0:00:01.000,0:00:04.120
An article in the Yale Alumni Magazine

0:00:05.240,0:00:07.816
told the story of Clyde Murphy,

0:00:07.840,0:00:11.720
a black man who was a member[br]of the Class of 1970.

0:00:12.960,0:00:15.000
Clyde was a success story.

0:00:16.320,0:00:19.320
After Yale and a law degree from Columbia,

0:00:20.160,0:00:22.376
Clyde spent the next 30 years

0:00:22.400,0:00:25.560
as one of America's[br]top civil rights lawyers.

0:00:26.280,0:00:28.960
He was also a great husband and father.

0:00:30.080,0:00:32.816
But despite his success,

0:00:32.840,0:00:35.160
personally and professionally,

0:00:36.080,0:00:38.360
Clyde's story had a sad ending.

0:00:39.440,0:00:40.640
In 2010,

0:00:41.720,0:00:43.480
at the age of 62,

0:00:44.640,0:00:47.640
Clyde died from a blood clot in his lung.

0:00:50.120,0:00:53.920
Clyde's experience was not unique.

0:00:54.720,0:00:57.576
Many of his black classmates from Yale

0:00:57.600,0:00:59.080
also died young.

0:01:00.080,0:01:03.440
In fact, the magazine article indicated

0:01:04.319,0:01:08.016
that 41 years after graduation from Yale,

0:01:08.040,0:01:11.216
the black members of the Class of 1970

0:01:11.240,0:01:14.496
had a death rate[br]that was three times higher

0:01:14.520,0:01:16.960
than that of the average class member.

0:01:18.680,0:01:19.880
It's stunning.

0:01:21.240,0:01:23.760
America has recently awakened

0:01:24.680,0:01:26.856
to a steady drumbeat

0:01:26.880,0:01:30.640
of unarmed black men[br]being shot by the police.

0:01:31.960,0:01:35.160
What is even a bigger story

0:01:36.560,0:01:39.656
is that every seven minutes,

0:01:39.680,0:01:43.680
a black person dies prematurely[br]in the United States.

0:01:44.440,0:01:48.256
That is over 200 black people

0:01:48.280,0:01:50.416
die every single day

0:01:50.440,0:01:55.240
who would not die if the health[br]of blacks and whites were equal.

0:01:58.240,0:01:59.920
For the last 25 years,

0:02:00.920,0:02:02.856
I have been on a mission

0:02:02.880,0:02:05.656
to understand why does race

0:02:05.680,0:02:08.240
matter so profoundly for health.

0:02:09.759,0:02:11.536
When I started my career,

0:02:11.560,0:02:15.936
many believed that it was simply[br]about racial differences

0:02:15.960,0:02:17.720
in income and education.

0:02:18.480,0:02:23.320
I discovered that while[br]economic status matters for health,

0:02:24.200,0:02:26.096
there is more to the story.

0:02:26.120,0:02:31.040
So for example, if we look[br]at life expectancy at age 25,

0:02:31.960,0:02:37.056
at age 25 there's a five-year gap[br]between blacks and whites.

0:02:37.080,0:02:41.016
And the gap by education[br]for both whites and blacks

0:02:41.040,0:02:44.160
is even larger than the racial gap.

0:02:44.960,0:02:49.576
At the same time,[br]at every level of education,

0:02:49.600,0:02:51.840
whites live longer than blacks.

0:02:52.560,0:02:54.856
So whites who are high school dropouts

0:02:54.880,0:02:58.576
live 3.4 years longer[br]than their black counterparts,

0:02:58.600,0:03:01.496
and the gap is even larger

0:03:01.520,0:03:03.160
among college graduates.

0:03:04.200,0:03:07.216
Most surprising of all,

0:03:07.240,0:03:10.616
whites who have graduated from high school

0:03:10.640,0:03:14.336
live longer than blacks[br]with a college degree

0:03:14.360,0:03:15.600
or more education.

0:03:16.600,0:03:20.496
So why does race matter[br]so profoundly for health?

0:03:20.520,0:03:24.560
What else is it[br]beyond education and income

0:03:25.400,0:03:26.640
that might matter?

0:03:28.040,0:03:29.640
In the early 1990s,

0:03:30.520,0:03:32.680
I was asked to review a new book

0:03:33.600,0:03:35.480
on the health of black America.

0:03:36.200,0:03:39.296
I was struck that almost every single one

0:03:39.320,0:03:41.576
of its 25 chapters

0:03:41.600,0:03:43.376
said that racism

0:03:43.400,0:03:46.440
was a factor that was hurting[br]the health of blacks.

