CONCLUSION
Race and Health in the Post–Civil Rights Era

The effects of the Black Panther Party’s health activism have been multiform, registering in the evolution of individual lives, in the ebb and flow of institutions, and in the persistent struggle for health-care access. Many former Panthers continued their work on healthcare issues, with some remaining activists and others going on to careers in the medical professions, in public health administration, and in health-related community programs. Although the Seattle chapter’s break with the national group in 1972 was disheartening, Arthur Harris fully credits his time in the Party as inspiring his decision to become a nurse.¹ Cleo Silvers, who advocated for patients’ rights and conducted door-to-door testing for sickle cell anemia and lead poisoning in New York City (with both the Black Panther Party and the Young Lords Party) in later years directed Build a Better Bronx, an environmental justice community organization. At present, she is a community outreach director at a leading U.S. medical center.²

For Tolbert Small, involvement with the Party set him on his current path, serving as a bridge from his college activism as a Friend of SNCC to his present-day efforts to make medical care accessible. Small continues to practice medicine among the poor and working-class residents of Oakland, but he does so now at the Harriet Tubman Medical Office, a sliding-scale clinic he started in the 1980s.³ In addition to providing primary healthcare at his office, Small occasionally performs acupuncture—a skill learned when he toured China with a Black Panther Party contingent in 1972—in two treatment rooms in the lower level of the clinic dedicated to this purpose.⁴ He also serves on the board of the Coalition of Concerned Medical Professionals, a health rights organization,⁵ and lectures widely, advocating for universal healthcare and railing against the inadequacies of the Medicare, Medicaid, and health maintenance organization systems.

Norma Armour, who worked at the George Jackson PFMC between 1970 and 1974, remains dedicated to healthcare issues. After her time as a Panther, she studied health administration, with a focus on substance abuse issues, at a California college. Her career trajectory included a stint at the Watts Health Foundation and work as a manager for alcohol and drug abuse programs for an L.A.-area municipality. In the late 1980s she helped begin the University Muslim Medical Association clinic in Los Angeles. Armour today is a community instructor in that city’s Charles Drew University of Medicine and Science, where she advises health professionals on how to improve their communication and interactions with patients from the Watts community. In her words, this work is intended to “improve outcomes for our people and eliminate health disparities.” Armour notes with pride that she is “still doing the work I began over forty years ago.”⁶

Participation in the Black Panthers’ health politics also had a lasting effect on the future endeavors of Malik Rahim (formerly Donald Guyton). Rahim was the deputy of security for the New Orleans chapter of the Party.⁷ In 2005, in the wake of the federal government’s failure to ensure social welfare during Hurricane Katrina, Rahim played an essential role in helping restore services to Louisianans left abandoned in the city. Drawing on skills accumulated during his time in the Party, Rahim established, with two others, the Common Ground Health Clinic in New Orleans’ Algiers neighborhood.⁸ Linking his Panther past with his post-Katrina activism, Rahim has commented that “most of the things that I do now [are] based upon those experiences.”⁹ He explained that “to start a health clinic or a first aid station [after Katrina] wasn’t anything because . . . we did [this] in the Panther Party.”¹⁰

In describing the human-made, state-exacerbated tragedy in New Orleans, Rahim invoked the familiar Black Panther health political language of government neglect, social exclusion—and, in response, “survival programs”:

Right after the hurricane, we came to the realization that the city wasn’t going to provide any services. . . . there was no medical entity even operating in Algiers, and it wasn’t operating especially for black folks. . . . I said to myself, “My God, these people just mean for us to die. . . . Man, it’s time for you to do whatever you got to do to survive.” . . . under that environment of blatant racism and total abandonment . . . we founded Common Ground.¹¹

Just as the brutal facts of urban poverty, health inequality, and medical mistreatment showed the celebratory civil rights rhetoric of the late 1960s at its limits, the aftermath of Katrina confirmed that for vulnerable communities made up of lives deemed of little value, citizenship had indeed failed. The necessary building carried out by Rahim and others in New Orleans brings to light the persistent circumscription of “the right to have rights,” especially for poor and black communities.

