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An article in the Yale Alumni Magazine
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told the story of Clyde Murphy,
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a black man who was a member
of the Class of 1970.
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Clyde was a success story.
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After Yale and a law degree from Columbia,
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Clyde spent the next 30 years
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as one of America's
top civil rights lawyers.
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He was also a great husband and father.
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But despite his success,
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personally and professionally,
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Clyde's story had a sad ending.
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In 2010,
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at the age of 62,
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Clyde died from a blood clot in his lung.
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Clyde's experience was not unique.
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Many of his black classmates from Yale
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also died young.
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In fact, the magazine article indicated
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that 41 years after graduation from Yale,
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the black members of the Class of 1970
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had a death rate
that was three times higher
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than that of the average class member.
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It's stunning.
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America has recently awakened
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to a steady drumbeat
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of unarmed black men
being shot by the police.
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What is even a bigger story
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is that every seven minutes,
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a black person dies prematurely
in the United States.
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That is over 200 black people
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die every single day
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who would not die if the health
of blacks and whites were equal.
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For the last 25 years,
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I have been on a mission
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to understand why does race
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matter so profoundly for health.
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When I started my career,
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many believed that it was simply
about racial differences
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in income and education.
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I discovered that while
economic status matters for health,
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there is more to the story.
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So for example, if we look
at life expectancy at age 25,
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at age 25 there's a five-year gap
between blacks and whites.
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And the gap by education
for both whites and blacks
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is even larger than the racial gap.
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At the same time,
at every level of education,
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whites live longer than blacks.
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So whites who are high school dropouts
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live 3.4 years longer
than their black counterparts,
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and the gap is even larger
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among college graduates.
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Most surprising of all,
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whites who have graduated from high school
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live longer than blacks
with a college degree
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or more education.
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So why does race matter
so profoundly for health?
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What else is it
beyond education and income
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that might matter?
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In the early 1990s,
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I was asked to review a new book
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on the health of black America.
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I was struck that almost every single one
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of its 25 chapters
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said that racism
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was a factor that was hurting
the health of blacks.
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All of these researchers
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were stating that racism was a factor
adversely impacting blacks,
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but they provided no evidence.
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For me, that was not good enough.
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A few months later,
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I was speaking at a conference
in Washington, DC,
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and I said that one
of the priorities for research
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was to document the ways
in which racism affected health.
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A white gentleman stood in the audience
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and said that while he agreed
with me that racism was important,
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we could never measure racism.
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"We measure self-esteem," I said.
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"There's no reason
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why we can't measure racism
if we put our minds to it."
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And so I put my mind to it
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and developed three scales.
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The first one captured
major experiences of discrimination,
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like being unfairly fired
or being unfairly stopped by the police.
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But discrimination also occurs
in more minor and subtle experiences,
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and so my second scale,
called the Everyday Discrimination Scale,
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captures nine items
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that captures experiences
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like you're treated
with less courtesy than others,
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you receive poorer service
than others in restaurants or stores,
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or people act as if they're afraid of you.
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This scale captures
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ways in which the dignity and the respect
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of people who society does not value
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is chipped away on a daily basis.
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Research has found
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that higher levels of discrimination
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are associated with an elevated risk
of a broad range of diseases
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from blood pressure to abdominal obesity
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to breast cancer to heart disease
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and even premature mortality.
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Strikingly, some of the effects
are observed at a very young age.
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For example, a study of black teens
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found that those who reported higher
levels of discrimination as teenagers
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had higher levels of stress hormones,
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of blood pressure
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and of weight at age 20.
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However,
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the stress of discrimination
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is only one aspect.
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Discrimination and racism
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also matters in other
profound ways for health.
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For example, there's
discrimination in medical care.
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In 1999, the National Academy of Medicine
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asked me to serve on a committee
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that found, concluded
based on the scientific evidence,
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that blacks and other minorities
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receive poorer quality care than whites.
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This was true for all kinds
of medical treatment,
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from the most simple
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to the most technologically sophisticated.
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One explanation for this pattern
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was a phenomenon
that's called "implicit bias"
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or "unconscious discrimination."
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Research for decades
by social psychologists
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indicates that if you hold
a negative stereotype
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about a group in your subconscious mind
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and you meet someone from that group,
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you will discriminate against that person.
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You will treat them differently.
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It's an unconscious process.
It's an automatic process.
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It is a subtle process, but it's normal
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and it occurs even among
the most well-intentioned individuals.
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But the deeper that I delved
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into the health impact of racism,
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the more insidious the effects became.
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There is institutional discrimination,
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which refers to discrimination
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that exists in the processes
of social institutions.
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Residential segregation by race,
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which has led to blacks and whites living
in very different neighborhood contexts,
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is a classic example
of institutional racism.
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One of America's best-kept secrets
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is how residential segregation
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is the secret source
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that creates racial inequality
in the United States.
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In America, where you live
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determines your access to opportunities
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in education, in employment,
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in housing and even
in access to medical care.
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One study of the 171 largest
cities in the United States
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concluded that there is not even one city
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where whites live
under equal conditions to blacks,
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and that the worst urban contexts
in which whites reside
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is considerably better than the average
context of black communities.