0:03:47.360,0:03:49.080
All of these researchers

0:03:50.120,0:03:54.880
were stating that racism was a factor[br]adversely impacting blacks,

0:03:56.080,0:03:57.640
but they provided no evidence.

0:03:58.560,0:04:00.720
For me, that was not good enough.

0:04:01.960,0:04:03.616
A few months later,

0:04:03.640,0:04:06.576
I was speaking at a conference[br]in Washington, DC,

0:04:06.600,0:04:09.776
and I said that one[br]of the priorities for research

0:04:09.800,0:04:13.520
was to document the ways[br]in which racism affected health.

0:04:14.880,0:04:17.416
A white gentleman stood in the audience

0:04:17.440,0:04:20.760
and said that while he agreed[br]with me that racism was important,

0:04:22.240,0:04:23.720
we could never measure racism.

0:04:24.880,0:04:26.880
"We measure self-esteem," I said.

0:04:28.200,0:04:29.616
"There's no reason

0:04:29.640,0:04:32.640
why we can't measure racism[br]if we put our minds to it."

0:04:33.720,0:04:36.216
And so I put my mind to it

0:04:36.240,0:04:37.760
and developed three scales.

0:04:38.440,0:04:42.416
The first one captured[br]major experiences of discrimination,

0:04:42.440,0:04:46.696
like being unfairly fired[br]or being unfairly stopped by the police.

0:04:46.720,0:04:52.016
But discrimination also occurs[br]in more minor and subtle experiences,

0:04:52.040,0:04:55.120
and so my second scale,[br]called the Everyday Discrimination Scale,

0:04:56.000,0:04:57.736
captures nine items

0:04:57.760,0:04:59.096
that captures experiences

0:04:59.120,0:05:02.416
like you're treated[br]with less courtesy than others,

0:05:02.440,0:05:06.016
you receive poorer service[br]than others in restaurants or stores,

0:05:06.040,0:05:08.280
or people act as if they're afraid of you.

0:05:09.240,0:05:12.056
This scale captures

0:05:12.080,0:05:15.656
ways in which the dignity and the respect

0:05:15.680,0:05:18.616
of people who society does not value

0:05:18.640,0:05:21.000
is chipped away on a daily basis.

0:05:21.960,0:05:23.440
Research has found

0:05:25.440,0:05:28.296
that higher levels of discrimination

0:05:28.320,0:05:33.856
are associated with an elevated risk[br]of a broad range of diseases

0:05:33.880,0:05:37.136
from blood pressure to abdominal obesity

0:05:37.160,0:05:39.816
to breast cancer to heart disease

0:05:39.840,0:05:42.400
and even premature mortality.

0:05:43.520,0:05:48.616
Strikingly, some of the effects[br]are observed at a very young age.

0:05:48.640,0:05:52.760
For example, a study of black teens

0:05:54.120,0:05:59.560
found that those who reported higher[br]levels of discrimination as teenagers

0:06:01.120,0:06:03.800
had higher levels of stress hormones,

0:06:05.520,0:06:07.456
of blood pressure

0:06:07.480,0:06:10.200
and of weight at age 20.

0:06:12.440,0:06:13.640
However,

0:06:15.920,0:06:18.456
the stress of discrimination

0:06:18.480,0:06:20.416
is only one aspect.

0:06:20.440,0:06:22.936
Discrimination and racism

0:06:22.960,0:06:27.256
also matters in other[br]profound ways for health.

0:06:27.280,0:06:30.360
For example, there's[br]discrimination in medical care.

0:06:31.080,0:06:35.376
In 1999, the National Academy of Medicine

0:06:35.400,0:06:37.336
asked me to serve on a committee

0:06:37.360,0:06:42.416
that found, concluded[br]based on the scientific evidence,

0:06:42.440,0:06:44.936
that blacks and other minorities

0:06:44.960,0:06:47.840
receive poorer quality care than whites.

0:06:48.480,0:06:52.336
This was true for all kinds[br]of medical treatment,

0:06:52.360,0:06:53.720
from the most simple

0:06:54.720,0:06:57.560
to the most technologically sophisticated.

0:06:58.800,0:07:01.816
One explanation for this pattern

0:07:01.840,0:07:05.776
was a phenomenon[br]that's called "implicit bias"

0:07:05.800,0:07:08.096
or "unconscious discrimination."

