answer the question,
“How can one thank a Nazi doctor?” One day it occurred to her she could write a simple letter
of forgiveness for all that he had done. What she learned from this discovery was that forgiveness
is not for the perpetrator, but for the victim. Eva learned, she writes, “I had the power to forgive.
No one could give me this power, and no one could take it away. That made me feel powerful. It
made me feel good to have power over my life as a survivor.” Encouraged by her former English
professor to think about forgiving Dr. Mengele, Eva realized that, too, was in her power. At the
50th anniversary reunion in Auschwitz with Dr. Munch and both their families, Eva read her
personal statement of forgiveness and signed it. She wrote, “Immediately I felt that a burden of
pain had been lifted from my shoulders, a pain I had lived with for 50 years: I was no longer a
victim of Auschwitz, no longer a victim of my tragic past. I was free…Anger and hate are seeds
that germinate war. Forgiveness is a seed for peace. It is the ultimate act of self-healing.”
The three tenets of the Zen Peacemakers are Not Knowing, Bearing Witness, and
Taking Action. Human beings like to think they’re in control of their lives, but experience
shows otherwise. People don’t know how their lives will play out. It is a given that life will come
to an end, yet unless one suicides, individuals don’t know how or when. People make choices
throughout life. By bearing witness human beings can learn from past transgressions. The
philosopher George Santayana said, “Those who cannot remember the past are condemned
to repeat it.” What he may have meant is this: Re-membering is about putting back together
in a way that makes a whole. When human beings engage in diminishing fellow human beings
as sub-human, whether by words or heinous acts, it leads to dis-membering or dis-integrating
humanity. An ancient teaching says, “Taking a life is like taking a whole world; saving a life is
like saving a whole world.” Spiritual caregivers to patients and their families near the end of life
frequently encounter destructive family patterns that play out from generation to generation.
Such patterned behaviors are often unspoken, unexplored, and/or shrouded in fear or shame.
Yet, families can heal their broken relationships through simple but profound conversations,
including words of forgiveness, gratitude and love and by restoring human touch.
Inspiring teachings often come from those who have, as journalist Laurence Gonzales
notes, “survived survival. In the book Surviving Survival: The Art and Science of Resilience
Gonzales writes, “people who successfully negotiate their lives in the aftermath of trauma tend
to follow two routes. First, you have to desire something and engage in some activity to get it.
You can’t give up. You can’t give in.” In other words, one must take initiative and get organized.
And second, it’s essential to observe, take action and then pay it forward.
Resilience is not necessarily innate. Employing the following tools can cultivate
resilience and, in truth, have helped many survive and thrive after trauma.
Getting quiet. Even though it helps to stay busy, individuals need time regularly to
pay attention to mind and body to access their intuition. Taking a Sabbath for the soul, even 20
minutes a day, can make a difference. Establishing a spiritual practice, praying, tending a garden,
connecting with Nature all can recharge one’s battery.
Examining suffering. When suffering comes, if the sufferer engages with it, learning
can result. Perceptions can shift and help soften the experience of one’s own suffering when one
directly observes the suffering of others.
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Ritualizing the injustice. Traumatic experiences leave a permanent imprint on the
bodymind and, without reframing, sow the seeds for illness. They need to be acknowledged
for psychospiritual healing to occur. Creating a ritual specific to the injustice and witnessed by
a trusted friend (or a few) acknowledges, defuses and transforms the episode from trauma to
resolution.
Engaging in work or an activity. Working helps one cope, adapt, and develop a
routine to structure the day.
Paying it forward. Altruism helps a person move from victim to rescuer, elevates
purpose, increases self-esteem, and generates gratitude.
Finding a buddy. Cultivating a relationship with a friend, a walking partner, a
playmate establishes bonds of compassion and understanding. The bonds strengthen and foster
mutual safety when buddies pledge to listen without judging one other, allowing each to open
up to the listening ear of a trusted companion.
Connecting. Reaching out to others, not only with one’s voice, but by being physically
present, creates powerful energetic pathways and taps into the sacred. America is commonly
perceived as a nation of rugged individualists. The truth is that humans are born to live in
families, tribes, villages, neighborhoods, and communities. Touching reduces pain, depression,
improves the immune response, and increases trust. Hugging is healing. If one’s family is not a
supportive option, the need may be satisfied by, among others, a teacher, chaplain, life coach,
therapist, or support group.
Making art. Making images, sculpture, music, poetry, theater, and movement
are powerful healing tools. Websites of organizations promoting creativity, listed in the
bibliography, can help a person (the reader) get started.
Expressing gratitude for life. Even a professional musician who became quadriplegic
after a devastating car crash found a way to express himself through art and let the world know
he was still full of life.
Laughing and crying. Expressing emotions through laughter and tears helps heal the
psyche, the brain, the heart and the gut, and aids in disease prevention.
Speaking truth to power. Cultivating trusted allies builds support when preparing
to challenge the injustice. The Truth and Reconciliation Commission (TRC) in South Africa
created a safe container for the victims to confront their perpetrators.
Practicing forgiveness. Injustice can’t be undone, but people can be educated,
agitated and activated to bring about justice. Emotional baggage weighs heavily on individuals,
families, communities and nations unless and until it is examined, recontextualized and
released. Contrary to the popular expression, forgiveness is not about forgetting. It is not for the
perpetrator(s)—it is for the aggrieved to be freed from the torment, hurt and anger towards the
perpetrator(s). Eva Kor has inspired (as well as angered) many since she publicly forgave
Dr. Josef Mengele.
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Telling a personal story. Everyone has a story that’s uniquely theirs. What makes
people feel alive is being in relationship. What makes living so remarkable is getting to know
another by experiencing awe, wonder, empathy for another’s unique struggles and sharing
memories of common experiences. Dreams, as well, give many clues to one’s inner life and are
the soul’s way of speaking to the host’s consciousness.
Solomon Northup and Eva Kor are “poster children” for resilience. Not only did they
“survive” their trauma, they fiercely nourished their life force to fulfill their dreams. How to
foster resilience by intention? Since the Vietnam War the term “post traumatic stress disorder”
refers to the wounds of war that show up after military personnel return home. That is a
misnomer. It is not really a disorder. It is actually a natural response to trauma. Post traumatic
stress leads to severe psychological, mental, social and physical maladies. In resilient individuals,
however, scientists have identified what they term “post traumatic growth.” Common responses
of people who display this quality include:
1) My priorities have changed--I’m not afraid to do what makes me happy
2) I feel closer to my friends and family
3) I understand myself better
4) I have a sense of meaning and purpose
5) I’m better able to focus on my goals and dreams
Conclusion
It is incumbent upon society to honor the resilient ones who courageously shared their
stories of history’s most egregious injustices to ensure that the world will not only NOT forget,
but re-member to help heal the broken places and advance the future course of humanity and
this precious planet called Earth. Everyone can access the seeds of what is needed for posttraumatic growth. May each one, as individuals and communities large and small, plant them,
water them, weed them, and give them sunshine.
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References
Cyrulnik, B. (2011). Resilience: How Your Inner Strength Can Set You Free From the Past.
Tarcher Penguin, 5.
Frankl, V. (1959; 1984). Man’s Search for Meaning: An Introduction to Logotherapy, Touchstone, 74.
Gonzales, L. (2012). Surviving Survival: The Art and Science of Resilience. W.W. Norton, 31, 211.
Herman, J. (1997). Battle Station Sick Bay. Interview with Dr. Ferdinand Berley. Naval Institute
Press, 37-42.
Hillesum, E. (1996). An Interrupted Life: The Diaries of Etty Hillesum1941-1943. Retrieved
April 1, 2014 from BrainyQuote.com website. http://www.brainyquote.com/
quotes/e/ettyhilles133536.html.
Kor, E.M. and Buccieri, L. R. (2009). Surviving the Angel of Death: The Story of a Mengele Twin
in Auschwitz. Tanglewood Publishing, 131-133.
Northrup, S. (1853, 2013). Twelve Years a Slave, LSU Press.
Santayana, G. (n.d.). BrainyQuote.com. Retrieved April 1, 2014, from BrainyQuote.com
website. http://www.brainyquote.com/quotes/g/georgesant101521.html.
Stern, G. (2014, June 1). Phone interview by D. Herman.
Inspiring Resources about Resilience in the Face of Injustice
Books
An Interrupted Life. (1984; Henry Holt 1996). By Etty Hillesum.
Anne Frank: The Diary of a Young Girl. (1952; Bantam 1993).
Into the Light: The Healing Art of Kalman Aron. (2012). By Susan Beilby Magee, Hudson Hills.
Man’s Search for Meaning. (1946; Beacon Press 2006). By Viktor Frankl.
Memories of Survival. (2012). By Esther Niesenthal Krinitz and Bernice Steinhardt, TWP.
Nightt (1972; Hill & Wang 2006). By Eli Wiesel.
Resilience: How Your Inner Strength Can Set You Free from the Past. (2011). By Boris Cyrulnik,
Penguin.
Surviving the Angel of Death: The Story of a Mengele Twin in Auschwitz. (2009). By Eva Mozes
Kor and Lisa Rojany Buccieri, Tanglewood.
Surviving Survival: The Art and Science of Resilience. (2012). by Laurence Gonzales, W.W. Norton.
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That Takes Ovaries! Bold Females and Their Brazen Acts. (2002). Rivka Solomon, editor, Three
Rivers Press.
Twelve Years a Slave. (1853; Seven Treasures Publications 2013). By Solomon Northup.
Films and DVD’s
Eye of the Beholder. (2011). Documentary by Sohrob Fatoorechie, Children of Central Asia
Foundation www.childrenofcentralasia.org.
Forgiving Dr. Mengele. (2006). Documentary about Eva Mozes Kor, a twin who survived
Auschwitz, by First Run Features.
No Place on Earth: An Incredible True Story of Strength and Survival. (2012). Directed by Janet
Tobias; www.noplaceonearthfilm.com.
Viktor & I. (2011). Documentary by Alexander Vesely (Viktor Frankl’s grandson).
www.viktorandimovie.com.
Weapons of the Spirit. (1987). Documentary by Pierre Sauvage. www.chambon.org/weapons_en.htm.
Within the Eye of the Storm. (2012) Documentary by Shelly Hermon. http://withineyeofstorm.com/.
Websites
American Visionary Art Museum, www.avam.org.
The Anne Frank Center USA, www.annefrank.com.
Anne Frank Channel on YouTube, www.youtube.com/annefrank.
Art and Remembrance, www.artandremembrance.org.
Artworks for Freedom, www.artworksforfreedom.org.
Botlhale Boikanyo, http://vimeo.com/62704265.
Botlhale Boikanyo, www.facebook.com/BotlhaleBoikanyoOfficial.
Brother David Steindl-Rast, www.gratefulness.org (see TED talk).
Dance Exchange, www.danceexchange.org.
First Star, www.firststar.org.
InnerHarmony, www.innerharmony.com.
Metta Institute, www.mettainstitute.org.
Project Voice, www.project-voice.net.
