By Michael Eisenstein
Kweisi Mfume became executive leader of the National Medical Association (NMA) just under a year ago, but he has been drawing inspiration from this organization for over 25 years.
He cites the NMA—an organization founded in 1896 to advocate on behalf of African-American doctors and patients—as a major influence on his political priorities during his ten-year span as congressman for the state of Maryland and subsequent presidency of the National Association for the Advancement of Colored People (NAACP).
“It was the inspiration I got from the Association to establish, when I was at the NAACP, the requirement that all 1700 of our branches nationwide have a health committee,” says Mfume, “and for the first time ever at the NAACP, we developed a National Office of Health Advocacy.” His new role represents a natural progression from his efforts at this Office, which worked to provide the African-American community with ready access to medical information and resources for disease prevention and treatment.
Mfume anticipates few changes to the NMA’s mission. “The priorities are pretty much going to be what they are now: trying to find a way to make sure that, at the end of the day, everything we do, say and are part of seeks to lessen the [racial] disparities associated with major diseases, including cancer, cardiovascular disease, HIV, hypertension and stroke,” he says.
As a veteran of the Clinton-era battles over expansion of healthcare coverage, Mfume is cautiously hopeful that the NMA’s mission will be assisted by the recently passed Patient Protection and Affordable Care Act. “I think the bill and the effort behind it were effective at making sure that people riveted their attention on those aspects of healthcare that kind of got put on the shelf after Hillary Clinton’s efforts in 1992, when there was this rebuke by the voters at the polls and the Republican Party took over,” says Mfume.
He also praises the recent health bill for expanding guaranteed insurance coverage for families and attracting awareness to issues underlying inequalities in medical access and quality of care. “There are a number of things in there that will really empower the nation and the medical community to fight and drive down disparities,” says Mfume.
However, he is also aware that the bill is deeply flawed in some respects and is riddled by undermining provisions that bear the hallmarks of the behind-the-scenes, political maneuvering that impeded its progress through Congress.
“These were, in my opinion, just bad amendments by people who were never going to vote for the bill to begin with,” says Mfume. The most serious flaw may be the absence of the public option, a government-run insurance plan intended to provide a low-cost alternative to private insurance companies. By rejecting this approach and including a mandate to purchase coverage or pay a penalty, he suggests the government left itself vulnerable to the legal challenges now being pursued by 28 states.
These problems have been exacerbated by the failure of reform advocates to promptly and effectively counter criticisms from right-wing politicians and pundits. “I had a great deal of angst watching this bill being drafted, and watching the sideshow that was growing with the rhetoric and wondering where the response was from those who know better,” says Mfume. “There wasn’t one—and when there was, it was almost too late, because what was once ‘healthcare reform’ was now ‘Obamacare’ in the minds of a lot of people, and what was an effort to find ways to protect families was reduced to a slogan of ‘throwing grandmother under the bus’.”
Against this background, the efforts of the NMA and other like-minded organizations will remain essential to address unmet healthcare needs in minority communities. In particular, Mfume emphasizes the need for cultural competency: ensuring that physicians and nurses have the training and resources needed to interact and communicate effectively with patients in their community. “Language and cultural barriers can work against the ability to achieve the right diagnosis, treatment and follow-up,” he says.
This sort of awareness will also be essential for addressing issues of racial representation in clinical trials. Accurately determining the safety and efficacy of a drug or treatment requires a pool of volunteers that represent the true diversity of the American people, but recruiting African-Americans remains a serious challenge.
Mfume and others believe that much of this reluctance is based on mistrust of the government, fed in part by the betrayal of the Tuskegee syphilis experiments—a decades-long study in which African-American men were deliberately infected with syphilis without their knowledge. For many in this community, the subsequent apologies and reforms to the clinical trial process were insufficient to wash the blood off the hands of the U.S. medical establishment.
“It happened, and for years there was no discussion of it whatsoever,” says Mfume. “People remember that. And although time has passed, I think there are still some people who say, ‘I’m not going to be a guinea pig—this is not in my best interest.”
Recruiting more African-American medical professionals will be a key step in rebuilding trust and communicating the importance of African-American involvement in medical research. The NMA is making efforts in this regard by providing scholarships to help fund medical training, but Mfume believes that medical schools must also take a more active role. “I’ve seen a greater effort on behalf of faculty at schools… and there’s also been a great deal of effort among graduates of those schools to get people to think about medicine as an occupation and a field of study,” he says.
“But, there are limited seats at medical schools, and it really requires a commitment up front by the university – you’ve got to creatively find a way to make the opportunities broader without negatively affecting or discriminating against anyone else.”