0:07:08.120,0:07:10.936
Research for decades[br]by social psychologists

0:07:10.960,0:07:14.456
indicates that if you hold[br]a negative stereotype

0:07:14.480,0:07:17.536
about a group in your subconscious mind

0:07:17.560,0:07:20.256
and you meet someone from that group,

0:07:20.280,0:07:22.576
you will discriminate against that person.

0:07:22.600,0:07:24.256
You will treat them differently.

0:07:24.280,0:07:28.896
It's an unconscious process.[br]It's an automatic process.

0:07:28.920,0:07:32.096
It is a subtle process, but it's normal

0:07:32.120,0:07:38.000
and it occurs even among[br]the most well-intentioned individuals.

0:07:39.280,0:07:42.296
But the deeper that I delved

0:07:42.320,0:07:44.480
into the health impact of racism,

0:07:45.360,0:07:48.080
the more insidious the effects became.

0:07:49.160,0:07:51.600
There is institutional discrimination,

0:07:52.600,0:07:55.416
which refers to discrimination

0:07:55.440,0:07:59.440
that exists in the processes[br]of social institutions.

0:08:00.400,0:08:02.736
Residential segregation by race,

0:08:02.760,0:08:07.736
which has led to blacks and whites living[br]in very different neighborhood contexts,

0:08:07.760,0:08:11.320
is a classic example[br]of institutional racism.

0:08:13.120,0:08:17.056
One of America's best-kept secrets

0:08:17.080,0:08:19.256
is how residential segregation

0:08:19.280,0:08:21.616
is the secret source

0:08:21.640,0:08:25.360
that creates racial inequality[br]in the United States.

0:08:26.800,0:08:29.736
In America, where you live

0:08:29.760,0:08:32.895
determines your access to opportunities

0:08:32.919,0:08:36.216
in education, in employment,

0:08:36.240,0:08:40.280
in housing and even[br]in access to medical care.

0:08:41.640,0:08:48.056
One study of the 171 largest[br]cities in the United States

0:08:48.080,0:08:51.376
concluded that there is not even one city

0:08:51.400,0:08:54.736
where whites live[br]under equal conditions to blacks,

0:08:54.760,0:08:58.696
and that the worst urban contexts[br]in which whites reside

0:08:58.720,0:09:03.360
is considerably better than the average[br]context of black communities.

0:09:03.920,0:09:05.616
Another study found

0:09:05.640,0:09:08.656
that if you could eliminate statistically

0:09:08.680,0:09:10.336
residential segregation,

0:09:10.360,0:09:14.496
you would completely erase[br]black-white differences in income,

0:09:14.520,0:09:17.016
education and unemployment,

0:09:17.040,0:09:20.336
and reduce black-white differences[br]in single motherhood

0:09:20.360,0:09:21.576
by two thirds,

0:09:21.600,0:09:23.960
all of that driven by segregation.

0:09:24.960,0:09:27.016
I have also learned

0:09:27.040,0:09:29.816
how the negative stereotypes

0:09:29.840,0:09:32.816
and images of blacks in our culture

0:09:32.840,0:09:35.856
literally create and sustain

0:09:35.880,0:09:39.320
both institutional[br]and individual discrimination.

0:09:40.640,0:09:43.600
A group of researchers[br]have put together a database

0:09:44.480,0:09:46.696
that contains the books,

0:09:46.720,0:09:49.736
magazines and articles

0:09:49.760,0:09:54.456
that an average college-educated[br]American would read over their lifetime.

0:09:54.480,0:09:57.296
It allows us to look within this database

0:09:57.320,0:10:02.656
and see how Americans[br]have seen words paired together

0:10:02.680,0:10:05.176
as they grow up in their society.

0:10:05.200,0:10:09.176
So when the word "black"[br]appears in American culture,

0:10:09.200,0:10:11.256
what co-occurs with it?

0:10:11.280,0:10:12.696
"Poor,"

0:10:12.720,0:10:13.936
"violent,"

0:10:13.960,0:10:15.296
"religious,"

0:10:15.320,0:10:16.536
"lazy,"

0:10:16.560,0:10:17.776
"cheerful,"

0:10:17.800,0:10:19.536
"dangerous."

0:10:19.560,0:10:21.056
When "white" occurs,

0:10:21.080,0:10:23.336
the frequently co-occurring words

0:10:23.360,0:10:24.696
are "wealthy,"

0:10:24.720,0:10:25.976
"progressive,"

0:10:26.000,0:10:27.200
"conventional,"

0:10:28.120,0:10:29.336
"stubborn,"

0:10:29.360,0:10:30.576
"successful,"

0:10:30.600,0:10:31.880
"educated."