TED Talks, www.ted.com/talks: Jill Bolte Taylor, Jane McGonigal, Brother David Steindl-Rast;
also sort by “inspiring”.
Zen Peacemakers, www.zenpeacemakers.org.
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Public Health Injustices: “Media is the Message”
The Rev. Joan R. Harrell, MS, MDiv, DMIN (cand)
Strategic External Communications Consultant
The National Center for Bioethics in Research and Health Care at Tuskegee University
John A. Kenney Hall, 44-105
1200 West Montgomery Road
Tuskegee, AL 36088
Tel: (334) 724-4554
Email: jharrell@mytu.tuskegee.edu and jrhpublictheology@gmail.com
Author’s Note
This article stemmed from an address that was given to the descendants of the “United States
Public Health Service Study of Untreated Syphilis in the Negro Male in Macon County,
Alabama,” public health undergraduate and graduate students, community advocates, policy
makers, faith leaders and academics during the 2014 Public Health Ethics Intensive (PHEI). The
PHEI is annually sponsored by the National Center for Bioethics in Research and Health Care
at Tuskegee University. The author is solely responsible for the contents of this article.
Abstract
The poor health and unsanitary living conditions of enslaved blacks in the United States of
America represented public health injustices caused by the intended lack of health care for
enslaved Africans. During slavery many white physicians in the South wrote articles in medical
journals which authoritatively reported, black slaves from Africa were unhealthy and unsanitary.
These articles were framed as official medical evidence, circulated by news media and other
editorial influencers and informed the public about the health disparities of slaves and former
slaves. Later the deficient public health care for black people continued across the nation after
the Civil War. Today, in the 21st Century, we continue to witness the intersection of negatively
framed medical journal articles, public health data about the health disparities of African
Americans and sensationalized media message. Thus, perpetuating racially biased perceptions
about the humanity and value of black lives in the United States. The narrative of the United
States Public Health Service Study of Untreated Syphilis in the Negro Male in Macon County,
Alabama and Booker T. Washington’s public health activism are used as engaging resources
that provide examples of media messaging that can promote public health equity or perpetuate
injustice. The paper concludes with strategies for using media messaging to promote public
health equity.
Keywords: African, black lives, eugenics, marginalized people, manipulated media messages,
syphilis, U.S. Public Health Service
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Introduction
According to philosopher Paul Ricoeur, “symbols give rise to thought.” Within the
context of the meaning of “media is the message,” this paper critiques how selected public health
data about the health disparities of African Americans and other people of color was published
in traditional media, such as medical journals and disseminated by the news media as official
public health information. This paper addresses questions of whether: certain public health
disparities data are manipulated by influential gate keepers? Whether some health disparities
data about people of color are reported to intentionally construct negative stereotypes about
African Americans, Native Americans and other communities of color in the U.S.? Whether
health disparities data sometimes released to the public to perpetuate polarization between
communities? These questions are examined through an investigation of the historical
intersection of race, class and the framing of scientific data and public media about black bodies.
The narrative of the United States Public Health Service Study of Untreated Syphilis in the
Negro Male in Macon County, Alabama and Booker T. Washington’s public health activism
are used as engaging resources that provide examples of media messaging that can promote
public health equity or perpetuate injustice. The paper concludes with strategies for using media
messaging to promote public health equity and justice.
Historic Context
Symbols give rise to thought. Why is it oftentimes, when poverty is visually illustrated
in the United States, the image is usually a heart breaking photograph or video of an emaciated
and unclean body of a poor African American, black African, brown South American or Native
American child?
In his book, Channeling Blackness Studies in Television and Race, UCLA Sociologist,
Darnell Hunt reported, television editorial decision makers used this sociological construct:
White = European = Civilized = Rational = Superior = Free= Good
versus
Black = African = Savage = Emotional = Inferior = Slave = Bad.
This sociological formula revealed the practice of distinguishing negative and positive
differences between black and white people in television roles. This same black-white binary
used in television media is similar to the method that was used by certain white physicians in
medical journals during slavery to describe the health disparities of black slaves and later freed
black people in the United States.
Dr. Josiah Clark Nott of Mobile, Alabama and Dr. Samuel A. Cartwright of New
Orleans, Louisiana wrote and many published articles in medical journals, specifically about
diseases and physical disabilities, they theorized were only normal to black people. According to
James H. Jones, the author of Bad Blood, The Tuskegee Experiment, Drs. Nott and Cartwright’s
articles were used to “help inflame a legal fight for slavery” in the United States. Drs. Nott and
Cartwright wrote, “…among the diseases said to be unique to blacks were Cachexia Africana,
which meant dirt-eating and Stuma Africana, which meant Negro Consumption.”
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Historical records show, in the 18th, 19th and early 20th centuries, a number of
white physicians used medical journals, books and newspaper media platforms to publish
discriminating sociomedical profiles about the bodies of black people. None of the physicians
and researchers who published articles about racialized medicine never used their expertise as
health professionals to write the truth about how systemic racism manifested unhealthy living
conditions for slaves before the Civil War and black people in rural and urban communities in
the North and South, after the Civil War.
Records in the Library of Congress revealed certain white physicians, specifically in
the southern states where slavery was practiced, did not write about the dreadfully poor diets
which slave children, women and men had to eat. For example, in their book, Time on the Cross:
The Economics of American Slavery, Fogel and Engerman explained, many Southern plantation
owners forced enslaved Africans, including children to work 54 hours a week without proper
nutrition. Enslaved children, women and men lived on monthly rations of corn meal, corn,
pork, bread, and sometimes fish and vegetables.
Historians clarified, the slaves’ diets were not nutritive; their non-nutritious diets did
not include iron, calcium, and vitamin A. In fact, many slaves had poor eyesight because the
foods most plantation owners gave them did not have vitamin A. Other slaves suffered with
anemia and rickets because vitamin D was not in their diet.
Based on more information chronicled by historians, black slaves had health problems
due to dietary inequality, physical stress on their bodies, and filthy living conditions. Plantation
owners exploited slaves’ labor and did not feed them healthy food because slave owners of their
labeled the bodies of the slaves inferior, therefore black children, women and men were treated
like animals, not human beings. This chronicle of the intersection of race, class and medical
apartheid is aptly demonstrated in the United States Public Health Service Study of Untreated
Syphilis in the Negro Male in Macon County, Alabama narrative.
The Narrative
A narrative is a personal story about a human being or an issue about the human
condition. A narrative is an engaging resource to promote change, whether negative or positive.
A narrative can offer thorough or misleading public health information. This paper provides
examples of negative and positive public health narratives and media messaging. Media can
promote public health equity and or injustice.
The unethical 1932-1972 United States Public Health Syphilis Study in the Untreated
Negro Male is an historical narrative which exhibits the intersecting of race, class and medical
apartheid in rural Macon County (including Tuskegee), Alabama. This is a real lived experience
of the more than 500 African American men used as guinea pigs to find out how untreated
syphilis affects and kills the human body, by U.S. medical doctors and researchers. This historic
medical narrative is evidence how racially biased medical research can be implemented, reported
in medical journals and not be investigated by medical doctors, doctors of osteopathic medicine,
researchers, nor journalists. For example when researchers and physicians wrote articles in
the New England Journal of Medicine other industry periodicals about the “United States
Public Health Study of Untreated Syphilis in the Negro Male,” purportedly, no official medical
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research investigator nor news media inquired, why syphilitic black males in rural Alabama were
not treated with penicillin.
The U.S. medical profession discovered in the 1940s that penicillin cured syphilis
but during the estimated 40-year Syphilis Study, penicillin was never administered to the 399
poor, uneducated black male sharecroppers who were living with syphilis. There were also
an estimated 201 black men, also poor and uneducated who did not have syphilis but were
included in the study and used as a control group. None of the men in the study were asked
to sign consent forms for the study. They were told they were being treated for what was
colloquially know in that particular black community in Alabama as “bad blood.” They received
free medical treatment and burial insurance in exchange for their bodies to be unethically
used for scientific and medical research. (Williams and Hammond, 2012) During the 40-year
time period of the study no medical nor editorial gate keeper examined why the bodies of the
descendants of enslaved Africans in the rural south were treated as human laboratory animals.
It is critical to describe the sequence of the following descriptions which highlight
racism in the history of medicine in the U.S. and the world and health disparities in the African
American community. In the year 1888, 25-years after the Civil War, it was reported, that
syphilis was badly affecting the health and causing a high percentage of deaths in the black
community. Additionally, there appeared to be no treatment nor medicine for the black women
and men who lived with syphilis. Data about how syphilis impacted black women and unborn
children was rarely publicized.
In 1735 Systema Naturae was published by Swedish botanist, zoologist and physician
Carolous Linnaeus. Linnaeus introduced the Linnean taxonomy to the world. According to
Cedric M. Bright M.D., CACP, the former President of the National Medication Association
(NMA), “In this work, biological classes were introduced and people of African descent were
labeled anatomically inferior.”
In 1870, the American Medical Association (AMA) established a policy that did not
allow African American and women to become members of the largest professional organization
of medical doctors, doctors of osteopathic medicine and medical students in the United States.
The AMA was founded in 1847, while African Americans were enslaved in the U.S.
Medical apartheid (Washington, 2008) was practiced to justify white supremacy by
certain white physicians during slavery and continued six-decades after the Civil War. In the
year 1932, the “USPHS Study of Untreated Syphilis in the Negro Male in Macon County,
Alabama” was conducted within the context of systemic racism, and eugenics (Eng, 2005). This
racist medical practice perpetuated a negative image of the black body in the United States.
Furthermore, this widely publicized dehumanizing construct was subconsciously etched in
the consciousness of the citizenry of the United States. People of African descent were labeled
anatomically inferior, unsanitary, sexually promiscuous and carriers of infectious diseases.
Public health disparities data and media messages that gave the perception black people in the
United States are unhealthy, unsanitary and consequently, a threat to the human condition, were
disseminated throughout the U.S. for 300-years, from the 18th to the 20th Century. Within the
historical narrative regarding ethical violations of and disregard for black bodies, some African
American leaders seemed to understand how media messaging perpetuated public attitudes of
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mistrust and fueled stereotypes about blacks that were used to justify their unjust treatment.
Two leaders who knew the significance of public health data in the battle for equality and justice
will be examined. Both of whom are responsible for the legacy of public health activism at
Tuskegee University.
W.E.B. Dubois and Booker T. Washington
Respond to Public Health Data
In the early 20th century, W.E.B. DuBois, the first African American to earn a
doctorate from Harvard University and Booker T. Washington, founder and first president
of Tuskegee Institute (today, Tuskegee University) understood the power of disseminating
public health data, economics, history and media messages. An important note about DuBois
and Washington’s socio economic class, Washington was born into slavery and DuBois was a
descendant of a small free black population in Massachusetts and his great-great grandfather
was a slave in West Africa in 1730. Both Washington and DuBois recognized, the historical,
academic, political and socio-economic need to chronicle the health disparities of Negro
Americans and the necessity to organize a national mobilization of Negro doctors and nurses,
institutions, organizations and churches to improve the health care of the Negro community in
the United States.