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Another study found
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that if you could eliminate statistically
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residential segregation,
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you would completely erase
black-white differences in income,
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education and unemployment,
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and reduce black-white differences
in single motherhood
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by two thirds,
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all of that driven by segregation.
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I have also learned
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how the negative stereotypes
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and images of blacks in our culture
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literally create and sustain
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both institutional
and individual discrimination.
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A group of researchers
have put together a database
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that contains the books,
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magazines and articles
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that an average college-educated
American would read over their lifetime.
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It allows us to look within this database
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and see how Americans
have seen words paired together
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as they grow up in their society.
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So when the word "black"
appears in American culture,
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what co-occurs with it?
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"Poor,"
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"violent,"
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"religious,"
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"lazy,"
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"cheerful,"
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"dangerous."
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When "white" occurs,
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the frequently co-occurring words
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are "wealthy,"
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"progressive,"
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"conventional,"
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"stubborn,"
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"successful,"
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"educated."
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So when a police officer
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overreacts when he sees
an unarmed black male
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and perceives him
to be violent and dangerous,
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we are not necessarily dealing
with an inherently bad cop.
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We may be simply viewing
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a normal American
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who is reflecting
what he has been exposed to
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as a result of being raised
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in this society.
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From my own experience,
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I believe that your race
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does not have to be
a determinant of your destiny.
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I migrated to the United States
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from the Caribbean island of Saint Lucia
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in the late 1970s
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in pursuit of higher education,
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and in the last 40 years,
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I have done well.
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I have had a supportive family,
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I have worked hard,
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I have done well.
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But it took more for me to be successful.
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I received a minority fellowship
from the University of Michigan.
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Yes. I am an affirmative action baby.
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Without affirmative action,
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I would not be here.
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But in the last 40 years,
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black America has been
less successful than I have.
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In 1978, black households
in the United States
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earned 59 cents for every dollar
of income whites earned.
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In 2015,
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black families still earn 59 cents
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for every dollar of income
that white families receive,
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and the racial gaps in wealth
are even more stunning.
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For every dollar of wealth
that whites have,
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black families have six pennies
and Latinos have seven pennies.
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The fact is,
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racism
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is producing a truly rigged system
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that is systematically disadvantaging
some racial groups in the United States.
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To paraphrase Plato,
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there is nothing so unfair
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as the equal treatment of unequal people.
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And that's why I am committed
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to working to dismantle racism.
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I deeply appreciate the fact
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that I am standing on the shoulders
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of those who have sacrificed
even their lives to open the doors
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that I have walked through.
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I want to ensure
that those doors remain open
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and that everyone
can walk through those doors.
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Robert Kennedy said,
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"Each time a man" --
or woman, I would add --
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"stands up for an ideal
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or acts to improve the lot of others
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or strikes out against injustice,
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he sends forth a tiny ripple of hope,
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and those ripples can build a current
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that can sweep down the mightiest walls
of oppression and resistance."
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I am optimistic today
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because all across America,
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I have seen ripples of hope.
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The Boston Medical Center
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has added lawyers to the medical team
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so that physicians can improve
the health of their patients
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because the lawyers are addressing
the nonmedical needs their patients have.
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Loma Linda University
has built a gateway college
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in nearby San Bernardino
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so that in addition
to delivering medical care,
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they can provide job skills
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and job training
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to a predominantly minority,
low-income community members
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so that they will have the skills
they need to get a decent job.
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In Chapel Hill, North Carolina,
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the Abecedarian Project has figured out
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how to ensure that they have lowered
the risks for heart disease
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for blacks in their mid-30s
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by providing high-quality day care
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from birth to age five.
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In after-school centers
across the United States,
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Wintley Phipps and the US Dream Academy
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is breaking the cycle of incarceration
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by providing high-quality
academic enrichment and mentoring
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to the children of prisoners
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and children who have
fallen behind in school.
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In Huntsville, Alabama,
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Oakwood University,
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a historically black institution,
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is showing how we can improve
the health of black adults
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by including a health evaluation
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as a part of freshman orientation
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and giving those students
the tools they need
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to make healthy choices
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and providing them annually
a health transcript
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so they can monitor their progress.
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And in Atlanta, Georgia,
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Purpose Built Communities has dismantled
the negative effects of segregation
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by transforming a crime-ridden,
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drug-infested public housing project
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into an oasis of mixed-income housing,
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of academic performance,
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of great community wellness
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and of full employment.
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And finally,
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there is the Devine solution.
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Professor Patricia Devine
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of the University of Wisconsin
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has shown us how we can attack
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our hidden biases head on
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and effectively reduce them.
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Each one of us
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can be a ripple of hope.
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This work will not always be easy,
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but former Supreme Court Justice
Thurgood Marshall
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has told us, "We must dissent.
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We must dissent from the indifference.
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We must dissent from the apathy.
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We must dissent from the hatred
and from the mistrust.
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We must dissent
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because America can do better,
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because America has no choice
but to do better."
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Thank you.
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(Applause)