Sizing Up the Surgeon General: Unequal Scales in Health and Racial Privilege

By Michelle Chen Aug 03, 2009

The public reaction to Obama’s choice for surgeon general reveals how race and lopsided moralism are insinuating themselves into the health care debate. Many heralded Dr. Regina Benjamin’s nomination as a breakthrough. Her background as an advocate for underserved communities in the South called attention to ground zero of a failed healthcare system. But within a few days, the public attention that Benjamin had drawn toward systemic health disparities was eclipsed by low-intensity character assassination about the nation’s top doctor being too fat for the job. Yes, tens of millions are uninsured, but the real question is, what’s the ideal dress size for a surgeon general? Others have celebrated the fact that Benjamin, who appears overweight by pop cultural standards, reflects the reality lived by many Americans—especially Black women—as they navigate between racialized stereotypes and real health concerns. Ironically, the obsession with Dr. Benjamin’s body mass index coincides withnewly released government research confirming the higher prevalence of obesity among Blacks and Latinos and in the South. Obesity as a health issue (which is itself a murky research area) speaks to both the symptoms and causes of lethal, race-based disparities in care. Researchers have found that doctors’ sub-rosa biases may result in dangerously differential treatment, and there appears to be a similar impact in dealing with obese patients. Medical disenfranchisement is one product of biased doctors’ judgments, says Pamela Merritt at RH Reality Check:

As a full-figured woman of color I was also disturbed but not surprised that some critics of Dr. Benjamin’s weight come from the medical community. Even before research was released connecting the quality of medical care with a person’s weight and race, I knew from personal experience that some doctors make judgments based on their patient’s appearance and then provide medical care based on those flawed judgments. In my case, the flawed care came when I was about 40 pounds lighter and my then primary care doctor assumed that I was the picture of health. I wasn’t…and it took a change in physicians to finally get down to the business of addressing my health concerns. Now that I am 40 pounds heavier I’m alarmed to learn that a recent study found that 40 percent of doctors surveyed reported having a negative reaction to heavy people. Will my weight put me at risk of receiving inadequate care? Is the reward for not looking a certain way substandard medical care?

In the politics of healthcare reform, perceptions of weight and race reflect the degree of the public’s willingness to see the influence of social systems on our bodies and minds, versus the rhetoric of “personal responsibility” that relegates the stigmatized groups to a ghetto of self-blame. Amanda Marcotte at Pandagon reflects on obesity as moral crime in America:

There’s an increasing and unscientific belief that if you have poor health outcomes, it must be because you did something wrong and you don’t deserve help. Part of the reason for this is insurance companies and their willingness to deny coverage based on personal habits, and conservatives are pretty open about their fears that health care reform will mean you get the same coverage whether you smoke or eat Twinkies or don’t. On top of that, there’s an increasing tendency, if you do get sick, to start looking for what you did to deserve it.

Touching on the nexus of race and poverty, Dr. Otis Brawley, chief medical officer with the American Cancer Society, told ABC News, "Obesity has a huge environmental component and is rooted in how one is fed in childhood and what physical activities you partake in the inner city.” And as a surgeon general who has devoted her career to people facing those struggles, he added, “I think Dr. Benjamin may understand the root causes and effectively address the problems more than skinny people." Maybe more than a lot of white, well-to-do people, too, who don’t have to stretch a monthly food stamp allowance to feed their families. Folks who have never been inconvenienced by the lack of a supermarket in their neighborhood, never had to rely on the emergency room instead of a physician who knows them and their community well enough to focus on their long-term wellness. With Congress gridlocked over universal healthcare, the Right is stepping up the subliminal messages that breed a two-tier care system. The attacks on Benjamin smack of embedded rage against affirmative action—questioning the qualifications of women and people of color in high positions (and don’t forget the dismissive portrayal of Obama as “playing Doctor,” or even the distracting effect of the media obsession with Gates-gate). And in the background is subconscious antipathy for the less healthy: aren’t “they” just reaping what they sowed? Aren’t poor people of color inherently flawed and incompetent when it comes to taking care of themselves? To fix health care, we don’t need to talk about Dr. Benjamin’s dress size, but we do need to talk about the imbalance in the way social institutions weigh the value of good health across different communities. Image: Mobile Press-Register