In the year 1906, DuBois edited, The Health and Physique of the Negro American:
A Social Study Made Under the Direction of the Atlanta University by the Eleventh Atlanta
Conference. This academic work cited unsanitary living and life threatening health challenges in
the Negro American community. The study reported that because of the poor health statistics in
the Negro community, it was time for the Negro community to establish, “the formation of local
health leagues among colored people for the dissemination of better knowledge of sanitation
and preventive medicine.”
In the year 1915, Washington made a public declaration for better health care of the
Negro people in the United States. He asked, “The Negro people to join in a movement which
shall be known as Negro Health Improvement Week.” According to a 1950 report by the
United States Public Health Service, in 1915, “the infant mortality rate for blacks was 180.6
per 1,000 live births compared to 98.6 for white babies.” Before Booker T. Washington’s death
in November of 1915, National Negro Health Week evolved into National Negro Health
Month, which was first observed April 11th – 17th 1915 across the U.S. A National Negro
Health News Bulletin (NNHB) was written, edited and disseminated by Tuskegee Institute.
Six years later in 1921 the United States Public Health Service began publishing the National
Negro Health Week Bulletin.
After the radio was invented, leaders in the National Negro Health Week Movement,
produced featured radio programs and announcements. Media messages were integral to the
Negro Health Movement.
The first year the National Negro Health News Bulletin was published by Tuskegee
Institute, the black infant mortality rate was 180.6 per 1,000 live births compared to 98.6 for
white babies. Today, in the 21th Century health care professionals report, “Black infants are
between two and a half to three times more likely to die within their first year than white infants.”
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It is alarming to read that the infant mortality rates for black babies today in 2014 are
just as staggering as they were 52-years after the end of slavery was proclaimed in the U.S.
1. One in two black babies are poor in the U.S.
2. The shooting deaths of unarmed African American boys, women and men
3. The deaths of African American and Latino boys and men who have died to gun
violence in Chicago is higher than military women and men who have died fighting
in the war in Afghanistan.
4. Cancer rates and other health disparities are greater for Native Americans than any
other American.
5. Native Americans are 500% more likely to die from tuberculosis.
6. The majority of food deserts in the U.S. are located in communities of color and
economically poor neighborhoods.
Conclusion: Promoting Public Health and
Social Justice Media Messaging
The organized national health care movement for the Negro American was created
and birthed at the historic Tuskegee Institute. National Negro Health Week was observed in
the United States for 35-years from 1915 to 1951. The health conditions for freed African
Americans in the 21th Century are just as serious as they were for former enslaved Africans,
who were identified as Negro Americans after slavery in the early 20th Century. National Negro
Health Week was a catalyst for National Minority Health Month which is observed in the month
of April by the U.S. Department of Health and Human Services Office of Minority Health.
In conclusion, there is a crucial need for the National Center for Bioethics in Research
and Health Care to become the academic paradigm for keeping the U.S. and the world informed
about public health data, clinical trials, biomedical research, and health disparities impacting
African Americans, other people of color and oppressed communities. The Bioethics Center
could set up an International Public Health Digital Media Network. This public health
network would teach, promote, provide resources, and create discourses to discuss the cause of
health disparities in African American, other communities of color and poor neighborhoods.
The Bioethics Center’s network would disseminate digital media messages about public health
research, injustices and promote ethical work in the discipline of public health.
The Bioethics Center would develop and produce digital media applications. These
applications would build upon the Bioethics Center’s optimal health pedagogy and create Web
2.0 information technology, to generate an interactive space for public health content to be
exchanged. For example, the Bioethics Center can add communications media to its academic
curriculum and mission to offer the following resources:
1. Establish an institute in media to educate and provide communication skills for
public health and biomedical students, physicians, faith leaders working in health
care settings, medical journalists and other health care professionals. Seminars at
the Bioethics Center’s Institute would offer classes in writing articles, editorials,
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hosting and producing podcasts for the Internet and media stories and or messages
for radio and television platforms.
2. Provide media technology education and internships for public health and
biomedical students (undergraduate and graduate).
3. Write, edit and disseminate a bimonthly or quarterly electronic newsletter.
4. Create and develop web applications including an interactive website, blog,
electronic newsletter, Twitter, YouTube and Instagram accounts. These web
applications would disseminate public health information which include data,
health alerts and news about academic public health scholarships and fellowships.
5. Create and develop a mobile app which would provide public health resources and
contact with health care practitioners. This would assist vulnerable people living
in rural and urban communities which do not have access to health care insurance,
medical clinics, and or hospitals.
6. Work with descendants of the USPHS Syphilis Study and other unethical
mistreatment; assist these survivors with to tell their stories and help them advocate
for justice in the public square.
7. Give descendants and surviving unconsented study participants (of any bioethical
episode) classroom space to dialogue with scientific/biomedical researchers and
medical journalists. Descendants and survivors would participate in discourse to
help editorial gate keepers learn how to listen and hear the voices of marginalized
and vulnerable people who are or have experienced unethical treatment in the
health care system.
8. Provide an educational space to conduct academic and practical discourse for
health care professionals and journalist to learn about the history and culture of the
communities living with health disparities.
Within the context of minority health disparities and negative media images today in
the 21st Century in the United States, there is a critical need for transdisciplinary scholarship
and praxis in the discipline and vocation of public health care. The historical repetition of
medical apartheid upon unconsented and marginalized human beings, unethically treated
because of their race, class and or gender must stop.
Achievably, it is time to analytically study and reflect upon the work founded by
African American leaders of the early 20th Century National Negro Health Improvement
Movement and develop a Minority Health Movement for the 21th Century. The descendants of
the “United States Public Health Service Study of Untreated Syphilis in the Untreated Negro
Male,” public health students, faith leaders, community advocates, scientists, unconsented
human subjects of bioethical episodes, physicians, biomedical researchers, medical journalists,
and other public health professionals should collectively work with the National Center for
Bioethics in Research and Health Care to establish an International Public Health Ethics
Institute and Digital Media Network at the National Center for Bioethics in Research and
Health Care on the campus of Tuskegee University.
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References
DuBois, W.E.B., (1906). The Health and Physique of the Negro American. The Atlanta
University Press.
Fogel, R. W. & Engerman, S. L. eds. (2013). Time on the Cross: The Economics of American
Slavery. W.W. Norton and Company, Inc.
Hunt, D. M. (2005). Channeling Blackness: Studies on Television and Race in America. Oxford
University Press.
Jones, J. H. (1993). Bad Blood: The Tuskegee Syphilis Experiment. The Free Press.
Katz, R.V. & Warren, R.C. eds. (2011). The Search for the Legacy of the USPHS Syphilis Study at
Tuskegee. Lexington Books.
Quinn, S. and Thomas, S. (2001). National Negro Health Week, 1915 to 1951: A Descriptive
Account. Minority Health Today. 44-49
Washington, H.A. (2008). Medical Apartheid: The Dark History of Medical Experimentation on
Black Americans from Colonial Times to the Present. Doubleday.
Williams, L.S. and Hammond, A.L. (2012), Ethics in Research. Journal of Healthcare, Science
and The Humanities. 31-39.
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What Does One Do With a Master’s Degree in Bioethics?
Elana Aziza, MHSc, (SLP) Reg CASLPO, MHSc
Speech-Language Pathologist, University Health Network
Toronto, Canada
Email: elaziza@rogers.com
Nicole Devost, MD, CCFP, FCFP, MHSc
Family Physician
Palliative Care Services
Lakeridge Health
Ontario, Canada
Email: ndevost@hotmail.com
Christine McColeman, RRT, BA, MHSc
Registered Respiratory Therapist
The Scarborough Hospital, Birchmount Division
Ontario, Canada
Email:cmccole@hotmail.com
Gail A. Morris, BPE, MD, CCFP, MHSc
Family Physician
Markham Stouffville Hospital
Lecturer, University of Toronto
Ontario, Canada
Email: gmcp@rogers.com
Author’s Note
This article presents a qualitative reflection of a group of four health care professionals who have
recently completed a Master of Health Sciences (MHSc) degree in Bioethics, at a University in
Ontario, Canada. These four students collaborated on many assignments during this program
and formed a cohesive supportive group during their program.
Introduction
As the field of bioethics in Canada continues to evolve and move towards
professionalization, the structure and practice within each health care institute remains diverse.
Incorporated within each hospital’s “Mission, Vision and Values” statement is a devoted
commitment to ethical practice. Some hospitals employ a full-time ethicist on site while others
utilize ethicists on an “ad hoc” basis. Most hospitals have a Research Ethics Board (REB), the
director of which may or may not have formal academic training in the field of bioethics. This
multiplicity within the infrastructure of bioethics at differing hospitals lends itself to an array of
perceptions by practicing clinicians. Within the content of this reflection, we will explore these
perceptions as well as the personal and professional transformations experienced by the authors
as they continued their employment after completion of a graduate degree in Bioethics.
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The four health care professionals participating in the program arrived from
different professional backgrounds. They continued to practice while both completing their
2-year course of study and after completion of their degree. The MHSc degree in Bioethics,
completed at the University of Toronto, was similar to other Master’s Programs in Bioethics
in that it included courses in the Theory of Bioethics, Research Ethics, Organizational Ethics,
Legal and Empirical Approaches to Bioethics, Resource Allocation, Teaching of Bioethics, a
Writing Class, and a practicum. While this was a non-thesis program, a Capstone Project was
completed in the final semester.
At this time, the authors have not changed their career paths from their original
profession to work as a full-time clinical ethicist. Elana Aziza is a speech-language pathologist
working in oncology and acute care at a university teaching hospital. Nicole Devost is a physician
who specializes in palliative care at a community hospital. Christine McColeman is Respiratory
Therapist who works in an acute care community hospital. Gail Morris is a family physician who
also teaches ethics to family practice residents at a community hospital. After many years practice
in their individual professions encountering clinical ethical dilemmas on a daily basis, they
felt a tremendous desire to pursue the study of bioethics. For one author, it was her frustrating
experience as a clinical trial participant that led her to pursue further education in Bioethics, for
the other authors it was to link the clinical experience with the theory and analysis.
This study of Bioethics permitted the writers to connect the theory with their vast
clinical experience by getting the appropriate knowledge for analysis and resolution of ethical
dilemmas. However, they learned much more than anticipated especially about organizational
ethics, resource allocation and research. Almost one year after completion of the program, the
authors have continued to meet together to reflect upon the impact that the program has had
on their professional practices. This reflection was framed within the context of the following
questions: “Did the study of bioethics through this program, change, modify or transform our
personal and professional development and/or practice? Did it change how we do our work and
who we are? How? Why?”
Certain recurring themes were noted in the reflections. The authors noted that
instead of reacting to ethical issues on an intuitive level as they might have in the past, they
now have ethical frameworks and knowledge to support their responses and feelings. They are
all more involved either at their own institutions, or professional associations in providing inservices or other forms of ethics-related teaching. There is more ethics awareness both on their
parts and on the parts of those working around them, and more informal discussion about
what is right and why.