0:10:32.280,0:10:35.576
So when a police officer

0:10:35.600,0:10:39.880
overreacts when he sees[br]an unarmed black male

0:10:41.240,0:10:45.936
and perceives him[br]to be violent and dangerous,

0:10:45.960,0:10:50.520
we are not necessarily dealing[br]with an inherently bad cop.

0:10:51.280,0:10:53.816
We may be simply viewing

0:10:53.840,0:10:55.856
a normal American

0:10:55.880,0:10:59.656
who is reflecting[br]what he has been exposed to

0:10:59.680,0:11:02.096
as a result of being raised

0:11:02.120,0:11:03.360
in this society.

0:11:04.080,0:11:06.400
From my own experience,

0:11:07.840,0:11:10.456
I believe that your race

0:11:10.480,0:11:13.480
does not have to be[br]a determinant of your destiny.

0:11:14.720,0:11:17.256
I migrated to the United States

0:11:17.280,0:11:19.360
from the Caribbean island of Saint Lucia

0:11:20.440,0:11:22.080
in the late 1970s

0:11:22.840,0:11:24.680
in pursuit of higher education,

0:11:26.000,0:11:28.376
and in the last 40 years,

0:11:28.400,0:11:29.600
I have done well.

0:11:30.280,0:11:32.896
I have had a supportive family,

0:11:32.920,0:11:34.200
I have worked hard,

0:11:35.240,0:11:36.440
I have done well.

0:11:37.120,0:11:39.800
But it took more for me to be successful.

0:11:40.600,0:11:44.720
I received a minority fellowship[br]from the University of Michigan.

0:11:45.440,0:11:49.680
Yes. I am an affirmative action baby.

0:11:50.560,0:11:53.336
Without affirmative action,

0:11:53.360,0:11:55.040
I would not be here.

0:11:57.000,0:11:59.536
But in the last 40 years,

0:11:59.560,0:12:03.320
black America has been[br]less successful than I have.

0:12:04.720,0:12:10.016
In 1978, black households[br]in the United States

0:12:10.040,0:12:14.160
earned 59 cents for every dollar[br]of income whites earned.

0:12:15.040,0:12:17.296
In 2015,

0:12:17.320,0:12:22.176
black families still earn 59 cents

0:12:22.200,0:12:26.016
for every dollar of income[br]that white families receive,

0:12:26.040,0:12:29.640
and the racial gaps in wealth[br]are even more stunning.

0:12:30.600,0:12:32.880
For every dollar of wealth[br]that whites have,

0:12:33.880,0:12:37.360
black families have six pennies[br]and Latinos have seven pennies.

0:12:38.800,0:12:40.256
The fact is,

0:12:40.280,0:12:42.216
racism

0:12:42.240,0:12:46.576
is producing a truly rigged system

0:12:46.600,0:12:51.840
that is systematically disadvantaging[br]some racial groups in the United States.

0:12:52.880,0:12:55.056
To paraphrase Plato,

0:12:55.080,0:12:57.360
there is nothing so unfair

0:12:58.880,0:13:02.200
as the equal treatment of unequal people.

0:13:03.520,0:13:06.416
And that's why I am committed

0:13:06.440,0:13:08.960
to working to dismantle racism.

0:13:09.960,0:13:12.416
I deeply appreciate the fact

0:13:12.440,0:13:15.696
that I am standing on the shoulders

0:13:15.720,0:13:20.056
of those who have sacrificed[br]even their lives to open the doors

0:13:20.080,0:13:21.366
that I have walked through.

0:13:22.280,0:13:26.176
I want to ensure[br]that those doors remain open

0:13:26.200,0:13:29.840
and that everyone[br]can walk through those doors.

0:13:32.320,0:13:34.656
Robert Kennedy said,

0:13:34.680,0:13:38.216
"Each time a man" --[br]or woman, I would add --

0:13:38.240,0:13:40.336
"stands up for an ideal

0:13:40.360,0:13:42.936
or acts to improve the lot of others

0:13:42.960,0:13:45.536
or strikes out against injustice,

0:13:45.560,0:13:49.096
he sends forth a tiny ripple of hope,

0:13:49.120,0:13:52.216
and those ripples can build a current

0:13:52.240,0:13:57.200
that can sweep down the mightiest walls[br]of oppression and resistance."