The Party’s health politics reflected its similar recognition that the legal defeat of Jim Crow decades prior did not guarantee citizenship. At the same time, it exhibited the activists’ shared faith that social inclusion was of paramount value. Indeed, Seattle’s Elmer Dixon argued that the Black Panther Party emerged as “the struggle shifted from civil rights . . . to human rights.”¹² He said further that “[it] was our duty to stand up for our God-given rights. We were not going to beg for our rights, the rights to a decent education, health care, jobs—basic human rights.”¹³ The Party recognized and responded to the shifting stakes of U.S. citizenship as it came to focus on life-chances and a “politics of life itself,” in which rights and obligations were articulated in new domains and discourses, including that of health, well-being, medicine, and biomedical research.¹⁴

Medical discrimination took many forms in the second half of the twentieth century. As Jim Crow health inequality—racially segregated schools for nurses and doctors, hospital wards, and professional societies, and substandard healthcare and sociomedical racialism—began to diminish in the 1960s, different modalities of these long-standing health disparities came into focus, including issues of healthcare access and insurance coverage, physician accountability, patient empowerment, mobility in the health professions, and medical surveillance. Befitting the combination of old and new forms of health-based inequality that it faced (and faced down), the Party mobilized a wide range of responses. Principally, it created healthcare institutions via a network of community-based health clinics; it engaged in debates about the validity and merits of race-based biomedical research; and, after legal desegregation, it demanded inclusion as patient–citizens, in hospitals, in insurance plans, in community board meetings, and in legislative chambers. Consistent with an organization formed partly in contradistinction to weak notions of community control, the Party supported the right of poor blacks to shape their social welfare.

In response to the citizenship contradiction that became acute in the late 1960s when the fact that civil rights did not ensure social inclusion was brought into sharp relief, the Party envisioned a more radical form of democracy. The activists rejected capitalist liberalism and laid claim to democracy’s radical potential as this potentiality was articulated in the “WHAT WE WANT” and “WHAT WE NEED” that was the Party’s ten-point platform. The Party imagined and tried to engender a society in which collective goods were put above economic gain.

This was the grounding philosophy of its social health perspective. Social health included but was bigger than a single individual’s wellbeing. The Party understood health as a scalar phenomenon; social health linked the body to society, and inextricably so. The Party’s social health framing was placed in jeopardy when, for example, its accusations of neglect (and even genocide) were countered by the state through either the expansion (National Sickle Cell Anemia Act) or the contraction (UCLA violence center) of resources. The material response of the state and reformers to the issues of health inequality highlighted by the Party was, at a certain level, evidence of the activists’ efficacy. From another vantage, however, these gains were made at the cost of the Party’s social health perspective; marginalized communities were left with an anemic if sometimes efficacious form of biological inclusion in the place of racial equality, social justice, and economic citizenship.

It has become commonplace to describe lived intersections of state and biomedical regimes as forms of “biological citizenship.” Among scholars of patient advocacy and health social movements the phrase is often used felicitously, as a way to mark the emergence and politicization of new biosocial communities. The Party’s health politics prompts a return to the work of the anthropologist Adriana Petryna and, in particular, to the milieu of catastrophe and deprivation that impelled her theorization of biological citizenship. With the health politics of the Black Panthers in mind, it is worth emphasizing that biological citizenship for Petryna is a vehicle of inclusion for “increasingly poor citizens” who, if not for their “damaged biology,” might be otherwise lacking in social and economic rights.¹⁵ What happens when damaged biology or presumed biological pathology or disproportionate illness rates or disease identity come to stand in for citizenship? What are the transaction costs of biological citizenship?

Racial health disparities are a “21st Century Civil Rights Priority!”¹⁶ So declared the phalanx of religious, political, and health industry leaders, gathered under the auspices of the National Minority Quality Forum, at a September 2007 press conference in Washington, D.C. Members of this group, which was made up of Al Sharpton and Jesse Jackson, as well as the president of the Association of Black Cardiologists, the Washington bureau chief of the NAACP, and a member of the Congressional Black Caucus, among others, spoke in turn and with urgency about the epidemic of myriad black–white health inequities. As a case in point, several speakers raised the issue of disparities in heart disease: Dr. Gerald DeVaughn, the head of the Association of Black Cardiologists, lamented that African American mortality from heart disease significantly outpaced that of whites, drawing the conclusion that “a race neutral approach . . . has not worked.”¹⁷ “By ignoring scientific evidence,” added Dr. Elizabeth Ofili, a cardiologist affiliated with the Morehouse College School of Medicine, “we are placing our patients at unnecessary risk of premature death.”¹⁸