Methodology
While other scholars have reflected upon their experiences in their first year as they
transitioned to become clinical ethicists (Hardingham, Faith, Godkin & Chidwick, 2011), in
this case the authors did not leave their previous career paths. The methodology to be employed
in this study utilized an inductive examination of various subjective experiences of the authors.
This was achieved by posing key reflective questions through which the authors discerned
the attributes and deficiencies of ethics support within their institutes as well as their role in
promoting ethics awareness.
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Determining which topics to highlight, the authors collectively selected various
themes to examine. They posed questions through which they would compare/contrast their
findings. The goal would be a summary of the diversity in ethical structure within their home
institutes, and how they feel their role may or may not have changed with their enhanced
bioethical knowledge base.
The reflective questions they posed generated the following:
1. An observation of the ethical frameworks at their hospitals and their functioning,
including their thoughts on their involvement.
2. Their perception of their role in their hospital/department and how it has changed
– how they perceive this role, how others perceive their role, how they would like to
be perceived. They also explored barriers in how to achieve the role they would like.
3. Observations of how their hospitals handle “end of life” and “No CPR” issues,
including the gathering of information from patients or substitute decision makers
and the follow-through of the patients’ wishes.
4. Spreading knowledge – How they have spread their knowledge through teaching,
giving talks and being a resource.
5. How they now view the allocation of scarce resources.
6. Feelings – Anxiety they may feel in their role around bioethical issues, making a
wrong decision, around how others perceive them, how they may constrain others
by having bioethical knowledge.
The goal of this paper will be to present a summary of their reflections as they
endeavor to maximize their enhanced bioethical knowledge base to provide better patient care.
Findings
Observations of the ethical frameworks at their hospitals and their functioning,
including their thoughts on their involvement.
Canadian Hospital accreditation requires the presence of an ethics service in each
hospital. This being said, there is a degree of diversity in the structure and function of the ethics
departments at the four hospitals at which the authors are employed. The manner, in which the
authors utilize their knowledge or are utilized by the institute, varies as well.
All hospitals have a Research Ethics Board, as this is a requirement for institutions
that wish to conduct and monitor research projects. All hospitals provide some degree of ethics
information on their hospital website for staff to access. One hospital employs a full time
ethicist to cover two campuses. She created a detailed “ethics decision making guide” which
is posted on every nursing unit for quick access. She is available for assistance with ethical
dilemmas 7 days a week. This hospital also established an “ethics facilitator model” utilizing
chosen health care staff as volunteers. These health care professionals received an introduction
to ethics practice based on an 8-hour in-service. This format is based on the Hub and Spoke
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Model which configures the Bioethicist as the “hub” and the health care professionals as the
“spokes” (MacRae, Chidwick, Berry, Secker, Hebert, Zlotnik, Shaul, Faith & Singer, 2011).
This is an ideal manner in which to bring ethics to the frontline staff, addressing ruminating
issues and enhancing visibility. Unfortunately, this program has not been widely publicized and
appears underutilized at this time.
One teaching and one community hospital have a formalized ethics program with
full- time ethicists. Another hospital currently does not have an ethicist in its employ but
has recently created an “ethics committee” on which sits two health care practitioners with
Master’s Degrees in Bioethics. The format of ethics dissemination to staff usually consists of
lunch based in-services or consultation to address specific issues. One commonality among
all institutes is a deficiency in day-to-day or “grass roots” awareness of the ethics service by the
hospital staff.
The manner, in which the authors utilize their knowledge or are utilized by
the institute, varies as well. These differences in utilization are somewhat related to their
professional roles. A Respiratory Therapist and Palliative Care Physician are involved in
“end of life” discussions with patients and their families on a frequent basis. As a result these
individuals may observe deficiencies within this practice and take the initiative to help in
policy revision surrounding such issues. A family physician supervising residents is acutely
aware of the need for a well-rounded introduction to ethics for her students. She created a
curriculum to cover key issues. A Speech Language Pathologist observes ethical conundrums
within her practice and feels compelled to bring these issues to the appropriate party, hoping
for a resolution. These approaches are “grass roots” in nature initiated by concerned clinicians.
These issues are well below the radar of a lone ethicist or small ethics department responsible
for multi-site institution.
The authors’ involvement in supporting ethical practice post-graduation (MHSc)
is varied. Their colleagues at the local level are aware of their recent convocation and will
employ their informal opinions as a sounding board, or for advice should they encounter
ethical challenges. They endeavor to inject their ethical expertise into their clinical practice
at every opportunity. Since they are not employed as Bioethicists they are not consulted in
this capacity and should direct such inquires to the appropriate parties. In this arena they feel
their extensive training is being underused. They have all participated in some form of ethics
education, whether it involves teaching, policy revision, writing articles for hospital papers or
participating on Ethics Committees. One of the authors, who participates on her institute’s
Research Ethics Board (REB) committee, was asked if she would like to be the new Chair of
the REB. Although this was an honor, she felt she would like to gain more experience before
confronting this challenge. Generally speaking, for the most part, the authors feel their new
knowledge base is underutilized.
Their perception of their role in their hospital/department and how it has changed –
how they perceive this role, how others perceive their role, how they would like to
be perceived: Barriers in how to achieve the role they would like.
Among this group, none of the authors has made formal changes to their roles or
designations, yet all have commented that they are viewed somewhat differently. This bioethics
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course of study placed them in the position of being an “ethics sounding board”, or being asked
to sit on ethics committees or REB’s. One person commented on the dichotomy of feeling
“undervalued” in some instances and “overvalued” in others. This is because, although they
have this new degree, they are not practicing as ethicists. It is challenging to present and to use
this new knowledge with their work colleagues. Similarly, some colleagues aware of their ethics
education are discussing issues and cases with them, asking them to write or edit policies, or
chair committees, yet the authors question if this is appropriate. Another type of dichotomy was
noted by one author, wherein on the one hand, a co-worker made a demeaning comment that
“she is just pretending to do ethics”, yet the same institution was willing to utilize her services for
free. This seems to reflect a common feeling among the four authors – they feel that they have
worked hard to complete this degree, and have useful knowledge, yet don’t have an adequate
venue in which to utilize it. On the other hand, some of them are being placed in positions
where they are being asked to do perhaps more than the degree merits.
All of the authors agree that they are more ethics-aware, and because of this, others
around them are as well. There are more discussions about ethics-related issues than there were
before. This increased ethics awareness extends to helping with resource allocation questions
within offices and departments. They also feel more empowered to speak out in advocating
for patients and their families than they might have before taking this program. One author
indicated that she felt confident to speak out to a resident physician about an ethical issue
arising out of the resident’s care of patients. This theme of increased awareness and confidence
to speak out about ethical issues resonated within all of the authors.
Observations of how their hospitals handle “end of life” and “No CPR” issues,
including the gathering of information from patients or substitute decision makers
and the follow-through of the patients’ wishes.
All the authors observed many activities concerning this compelling subject of end
of life and “No CPR issues” in their respective institutions. Certainly, end of life care is an
emergent topic in Canada, especially, following the passing of Bill 52 in the Province of Québec
in June 2014 and the case “Carter v Canada” heard at the Supreme Court of Canada (SCC) in
February 2015. The SCC ruled in favor of physician-assisted death. With the aging population
and the “baby boomers” desiring more personalized choices around death and dying, so, both
Health Care Providers and the Health Care System must prepare to deliver improved end of
life care (Forestell, April 2014). Recently, in Toronto, two prominent physicians with terminal
diseases have made their end of life stories known through videos, prompting many discussions
around end of life care. Perhaps all these factors hastened the Ontario Medical Association
(OMA) to launch a Framework on End of Life Care in May 2014 (Forestell, June 2014) to assist
Health Care Providers in this difficult task.
To their astonishment, the authors discovered that the policies around “end of life
care” and “No CPR” varied considerably among their own institutions. Even more compelling
was the finding that the gathering of information from patients or substitute decision makers
and the follow- through of the patients’ wishes are disparate and deficient. This awareness comes
from having completed the MHSc. As one of the authors stated: “It is interesting how having
some knowledge of these issues has opened my eyes to deficiencies in hospital function, that I would
not have been cognizant of before (the MHSc).”
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Their recently acquired awareness about ethical issues permitted them to observe
some possible reasons for this lack of consistency, which may include insufficient staff training,
the absence of discussions around the topic, or information not disseminated among the ranks.
The most significant roadblock appears to be a reluctance of health care workers to assume the
responsibility for discussion around end of life issues.
On several occasions, most of the authors have taken it upon themselves to be involved
on committees or they were asked to take leadership roles to enhance the quality of end of life
care. Whether it was involvement in an institutional dilemma between CPR and Active Care,
participating on an End of Life Committee, or writing policies and articles around end of life,
each of them has contributed to this issue within their home institutions. One of the authors,
in discussing her involvement, expressed her hope for making a difference: “This suggestion was
endorsed by the members of the inter-professional team on the unit, and will be brought forward to
the quality committee to hopefully be implemented.” The authors all believe that one of the reasons
they have made a difference in this area is because of the knowledge and awareness acquired during
the MHSc.”
Spreading knowledge – How the authors have spread our knowledge through
teaching, giving talks and being a resource.
Being life-long learners and having acquired the MHSc in Bioethics as mature students,
these four professionals have used the knowledge gained to teach others in their fields. They have
achieved this goal by engaging in teaching at institutional, community, and society levels.
At an institution level, they have engaged in both intraprofessional and
interprofessional teaching. Intraprofessional teaching has included speaking to a provincial
group about ethical issues arising in both their own and their colleagues’ practices, teaching
Bioethics to medical students and residents and through teaching to their professional
colleagues. They have also been active in interprofessional teaching through talks given at
“Brown Bag Ethical Lunches,” “Global Health Rounds,” and Departmental Rounds with
physicians, nurses, other professional staff, and support staff at their institutions. Three of them
have been involved in rewriting hospital policies regarding ethical issues.
At the community level, one author has been involved in talking about ethics in her
religious community with an emphasis on the intersection of religious and secular ethics.
At the societal level, the American Society of Bioethics and Humanities annual
meeting presented one of the authors with the opportunity to display a poster prepared for her
Capstone project for the MHSc program. Another author made a similar presentation at the
annual Canadian College of Family Physicians meeting.
In addition to the formal teaching of knowledge, they find that within the community,
and in their own institutions, they are engaged in more informal discussions about bioethical
issues. Having obtained their training in Bioethics, they feel more of a responsibility to respond
to ethical issues and address them. They feel more qualified to respond to ethical issues. As one
of the authors stated: “I felt we must revise our “CPR/No CPR/Active Care/RN to Pronounce”
order sheet and communicated my concerns to the hospital Bioethicist…after several months the
Bioethicist sent a draft of a revised CPR Policy onto me to review. It succinctly addressed the issues
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I was concerned with. I felt elated! This policy would be forwarded onto the Medical Advisory and
Critical Care Committees for review and approval. Would I have taken this initiative prior to my
experience in the MHSc program? Since this has been an ongoing problem for many years and I
have not addressed it in the past, I likely would not have. I felt a responsibility to advocate, this was a
flaw in the system that could be addressed, and I felt empowered to address it.”