0:13:58.040,0:14:00.096
I am optimistic today

0:14:00.120,0:14:02.696
because all across America,

0:14:02.720,0:14:04.960
I have seen ripples of hope.

0:14:05.720,0:14:07.616
The Boston Medical Center

0:14:07.640,0:14:10.360
has added lawyers to the medical team

0:14:11.160,0:14:15.216
so that physicians can improve[br]the health of their patients

0:14:15.240,0:14:19.520
because the lawyers are addressing[br]the nonmedical needs their patients have.

0:14:20.480,0:14:24.296
Loma Linda University[br]has built a gateway college

0:14:24.320,0:14:26.136
in nearby San Bernardino

0:14:26.160,0:14:29.456
so that in addition[br]to delivering medical care,

0:14:29.480,0:14:32.296
they can provide job skills

0:14:32.320,0:14:33.976
and job training

0:14:34.000,0:14:38.776
to a predominantly minority,[br]low-income community members

0:14:38.800,0:14:42.760
so that they will have the skills[br]they need to get a decent job.

0:14:44.960,0:14:47.336
In Chapel Hill, North Carolina,

0:14:47.360,0:14:51.056
the Abecedarian Project has figured out

0:14:51.080,0:14:56.376
how to ensure that they have lowered[br]the risks for heart disease

0:14:56.400,0:14:59.456
for blacks in their mid-30s

0:14:59.480,0:15:02.496
by providing high-quality day care

0:15:02.520,0:15:05.216
from birth to age five.

0:15:05.240,0:15:08.536
In after-school centers[br]across the United States,

0:15:08.560,0:15:11.216
Wintley Phipps and the US Dream Academy

0:15:11.240,0:15:14.016
is breaking the cycle of incarceration

0:15:14.040,0:15:18.456
by providing high-quality[br]academic enrichment and mentoring

0:15:18.480,0:15:21.176
to the children of prisoners

0:15:21.200,0:15:23.840
and children who have[br]fallen behind in school.

0:15:24.600,0:15:26.296
In Huntsville, Alabama,

0:15:26.320,0:15:27.736
Oakwood University,

0:15:27.760,0:15:30.096
a historically black institution,

0:15:30.120,0:15:34.416
is showing how we can improve[br]the health of black adults

0:15:34.440,0:15:37.456
by including a health evaluation

0:15:37.480,0:15:40.616
as a part of freshman orientation

0:15:40.640,0:15:43.616
and giving those students[br]the tools they need

0:15:43.640,0:15:45.296
to make healthy choices

0:15:45.320,0:15:48.696
and providing them annually[br]a health transcript

0:15:48.720,0:15:50.560
so they can monitor their progress.

0:15:51.520,0:15:53.256
And in Atlanta, Georgia,

0:15:53.280,0:15:59.216
Purpose Built Communities has dismantled[br]the negative effects of segregation

0:15:59.240,0:16:01.896
by transforming a crime-ridden,

0:16:01.920,0:16:04.856
drug-infested public housing project

0:16:04.880,0:16:08.576
into an oasis of mixed-income housing,

0:16:08.600,0:16:10.776
of academic performance,

0:16:10.800,0:16:13.656
of great community wellness

0:16:13.680,0:16:15.080
and of full employment.

0:16:16.160,0:16:17.856
And finally,

0:16:17.880,0:16:19.880
there is the Devine solution.

0:16:20.680,0:16:23.320
Professor Patricia Devine

0:16:24.400,0:16:26.976
of the University of Wisconsin

0:16:27.000,0:16:30.696
has shown us how we can attack

0:16:30.720,0:16:33.696
our hidden biases head on

0:16:33.720,0:16:35.760
and effectively reduce them.

0:16:36.680,0:16:38.456
Each one of us

0:16:38.480,0:16:40.640
can be a ripple of hope.

0:16:41.200,0:16:44.696
This work will not always be easy,

0:16:44.720,0:16:47.640
but former Supreme Court Justice[br]Thurgood Marshall

0:16:48.680,0:16:51.576
has told us, "We must dissent.

0:16:51.600,0:16:54.016
We must dissent from the indifference.

0:16:54.040,0:16:56.096
We must dissent from the apathy.

0:16:56.120,0:16:59.576
We must dissent from the hatred[br]and from the mistrust.

0:16:59.600,0:17:01.256
We must dissent

0:17:01.280,0:17:04.536
because America can do better,

0:17:04.560,0:17:09.376
because America has no choice[br]but to do better."

0:17:09.400,0:17:10.616
Thank you.

0:17:10.640,0:17:14.280
(Applause)