The data to which Ofili referred were controversial clinical studies on the differential efficacy by race of BiDil, a pharmaceutical treatment for congestive heart failure. BiDil was approved by the Food and Drug Administration in 2005 for the exclusive use of “self-identified African American patients,”¹⁹ on the logic that the genetic makeup of blacks was sufficiently distinct from other groups to warrant a “race-specific” drug. In dismissing a “race neutral approach” to cardiopathy, DeVaughn also dismissed decades of scholarship—on scientific racism, on the Tuskegee syphilis study and other forms of invidious medical experimentation, on the expropriation of black bodies for the benefit of medical science from “night riders” to Henrietta Lacks, and on racial discrimination in both healthcare facilities and the medical profession—that has rendered the perils of biological theories of race in fine detail and shown how these have been used to justify the very disparities this coalition aimed to bridge. By implication, the day’s speakers suggested that race-biased or race-based medicine that began from the assumption of a shared and distinctive genetic profile was a cure for what ailed black America. Placing the issue of African Americans’ access to BiDil on the front lines of “the next battleground for civil rights,” the speakers at the same time represented the struggle over access to BiDil as a natural next phase in the longue durée of the black protest tradition.²⁰

Given the history of medical discrimination in the United States, how was it that the demand for access to a race-based drug said to be efficacious for the supposed idiosyncratic physiology of black people came to be regarded as the next stage in the struggle for full citizenship? How did a civil rights tradition undergirded by claims about common humanity and shared inalienable rights become the banner under which social, political, and health industry leaders endorsed a drug predicated on African Americans’ supposed essential biological difference?

The Black Panthers’ activism was a critical and unwitting way station on the road to this vexed, contemporary politics of health and race that the sociologist Steven Epstein has characterized as the “inclusionand-difference” paradigm. The Black Panther Party understood that the health inequality experienced by blacks and the poor was a dialectic of neglect and surveillance. As has been described in the preceding pages, the Black Panthers’ politics of race and health accordingly had two emphases. First, the Party both advanced and rejected theories of health and human difference toward efficacious political ends. In the case of sickling and race, the Party ventured close to essentialism in its uptake of genetics theories that permitted it to make strong claims about racial oppression. Second, the Party rejected outright the suggestion that African Americans might be biologically inferior. More specifically, the activists recontextualized the assumptions of 1970s genetic science and advanced the position that socially just genetics would study all human groups rather than focus on blacks solely.

Today genomic science has resuscitated some debates about race, health, and biology thought to have been dormant since before the Panther era, but as the controversies over black disease predisposition and inferiority discussed in chapter 5 suggest, these debates never really went away. The dual discourse of the Party’s politics of health and race suggest how we got here and where we might be headed. The Party found in health not only a new moral terrain for civil and social rights struggles but also a marker of African American inclusion and exclusion. The Black Panthers worked both within and outside mainstream medicine, critiquing its excesses, its discrimination, and its paternalism while seeking social health for poor communities. Party health activism suggests that we may be moving toward a “curious conjunction of a reliance on and a repudiation of race”—as Anthony Appiah remarked about Du Bois’s early work—that will converge in new ways in the era of genetic ancestry testing for race and ethnicity and personalized medicine.²¹ This is not exactly a rock and a hard place, but it is the place where marginalized communities are left after years of yearning for social inclusion on various registers. The articulation of BiDil, a pharmaceutical for African Americans, as a civil rights issue should be viewed in light of these historical dynamics that the Black Panthers demonstrate: the emergence of health as a civil rights mantle in the 1970s; postsegregationist aspirations for inclusion and social health, the repudiation of Jim Crow, and the progression of racial inequality from segregated water fountains and lunch counters to entrenched urban poverty.

Following Fanon, the Panthers also recognized how medicine could serve as a vehicle of social control; indeed, it might be said that their mission to police the police was extended onto biopolitical terrain. The Panthers’ characterization of the power exercised by the medical–industrial complex as neglect resulting in genocide signaled the group’s sensitivity both to how the black body had been a site of domination historically—as expressed, for example, in its analogizing of the suffering of slavery with that of sickling—and to blacks’ vulnerability to the constriction of health rights, to which the activists responded with clinics and initiatives. Health was the site where these two concerns articulated. From this vantage, we can see that the Party’s health politics—its provision of medical services, its health education outreach, and its social health paradigm—was also a struggle over the terms of black citizenship, a confrontation with the authority of biomedical science, and a challenge to the process of biomedical racialization. The black body came to represent the broader treatment of blacks in the United States.