Along with their feelings of responsibility in addressing ethical issues, comes some
uncertainty about their role. While some colleagues may see them as a resource, others may
feel either that they are not qualified, or may feel constrained in speaking of ethical issues in
their presence. As one author put it: “Not to be recognized as an expert is disappointing but to be
recognized also comes with responsibilities. I am not sure I want those responsibilities.”
How the authors now view the allocation of scarce resources.
Within the context of many institutes, the “new normal” involves working more
efficiently with less. This can impact care in many different ways, from having fewer RNs on
hospital wards to cutting back access to investigations and surgery. Each of the authors in their
own professions is affected by resource allocations made at a macro level, that being at the level
of the government. A respiratory therapist observes precious ICU beds are tied up by patients
with chronic neuromuscular conditions that could be more appropriately managed in long term
care facility, if the beds were available. A palliative care physician observes that the floor’s RN
is let go without notice or a plan to incorporate her work. A speech-language pathologist and
her group come up with a plan to better manage their caseloads only to have it turned down by
management. A family physician has difficulty accessing prompt imaging and surgery, and even
specialist appointments for her patients.
Having completed the MHSc in Bioethics, the authors now think much more deeply
about how these issues affect their patients. They have thought about how to make changes
if even at a micro level, for example in the physician’s office. Some have written articles on
Resource Allocation for publications, devised plans to better manage resources, discussed
Resource Allocation issues affecting their departments with management, and made small
changes in trying to direct patients to more cost-effective yet valid treatment options.
Feelings – Anxiety they may feel in their role around bioethical issues, making a
wrong decision, around how others perceive them, how they may constrain
others by having bioethical knowledge.
All of the authors expressed that they are glad that they undertook this course of study.
They reported increased self-awareness of ethical issues, increased insight, and mindfulness
about ethics issues and more comfort in advocating for patients, ethical practices and consults
with ethics services. However, all of the authors also expressed a certain amount of frustration
with their status after completing this program.
For many years in Ontario, practicing in a clinical discipline with convocation from
a MHSc (Bioethics) program was sufficient to practice as an institutional ethicist. Then a oneyear fellowship was introduced by an Ontario university. This became a preferred requirement
to practice as a bioethicist within health care institutes in Ontario.
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The aforementioned “preferred requirement” in Ontario appears to contrast
somewhat with the apparent practice in the United States. In the most recent (2nd Edition)
of the American Society for Bioethics and Humanities (ASBH) “Improving Competencies
in Clinical Ethics Consultation An education guide” within the content of the introduction,
the guide states that “only 5% of people performing ethics consultation in the United States
have completed a fellowship or graduate program in bioethics” and only 41% learned to
perform ethics consultation with formal, direct supervision by an experienced member of an
ethics consultation service” (Fox, Meyers, & Pearlman, 2007). The education guide stated
the composition of individuals performing clinical ethics consultation in the U.S. is very
interdisciplinary with physicians (36%), nurses (30%), social workers (11%), chaplains (10%),
and administrators (10%) (Fox, Meyers, & Pearlman, 2007).
Discussion
This study was completed using the reflections of four clinicians, each with 25 years
or more in their field of practice. On one hand, the fact that their levels of experience were
so similar may lend support to the possibility these reflections could mirror the experience of
other clinicians continuing in clinical practice after completing a Bioethics degree. This being
said, the authors acknowledge that if they had been at the beginning of their careers, their
findings and observations may have been different. A clinician new in their profession may
complete the MHSc feeling equipped with bioethical theory but perhaps not practice. The
writers approached the MHSc program with extensive clinical ethics exposure and learned the
philosophical theory behind their observations.
All the authors practice in urban areas where Bioethics services and consultation
are available. The experience may have been completely different if the authors practiced in
an area where clinical ethics was not readily accessible. It is possible that in this situation, their
knowledge in Bioethics and their MHSc degree would have been noticed and utilized to a
greater degree.
The authors have not attempted to compare their MHSc degree in Bioethics to other
Bioethics Programs in this paper. It was an extremely comprehensive Master’s program. However,
the experience of graduates from other programs may yield different results. The authors argue
that if a program such as this does not confer the title of “Clinical Ethicist”, even though, the
knowledge base is the same, the experience reported in this paper would remain similar.
These observations and discussions were generated in the first year following
completion of the Bioethics degree. It would be interesting to continue to monitor these
observations and reflections in order to determine the impact of the passage of time on the
perceptions and reflections of the clinicians, and also those of the people they work with.
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Conclusion
Since their convocation, the authors have met about every 6 weeks to discuss ethics
issues, share insights and concerns that arise within their practices. These forums have been
helpful in providing a venue for sharing questions, concerns, frustrations, and triumphs in a
supportive social setting. They plan to continue this routine as they endeavor to enhance ethical
practices and patient advocacy within their respective disciplines
All of the authors indicate they have benefited from completing the MHSc (Bioethics)
curriculum and have changed their practice in some ways to reflect their ethics awareness. They
are using their MHSc degrees in quiet ways by disseminating ethics knowledge, participating
on committees, assisting with policy revision, teaching, and promoting bioethical awareness. As
a result of this degree, all are more involved and comfortable in advocating for patients, and in
broaching ethical topics in the work setting. One writer commented on the fact that this degree
highlighted the aspect of “ethics within (her) practice” though we do not formally “practice ethics”.
And yet, all of the authors expressed frustration at the fact that they felt their
degree was unrecognized and underutilized in their workplace settings. Currently there is no
designation (other than the MHSc) for graduates who have completed an ethics degree but
not a fellowship. It would be helpful to acknowledge the training obtained through graduating
with a MHSc in Bioethics by having a special recognition for individuals who have completed
this extensive ethics education. We would like to propose a possible designation of “Ethics
Associate” be conferred to these graduates. This would not only recognize the advanced degree
but perhaps provide guidance as to how this extensive knowledge could be effectively utilized.
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References
American Society for Bioethics and Humanities. (2009). Improving competencies in clinical ethics
consultation, an education guide. Clifton: Humana Press
Chidwick, P., Faith, K., Godkin, D., & Hardingham, L. (2004). Clinical education of ethicists:
The role of a clinical ethics fellowship. BMC Medical Ethics, 5(1):E6
Forestell, M. (2014). Ontario Medical Association End of Life Care Strategy. OMR-Ontario
Medical Review. April, 81(4), 8-11.
Forestell, M. (2014). OMA hosts public launch of Framework on End of Life Care. OMROntario Medical Review. June, 81(6), 12-13
Hardingham, L., Faith, K., Godkin, D., Chidwick, P. (2011).Reflections on our inaugural year
as clinical ethicists. Journal of Healthcare, Science and the Humanities, 1(2), 119-124.
MacRae S, Chidwick P, Berry S, Secker B, Hebert P, Zlotnik Shaul R, Faith K, Singer P A.
Clinical bioethics integration, sustainability, and accountability: the hub and spokes
strategy. J Med Ethics. 2005 March; 31:256-261.
Mogyoros, A., Smith, M., Diego, S. & Purdy. (2011) Reflections on the current status of
bioethics education. (2011). Journal of Healthcare, Science and the Humanities 1(1),
143-149.
[Online] [Cited: September 13, 2014.] www.cbc.ca/news/canada/montreal/quebec-passeslandmark-end-of-life-care-bill-1.2665834.
[Online] [Cited: September 13, 2014.] www.youtube.com/watch?v=q3jgSKxV1rw; In memory
of Donald Low and www.youtube.com/watch?v=z2fQuTSrhic; The Truth of it Video
Series: Palliative Care: Patient experience-Dr Larry Librach.
[Online] [Cited: September 13, 2014.] www.bccla.org/our_work/carter-et-al-vattorney=general-of-canada-2/.
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COMMEMORATING
LEGACY OF
BOOKER T. WASHINGTON
Tuskegee University Archives
Articles
“National Negro Health Week to National Minority Health Month:
100 Years of Moving Public Health Forward”
The Rev. Joan R. Harrell, M.Div., M.S., DMIN (cand)
Why acknowledge National Negro Health Week in the 21st Century? The year 2015 is
the 100 Anniversary of the death of Booker T. Washington, the founder and first president of
the historic Tuskegee Institute. The Commemorative Booker T. Washington 1915 – 1951 Negro
Health Week Forum documents Tuskegee University’s work in public health which preceded the
unethical U.S. Public Health Service Syphilis Study at Tuskegee.
th
The 2015 Commemorative Booker T. Washington Public Health Forum is titled,
“National Negro Health Week to Minority Health Month: 100 Years of Moving Public Health
Forward.” This crucial public health forum that will occur on April 17, 2015, contextually
revisits the 100-year public health evolution from the 1915 National Negro Health Week to
Minority Health Month in 2015. The precedent setting discussion will begin to reframe the
negative image of Tuskegee University as the site of the infamous unethical Syphilis Study and
reveal the ongoing current collaborative work and relationship between the National Center
for Bioethics in Research and Health Care at Tuskegee University and the Office of Minority
Health and Equity at the Centers for Disease Control and Prevention (CDC).
Within the historic context of comparing the health disparities between Euro
Americans and African Americans, the article that was written by Sandra Course Quinn and
Stephen B. Thomas, in the Minority Health Today (Volume 2, Number 3 March/April 2001)
“The National Negro Health Week 1915 to 1951: A Descriptive Account, recognized Booker T.
Washington’s intentionality in creating National Negro Health Week. Quinn and Thomas’ piece
on the National Negro Health Week, 1915 to 1951 can be read in full online at http://minorityhealth.pitt.edu/541/1/National_Negro_Health_Week.pdf
Washington’s work in public health was a catalyst for developing National Negro
Health Week which was implemented in the United States from 1915 to 1951. Thus, National
Negro Health Week laid a foundation for the prevention of health disparities in the cultural
community historically referred to as Colored and or Negro American. We fast forward to the
21st Century and Washington’s effort is documented as an impetus for the federal government
to develop specific health agencies to proactively work to promote health, prevent and end
health disparities in communities of color.
The National Center for Bioethics in Research and Health Care at Tuskegee
University is providing a space where 21st Century students in public health, community
advocates, policy makers and federal government health officials can engage in critical discourse
regarding public health, ethics, and health disparities. Our contextual background focus is the
history of health and health disparities in Colored/Negro/Black/African American culture. In
addition, the National Center for Bioethics in Research and Health Care’s forum will create an
intentional dialogue to develop appropriate intersecting practical strategies which will benefit
the public health of all populations under the auspices of the Office of Minority Health and
Equity at the CDC. This forum will be held at the main campus of CDC in Atlanta and is
cosponsored by the National Center of Bioethics in Research and Health Care at Tuskegee
University, Office of Minority Health and Equity and Morehouse School of Medicine.
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NatioNal Negro HealtH Week to NatioNal MiNority HealtH MoNtH:
Articles
“100 Years of Moving
Public Health Forward”
Booker T. Washington, founder of National
Negro Health Week (NNHW) and members of the first
National Negro Health Week Committee in 1915
April 17, 2015
Keynote Speakers:
9:00 a.m. to 5:00 p.m.
CDC Roybal Campus, Building 19
1600 Clifton Road NE
Atlanta, GA 30329
Topics Include:
Sherman A. James, Ph.D. Yvonne T. Maddox, Ph.D.
Research Professor of Epidemiology
and African American Studies
Emory University
Acting Director, National Institute
on Minority Health and Health
Disparities
Angela Glover Blackwell
Founder and CEO, PolicyLink
- the health of African Americans 1915-2015
- a vision for eliminating racial and health disparities
- from health disparities to health equity
- developing public health professionals
- effective use of data
Registration:
www.tuskegeebioethics.org/HealthEquity
Sponsor:
Leandris Liburd, Ph.D.,
MPH. MA
Associate Director, Minority Health
and Health Equity, CDC
84
David Satcher, M.D.
Ph.D., FAARP, FACPM,
FACP
16th Surgeon General
of the United States
National Center for Bioethics in Research
and Healthcare at Tuskegee University
Collaborators: Morehouse School of Medicine
and Office of Minority Health
and Health Equity, CDC
Register
Today!
Articles
85
Articles
Order of Service
Booker Taliaferro Washington Commemoration Convocation
Rueben C. Warren D.D.S., Dr. P.H., M.Div.
Director, Tuskegee University National Center for Bioethics in Research and Health Care
Washington Commemoration Committee Chair
Presiding
PRELUDE .......................................................... Introduction and Passacagila...................................................... Max Reger
Wayne A. Barr, DMA
Organist
PROCESSIONAL ........................................... “The Prince of Denmark’s March........................................... Jeremiah Clarke
ANTHEM ........................................................... “Lift Every Voice and Sing” ........................................... James W. Johnson
INVOCATION ...................................................................................................................Gregory S. Gray, Ph.D., M.Div.
Dean of the Chapel
GREETINGS .................................................................................................................................. The Washington Family
Robin C. Banks
SELECTION......................................................... “Ezekiel Saw De Wheel” ............................................William L. Dawson
INTRODUCTION OF THE SPEAKER ........................................................Rueben C. Warren D.D.S., Dr. P.H., M.Div.
ADDRESS ...........................................................................................................................................Brian Johnson, Ph.D.
President
SELECTION.................................................................................................................................... The Tuskegee Song
BENEDICTION ............................................................................................................ Gregory S. Gray, Ph.D., M.Div.
RECESSIONAL ...................................................... “Trumpet Tune in D” .................................................by Henry Purcell
ORGAN POSTLUDE ....................................... “Now Thank We All Our God .....................................by Sigfrid Karg-Elert
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Articles
Summary of Year Yong Commemoration Events
January
Julyy
February
August
Booker T. Washington Centennial Year Kick-Off Lecture
The Commemoration will begin on the campus of Tuskegee University with an opening
lecture hosted by President Brain L. Johnson. President Johnson will share his vision
for commemorating the life and legacy of Booker T. Washington and an overview of
the year’s activities.
Black History Month Seminars
The history and evolution of Tuskegee University starting with Tuskegee Normal, as
an institution of learning, targeting primary education for youth and adults will be
discussed. The second phase was developing an educational institution of higher
learning, Tuskegee Institute, known worldwide as a place “founded in 1881 by Lewis
Adams (former slave) and George Campbell (former slave owner) with Booker T.
Washington serving as first principle” to uplift the Black population through industrial
training and education to augment agricultural training in the rural South. In the 20th
Century, Tuskegee Institute was elevated to Tuskegee University. The session will end
with the President Johnson’s vision for the university in 21st Century.
TBD
This session focuses on the Booker T. Washington many trips to New York soliciting
financial support for Tuskegee Institute. His social philosophy will be explored to better
understand how he convinced northern philanthropists to support his work in the small
rural, mostly Black town of Tuskegee.
The Impact of Booker. T. Washington’s Philosophy on the Work of Marcus Garvey
Booker T. Washington’s global reach will be explored. After reading, Up From
Slavery many Black people decide to attend Tuskegee Institute. Black activists, like
Marcus Garvey, were guided by Washington’s work. Marcus Mosiah Garvey and his
organization, the Universal Negro Improvement Association (UNIA), represent the
largest mass movement in African-American history. Proclaiming a Black Nationalist
“Back to Africa” message, Garvey and the UNIA established 700 branches in 38
states by the early 1920s. August 27, 2015: Exhibition all day
Panel/Forum Time: 2:00-5:00 PM
Kellogg Hotel and Conference Center
Contact person: Dr. Henry J. Findlay/ 334-724-4316
March
Women’s History Month
The Women’s History Month will host a series of events highlighting the contributions
of African American women with a specific focus of Booker T. Washington’s wives. The
Roundtable speakers will analyze the role that women played in the development of
Tuskegee and continuing Washington’s legacy. The Roundtable luncheon is free and
open to the public.
April
March 21, 2015
Kenney A. Hall Bioethics Auditorium, RM 71-243
5:30 - 7:00 p.m.
For more information contact: Dr. Sheena Harris
sharris@mytu.tuskegee.edu
Negro Health Week to Minority Health Month: 1915-2015
The month of April is Minority Health Month and Public Health Month. This
session will focus on the health of Black people in 1915, when Booker T. Washington
established Negro Health Week. A comparative analysis between the health of Black
people in 1915 and 2015 will be conducted. This session will be held at the Centers for
Disease Control and Prevention (CDC) in Atlanta Georgia, April 17, 2015 and will be
co-hosted by Morehouse School of Medicine, CDC and the Tuskegee Bioethics Center.
May
Brick making demonstration
When Booker T. Washington was faced with the challenge of building a campus with
no state funding, he had to rely on the work of students and faculty to construct hand
made bricks. Today, Tuskegee University is renowned for its historic brick buildings.
This month will feature a brick making demonstration highlighting the work and talent
of current students in the Robert R. Taylor School of Architecture and Construction
Science.
June
Retracing Booker T. Washington’s Journey to Tuskegee in West Virginia
Selected administrators, faculty and staff, will visit Hale’s Ford, VA, the birthplace of
Booker T. Washington, and Hardy, VA, where the Booker T. Washington National
Monument is located. Mrs. Lillie Head, a Tuskegee alumnus, founding member of the
Friends of Booker T. Washington and daughter of one the men who was victimized by
the U.S. Public Health Syphilis Study at Tuskegee, will provide the leadership for the
session.
September
Symposium on Booker T. Washington’s Cotton State Exposition Speech
Booker T. Washington’s famous speech during Cotton State Exposition will be
discussed. Dr. Rayford W. Logan, head of history at Howard University wrote, “Booker
T. Washington’s speech in Atlanta, Georgia on September 18, 1895 was one of the
most effective political oratories in the history of the United States. Pulitzer Prize
winner David Levering Lewis wrote that Washington’s Speech was, “one of the most
consequential pronouncements in American history.” Coordinate with the Atlanta
University Center about a possible field study to Grant Park.
September 9, 2015
Morehouse School of Medicine
October
Atlanta University/Tuskegee University Students’ Debate (W.E.B. Du Bois/Booker
T. Washington in Atlanta, GA
The W.E.B Du Bois/ Booker T. Washington debate will be held in the Atlanta University
Center co-hosted by Clark-Atlanta University (then Atlanta University) and Tuskegee
University. A panel of W.E.B. and BTW scholars will debate the various educational/
philosophical approaches to the education of Black people.
October 13, 2015
Morehouse College
November
Symposium: A Critical Reappraisal of Booker T. Washington
The Tuskegee University NEH Humanities Initiatives grant project, “A Critical
Reappraisal of Booker T. Washington,” will host a symposium November 15-17, 2015,
to provide an opportunity for visiting scholars, grant participants, other members of the
campus community, and members of the public to participate in rigorous analysis and
discussion of Washington’s position in American and African American history. December
End of the Year Closing Celebration
Where do we go from here? The year’s commemorative activities will be summarized
and discussions about “lessons learned” and strategic thinking concerning the future of
HBCUs, in the context of the Booker T. Washington legacy.
For more information on these events, visit: www.tuskegee.edu/BTWcommemoration
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Articles
Great is Thy Faithfulness
Lift Every Voice and Sing
Great is Thy faithfulness, O God my Father;
There is no shadow of turning with Thee;
Thou changest not, Thy compassions, they fail not;
As Thou hast been, Thou forever will be.
Lift every voice and sing, till earth and Heaven ring,
Ring with the harmonies of liberty;
Let our rejoicing rise, high as the listening skies,
Let it resound loud as the rolling sea.
Great is Thy faithfulness!
Great is Thy faithfulness!
Morning by morning new mercies I see.
All I have needed Thy hand hath provided;
Great is Thy faithfulness, Lord, unto me!
Sing a song full of the faith that the dark past has taught us,
Sing a song full of the hope that the present has brought us;
Facing the rising sun of our new day begun,
Let us march on till victory is won.
Summer and winter and springtime and harvest,
Sun, moon and stars in their courses above
Join with all nature in manifold witness
To Thy great faithfulness, mercy and love.
Pardon for sin and a peace that endureth
Thine own dear presence to cheer and to guide;
Strength for today and bright hope for tomorrow,
Blessings all mine, with ten thousand beside!
The Tuskegee Song
Tuskegee, thou pride of the swift growing South
We pay thee our homage today
For the worth of thy teaching, the joy of thy care;
And the good we have known ‘neath thy sway.
Oh, long-striving mother of diligent sons
And of daughters whose strength is their pride,
We will love thee forever and ever shall walk
Thro’ the oncoming years at thy side.
Stony the road we trod, bitter the chastening rod,
Felt in the days when hope unborn had died;
Yet with a steady beat, have not our weary feet,
Come to the place for which our fathers sighed?
We have come over a way that with tears has been watered,
We have come, treading our path through the blood of the slaughtered;
Out from the gloomy past, till now we stand at last
Where the white gleam of our bright star is cast.
God of our weary years, God of our silent tears,
Thou Who hast brought us thus far on the way;
Thou Who hast by Thy might, led us into the light,
Keep us forever in the path, we pray.
Lest our feet stray from the places, our God, where we met Thee.
Lest our hearts, drunk with the wine of the world, we forget Thee.
Shadowed beneath Thy hand, may we forever stand,
True to our God, true to our native land.
Thy Hand we have held up the difficult steeps,
When painful and slow was the pace,
And onward and upward we’ve labored with thee
For the glory of God and our race.
The fields smile to greet us, the forests are glad,
The ring of the anvil and hoe
Have a music as thrilling and sweet as a harp
Which thou taught us to hear and to know.
Oh, mother Tuskegee, thou shinest today
As a gem in the fairest of lands;
Thou gavest the Heav’n-blessed power to see
The worth of our minds and our hands.
We thank thee, we bless thee, we pray for thee years
Imploring with grateful accord,
Full fruit for thy striving, time longer to strive,
Sweet love and true labor’s reward.
88
AUTHOR
REQUIREMENTS
Author Requirements
The Journal of Healthcare, Science and the Humanities
June 2014
I. General Information
The Journal of Healthcare, Science and the Humanities ( JHSH) publishes a wide variety of
articles intended to enrich and advance the knowledge of health and health care, science and the
humanities, as well as the art and science of health care delivery and the health professions.
Program or project summaries/exemplars, formal case studies, or case scenarios are acceptable,
but must be carefully constructed to avoid any subtle commercialization or politicization.
Authors are free to submit academic manuscripts that present differing or alternative views
to current issues and debates. The Editor will make final decisions regarding these issues after
consultation with the members of the Journal Executive Leadership, including Intellectual
Property Counsel if so required.
JHSH will not consider manuscripts that are being submitted or considered elsewhere
simultaneously. If an author wishes to have a work rescinded from JHSH consideration for
submission to another publication, the author must request in writing and be granted an official
written notification regarding the same from the Editor or Senior Associate Editor.
Unless there is clear justification, and only with the written permission of the previous
publisher, JHSH will not accept manuscripts published elsewhere, or that will be published
prior to appearing in JHSH. Authors must inform the Editor of such matters at the time their
manuscript is submitted; review by Intellectual Property Counsel may be required. Such matters
must be acknowledged in the Author Note.
II. Representative Manuscript Categories
JHSH encourages authors to choose from a wide range of subject matter categories. Authors
may explore various categories and possibilities with the Senior Associate Editor, who will
subsequently discuss with the Editor. The Editor has responsibility for final decisions in this
area. The following are representative categories.
a. Research papers, theoretical investigations.
b. Scholarly critiques and commentaries on various topics.
c. Formal case studies and program/project reports.
d. Reaction papers and editorials.
e. Book, film, media, law, education or other reviews.
f. Other academic or professional articles related to the JHSH interdisciplinary mission.
g. Creative work, including poetry and short fiction relevant to the JHSH mission.
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Author Requirements
III. Submission Review Processes
Submissions undergo a four-stage process of rigorous review, discernment, evaluation, and
approval. The Editor may adapt these processes to meet specific circumstances.
Stage 1:
Authors submit full manuscripts or manuscript concept proposals to both the Editor and
Senior Associate Editor. The Editor, Senior Associate Editor, and Associate Editors will
conduct a preliminary assessment for relevance to the JHSH mission. The Senior Associate
Editor will provide guidance to the corresponding author about shaping the manuscript for
JHSH readers. All manuscripts, including all figures and graphics, must be formatted
correctly and comply with JHSH Author Requirements before manuscripts will be
allowed by the Editor to progress to Stage 2. Compliance with this requirement is
mandatory. Exceptions will not be granted.
Stage 2:
After the Senior Associate Editor determines that all Stage 1 requirements are met and
that all manuscript and graphics/figures formatting is in compliance, the Senior Associate
Editor forwards the manuscript to the Chairs of the Academic Review Committee (ARC)
for rigorous peer review. Also, at the time of Stage 2 submission, all authors must submit
their completed Author Agreements and Copyright Release Forms. No article can be
published unless this requirement is met by all authors. All Journal peer reviewers have
executed non-disclosure agreements and conflict of interest declarations to protect an author’s
rights and academic property. Peer review routinely results in manuscript revision. The first
author and the ARC Chairs work together to address matters stemming from peer review
and to ensure that the manuscript is revised accordingly.
Stage 3:
After successful peer review and revision, the ARC Chairs send the revised manuscript
to the Chairs of the Manuscript Editorial Committee (MEC) for rigorous editorial and
formatting review, revision, and critique of actual content and language. This also includes
careful review of all figures, graphics, and other related elements for compliance with
requirements. The MEC also reviews, critiques and recommends minor formatting needs.
The author and the MEC Chairs process and finalize the manuscript. When this process is
completed, the MEC Chairs send the final manuscript back to the Senior Associate Editor
as certified ready for final review.
Stage 4:
Upon receipt from the MEC Chairs, the Senior Associate Editor sends the final edition
of the manuscript to the Journal Associate Editors for a final qualitative review. Any
additional changes required are completed between the author and the Senior Associate
Editor. Upon successful final qualitative review by the Associate Editors, the Senior
Associate Editor sends the final edition to the Editor for final review and approval. If all
items are in order, the Editor formally approves and accepts the manuscript for a future
edition of JHSH. The Editor notifies the author of final acceptance.
Note: The Editor may make further determinations regarding requirements or revisions to
manuscripts. In the event of circumstances, the Editor may disapprove a final edition.
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Author Requirements
IV. Style Requirements
APA Style Requirements: JHSH has adopted the publication style manual of the American
Psychological Association (APA). Copies are available in most public and university libraries or
through most university psychology departments. Reference information: Publication Manual
of the American Psychological Association (6th Ed., 2010), Washington, DC: American
Psychological Association.
APA Style Web Resources: The URL links below provide additional information and
assistance for APA style requirements.
http://owl.english.purdue.edu/owl/resource/560/01/
http://www.apastyle.org/elecref.html
http://www.psychwww.com/resource/apacrib.htm
Formatting Specifics:
In addition to meeting APA style requirements, articles must be organized according to the
format below. All papers must be divided into appropriate, titled sections and subsections based
on subject matter.
a. Introductory Material. Each manuscript must begin with the title, name of author(s)
with current title(s) and institutional affiliation(s). With the exception of creative essays
pre-approved by the Editor, manuscript titles shall be consistent with the scholarly and
professional nature of the Journal. Informality, a casual tone and colloquialisms must be
avoided. When using degrees after an author’s name, periods are omitted. (e.g., PhD, not
Ph.D). Contact information for the corresponding author is to be included, either in the
introductory material or as part of the Author Note. Authors are to provide complete,
precise information for themselves and each co-author, to include street address, phone, fax
and e-mail address (see example below):
Mary Smith, MD, PhD, CPI
Chair, Department of Surgery
University of Smithville
301 Smithville Road
Smithville, MD
Tel: (301) 456-1234
Fax: (301) 456-1235
Email: Mary.Smith@smithville.edu
b. Author Note. Immediately following the title and author information, each manuscript
must include a brief, un-indented paragraph containing important preliminary and/or
disclaimer information. This paragraph, called an Author Note, will state the source of
the subject material (e.g., preliminary presentation or doctoral dissertation). If the work
was supported by a grant, contract, or similar instrument, proper credit must be given. In
the Author Note it is required to place the information about IRB and IACUC review
and approval with relevant protocol identification numbers and dates of approval or
determination. The Author Note should include any required institutional disclaimers.
The author/authors must declare any and all financial conflicts of interest (or lack thereof )
in the Author Note. The Author Note shall include information regarding contributors.
95
Author Requirements
See Section VII below concerning requirements for designating authorship as opposed to
contributors. Acknowledgments are placed in the Author Note.
c. Abstract. Immediately following the Author’s Note and without any page break, all articles
will have an abstract of approximately 200 words. The abstract is a single, unindented
paragraph of plain text without bullets or subsections. The abstract must use key
information from the text to provide a clear, concise and unbiased summary. Review
Articles or Creative Writing submissions do not have an abstract.
d. Keywords. Immediately following the abstract and without any page break, list at least three
key words to facilitate electronic searches of the manuscript. The choice of key words will
depend on the subject matter. Review Articles or Creative Writing submissions do not
include key words.
e. Introduction. Immediately following the Keywords and without any page break, the text
must begin with a section entitled “Introduction.” In the Introduction the author should
preview what is about to be presented, and may chronicle the past history of the subject
under discussion with appropriate use of references from the literature. Both the content
and length of the introduction will vary according to subject matter. Review Articles
and Creative Writing must include an introduction explaining the intent and providing
important background to what follows.
f. Middle Sections. Based upon subject matter and methodology, the middle portion of
the manuscript is to be divided into appropriate sections and subsections, each of which
must be appropriately titled. See Section V for the formatting of section and subsection
headings.
g. Conclusion. This section provides a concise summary of the materials previously presented,
and points toward future or practical implications and/or implementation. Review Articles
and Creative Writing should include a conclusion that points out the benefit of what has
been presented to the reader and to the JHSH mission.
h. References. For those manuscripts requiring them, references will be listed on a separate
page following the text. Accuracy is the responsibility of the author; references will not
be validated in editorial review. The APA publication manual provides detail on the
correct format for references. Review Articles do not require references, unless deemed
by the Editor as essential. However, if useful Review Articles, Commentaries, Academic
Reflections and other non-research presentations strictly speaking may offer Select
Bibliographies or listings of works as For Further Reading.
V. Manuscript Preparation Requirements
Manuscripts must be submitted (including tables and figures) in single spaced copy. Standard
American or UK English usage and spelling are the norm, the latter for authors from UK
English-speaking communities. Except for clearly stylistic conventions that can be reasonably
justified in an academic and professional publication of this nature, authors are to avoid
overly informal compositional style and language. Similarly, to maintain the highest level
of academic quality, the use of the first person singular or plural is normally not accepted in
JHSH research-oriented works. However it can be used in commentaries, reviews, and creative
works and in those categories where its usage mirrors the style of academic/scientific papers in
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Author Requirements
scholarly publications. Contractions are not to be used except for intentional style purposes or
within quoted materials. For all tables and figures, see the Graphics Section below for detailed
instructions. All manuscripts must use one-inch margins throughout. Authors are to submit
all material in electronic format compatible with MS Word for MacOS and Windows. It is the
author’s responsibility to ensure software compatibility of both text and graphics. Manuscripts
should not contain any specialized formats, automatic styles, or other features not easily
translated between computing platforms or any content that cannot be shaped by desktop
graphics technicians at the publishing house. For example, the use of references must not require
editing or graphics personnel to obtain commercial notation software. Such editing must be
able to be accomplished within MS Word. It is the responsibility of authors to require with this
matter. Submission that do not comply will be returned until the matter is resolved.
Bullets
Bullets are not permitted within the text. Numbered or lettered lists are acceptable.
Electronic Submission
All manuscripts are to be submitted to the Editor and the Senior Associate Editor as an
e-mail attachment. All manuscripts must be submitted in MS Word format for MacOS
and/or Windows (.doc or .docx format). Do not send manuscripts using the pdf or
webarchive format. Such will be returned. See Section VI regarding graphics. Authors
may wish to review examples of previously published articles as guides. These can be made
available upon request.
Headings
Each manuscript must be subdivided into relevant sections as discussed above. Sections
may be further subdivided to enhance the discussion or for other editorial reasons. Major
sections should use Level 1 headings. Subsections should use headings for Levels 2 through
4. Directions for formatting Headings follow:
Level 1: Helvetica 14pt Centered Uppercase and Lowercase Heading [Bold]
Level 2: Helvetica 11pt. Centered, Italicized, Upper and Lowercase Heading
Level 3: Helvetica 14pt Flush Left, Italicized, Uppercase and Lowercase Heading
Level 4: Helvetica 14pt Indented, italicized, lowercase paragraph heading and
ending with a period.
Authors who do not have Helvetica font may substitute Arial.
Typeface
Except for headings as listed above, Times New Roman 12pt font is required for the body
of the manuscript and references. Do not use bold or underlining for emphasis. Italics are
allowed provided they fit APA style guidelines.
Headers and Footers
Headers or footers (including footnotes) are not permitted in the manuscript.
Pagination is allowed at the bottom center or bottom right for review purposes only. Page
numbers will be removed from the final versions of manuscripts.
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Author Requirements
Length
Articles are typically approximately 15-25 pages single-spaced (approx. 9,000 – 15,000
words), not including references, tables, graphics, or other appendices.
For lengthier articles, authors may arrange with the Editor for the publication of
companion manuscripts in back-to-back editions of the Journal.
Review and other similar works are limited to 10-15 pages single-spaced, including references.
Punctuation
The Abstract and Author Note are single, unindented paragraphs. Indent all remaining
paragraphs. Use a comma between elements and preceding the conjunction (and, or) in
a series of three or more. Use a semicolon to separate elements in a series that contains
commas. Use a colon between a grammatically complete introductory clause and a final
clause. Do not use a colon to introduce an incomplete sentence. Avoid the overuse of
double quotation marks for words. Introduce a key or new technical term in italics.
References
The APA publication manual provides detail on the correct format, including the hanging
indent for the second and subsequent lines of the reference. Double-space between
references. A brief list of common citation types follows. Use Arabic numbers throughout
the references unless a Roman numeral is part of a title.
Book (author):
Hewlett, L.S. (1967). Title of work. Location: Publisher.
Book (editor):
Roberts, N.M. (Ed.). (2001). Book title. Location: Publisher.
Chapter in an Edited Book:
Hewlett, L.S. (1999). Title of chapter in book. In N.M. Roberts (Ed.), Title of book.
(pp. xxx-xxx). Location: Publisher.
Journal Article (print):
Hewlett, L.S., Evans, A. E., & Belfar, S. F. (in press). Title of article. Title of Periodical, volume xx(number x), (pp. xxx-xxx).
Journal Article, more than seven authors
Allison, D. G., Bartolivich, E. H., Connolly, F. I., Davidson, G. J., Edwards, H. K.,
Franklin, I. L., . . . Zastrow, A. C. (2007). Title of article. Title of Periodical, volume
xx(number x), (pp. xxx-xxx).
Journal Article (electronic):
Justin, A.A. (2001). Title of on-line article. Title of Periodical. Retrieved day, month,
year from http://www....[rest of source url address]
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Author Requirements
Newspaper Article (print):
Schwartz, J. (1993, September 30). Obesity affects economic, social status. The
Washington Post, pp. A1, A4.
Newspaper Article (electronic):
Brody, J. E. (2007, December 11). Mental reserves keep brain agile. The New York
Times. Retrieved from http://www.nytimes.com
VI. Special Manuscript Preparations
JHSH regularly includes sections dedicated to special types of manuscripts. Such sections
include:
Book , Film, or Other Reviews
Special Technical Reports, Scholarly Reflections, or Professional Summaries
Literary Works
Manuscripts for review and reports generally must follow all author requirements. However,
such manuscripts require careful adaptation depending upon the nature of the manuscript, its
intention, its place within the JHSH edition, and other factors. The adaptation of requirements
for reviews and reports is subject to the direction and approval of the Editor. The Editor may
delegate the same to the Senior Associate Editor.
Literary works submitted for publication must meet the highest standards for each specific
literary genre. The requirements for literary works are subject to the direction and approval of
the Editor. The Editor may delegate the same to the Senior Associate Editor.
VII. Graphics Requirements
All graphics must be submitted within the individual manuscript at the end of the manuscript
itself. With each figure or graphic, a short, explanatory caption must be provided. The caption is
to be placed appropriately.
Where they are to be placed within the manuscript are to be indicated in a centered directions
such as:
Figure 1 inserted here.
In addition to placing the graphic at the end of the manuscript, each is to be sent as a separate
file in high resolution as a JPEG, TIFF, PNG etc. If the graphic is a Table created in MS Word,
it is to be provided additionally as a separate graphic file that ensures that text and other
elements are spaced and formatted correctly. During publication processes, first authors are to
remain available for the publishing house to contact them for additional refinements for graphic
elements. JHSH Editorial Leadership and the publishing house are not responsible for errors in
graphics that should have been overseen and corrected by the actual authors.
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Author Requirements
VIII. Authorship
The naming of authors must conform with the “Ethical Considerations in the Conduct and
Reporting of Research: Authorship and Contributorship” of the International Committee of
Medical Journal Editors (http://www.icmje.org/ethical_1author.html). Authorship may only
be ascribed to those individuals who personally, actually and substantively contributed to the
actual writing of a manuscript, its design, conceptual development, or its academic or professional
scholarship. Honorary authorship by virtue of one’s position within one’s institutional
organizational structure (e.g., Department Chair) is not permitted at any time or for any reason.
Authors are permitted to list other individuals as contributors in the Author Note when relevant
and appropriate. However, information about contributors must be brief and relevant.
Authors submitting manuscripts must apprise the Editor immediately if controversies exist
concerning authorship or other related issues. JHSH cannot take responsibility for mitigating
author disputes or related controversies. If an author dispute is discovered and claimed after
publication, JHSH and Intellectual Property Counsel have the right to direct retractions, errata,
or other corrections in future JHSH editions in accordance with pertinent laws, regulations,
federal requirements, or academic standards. These actions and others may be taken in the event
of research misconduct.
IX. Responsible Conduct of Research Standards
Authors must adhere to all standards regarding research integrity and the responsible conduct
of research. JHSH strictly adheres to requirements regarding research misconduct, namely
falsification, fabrication, and plagiarism. Any allegation of research misconduct is immediately
referred to the Editor, who will immediately refer the matter to the JHSH Intellectual Property
Counsel. JHSH will support all requirements and processes for such matters to their conclusion.
Articles involving human subjects or animal research must indicate appropriate IRB or IACUC
protocol determinations, reviews and approvals with dates. Authors must cite the approved
protocol numbers. Any information relative to these important areas must be placed within the
Author Note. When there may be questions regarding whether data/materials are determined to
involve either human subjects research or research exempt from human subjects regulations, the
text must clearly indicate who has made such determinations and the date of determination. It is
the right of the Editor and Senior Associate Editor to ensure that all such matters comply with
requisite ethical standards, regulations, laws and requirements.
Similarly, authors must disclose relevant conflict of interest information where applicable (or the
lack thereof ). Any information relative to this area also must be placed within the Author Note.
All questions regarding these areas and other matters related to academic, research, or
professional ethics are to be referred directly to the Editor or Senior Associate Editor.
X. Intellectual Property Information
JHSH is a peer reviewed publication of international renown. As such, it upholds and complies
with all requirements regarding the protection of intellectual property and copyrights as
applicable. JHSH adheres rigorously to United States norms for publications and responsible
authorship. JHSH furthermore honors the academic standards and expectations of other
international peer reviewed publications.
100
Author Requirements
When an author’s manuscript is accepted for publication, authors must sign author agreements
and comply with JHSH directives. One such area is to ensure that the JHSH respects the work
of authors especially if it is derived from previous efforts. Therefore, all authors must disclose
such factors and work with the Editor and Senior Associate Editor for the preservation of all
intellectual property and copyright issues. JHSH will not publish any materials whose authors
have not completed author agreement and copyright release requirements.
The following underscores information summarized previously. Questions concerning the
information below and its applicability to specific cases are to be referred to the Editor and
Senior Associate Editor.
Once an author submits a manuscript, the author is not permitted to have that work under
simultaneous consideration by any other publisher or organization. Similarly, if an author
submits a proposal for future manuscript development and the proposal is accepted, then the
proposal and its subsequent manuscript cannot be submitted elsewhere. If by chance an error
has been made in these regards, the author must obtain from the other publisher or publishers
a clear release and submit this to the Editor and Senior Associate Editor for consideration. If an
author wishes to have a previously submitted manuscript or already accepted proposal published
by another organization, the author must submit a formal request to the Editor. Permission is
needed before finalization.
In addition, unless there is clear justification and only with the written permission of the
previous publisher, JHSH will not accept manuscripts that have been published elsewhere, or
that will be published prior to appearing in JHSH. Authors must inform the Editor and Senior
Associate Editor of such matters at the time a manuscript is submitted. Such matters must be
acknowledged in the Author Note.
Similarly, if an author’s manuscript is based upon one’s thesis or dissertation, the author must
inform the Editor and Senior Associate Editor regarding copyright ownership. If the copyright
for the thesis or dissertation is owned by anyone other than the author, such as the degree
granting institution of higher learning, the author must obtain and submit to the Editor and
Senior Associate Editor a copyright release and permission to publish from the copyright owner.
Until the matter of copyright is completely processed and resolved successfully, the author’s
manuscript cannot be published in the Journal.
General Copyright Guidance: Unless expressly agreed to by JHSH, the copyright (i.e.,
ownership) of the material belongs to JHSH itself and its publishers. Other arrangements
may be made (e.g., exclusive or non-exclusive licenses) but must be proposed by the author
at the time of submission. If a contributor prepared the submission in the scope of his or her
employment, the employer must assign its rights, or the author must be able to prove that the
employer has already ceded copyright back to the employee (e.g., through an institutional
copyright policy). Government employees will be required to obtain publication clearance
approvals in accordance with agency procedures for works prepared as a part of their official
duties. Proof of government clearances will be required. Students submitting material from
a dissertation or other academic work in development should check with their institution to
confirm ownership. All authors must obtain permission for the use of any material owned by
others, including tables, figures, graphs, charts, drawings, photographs and other illustrations,
and digital media works.
101
Author Requirements
Regarding Reproduction and Copying for Private Use: JHSH encourages copying
and reproduction of information appearing in its editions so long as such copying and
reproduction is strictly limited to non-commercial educational and personal use. Any other
use must be under specific agreement. In every case, JHSH and the original author must be
prominently acknowledged as the source of the material. Furthermore, if an article were to
be used for widespread educational classes via on-line forums (e.g. MOOC), permission of
the Editor and Senior Associate Editor is required to ensure that no commercial use will be
tolerated after on-line use. Any use in on-line courses must also, as mentioned above, credit
the original author and JHSH.
XI. Contact Information
Manuscripts and/or concept proposals for articles are to be sent directly to the Editor and
Senior Associate Editor at jhsh@cryptictruth.com.
If needed, call: (334) 725-2378 or (334) 725-2314.
102
Looking Back to Move Forward
Please join us for the 2016 Commemoration
Events & Public Health Ethics Intensive
Monday, April 11th to Friday, April 15th
Assuring Ethics from Generation to Generation
National Center for Bioethics in Research & Health Care
Tuskegee University
John A. Kenney Hall, 44-107
1200 W. Montgomery Road
Tuskegee, AL 36088

Journal of Healthcare, Science and the Humanities Journal of

Transcription

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