Public health has a lot to answer for. Aside from its many justly celebrated triumphs from the mundane (clean water and improved sanitation) to the dramatic (the polio vaccine, the development of antibiotics), it has also been guilty of using people, especially African Americans, as a means to an end. The best-known example of public health gone wrong is of course the Tuskegee Study of Untreated Syphilis in the Negro Male conducted by the Public Health Service (predecessor to the CDC) in conjunction with the Tuskegee Institute. The CDC has a good timeline and explanation of the study here, but the essential point is that the researchers allowed the study subjects’ syphilis to go untreated even after the development of penicillin. The study began in 1932 and wasn’t discontinued until forty years later. Since then, compensation and a national apology have followed, but the damage has been done. Many African Americans harbor a deep, and to an extent justified, distrust of public health authorities.
At its more extreme form, this kind of sour taste spins off theories of vast conspiracies to wipe out the population. During the early stages of the HIV/AIDS epidemic, a rumor that the virus was a plot to cause genocide against blacks had some currency. Even more recently, about half of African-Americans surveyed either believed that HIV was a man-made virus created for black genocide or were “unsure” whether that was the case.1
It should be obvious that such distrust, and such theories, can impede prevention efforts. Nowhere is this more depressingly apparent than in a recent effort by the Georgia legislature to pass what must be the stupidest — just stupidest — bill ever considered in the effort to prevent abortions. Under the proposed law, aborting a fetus because of its race or gender would be a serious crime by a health care provider (not the woman who has the abortion). This piece of cosmic idiocy is being supported by an unlikely coalition of conspiracy-theorists and “traditional” anti-abortionists. A horrifying stew of toxic conspiracy theories can be found at this site, which seems to be a clearing house for several groups claiming, variously, that abortions are being performed on black women because doing so is profitable for abortionists, that abortion is some kind of plot to eliminate African-Americans, and that abortion is a way of controlling the birth rates of blacks (and the poor).
As with many conspiracy theories, this one has some basis in historical fact: This page does offer some useful information and links on the eugenics movement, which not surprisingly targeted African-Americans to a greater degree than the majority population. But the idea that those who are willing to perform abortions — in the face of protests, threats, and often for little financial reward — are part of some whispered effort to control or limit the African-American population is…well, nuts. But it’s this theory that accounts for the idea of punishing doctors for performing abortions: “They’re aborting to get rid of African-Americans! These genocidal maniacs must go to prison!”
How many cases do you expect would be brought, or would be successful? Very few, obviously. But the radical edge of the pro-life wing is willing to abandon principle or reason in service of any law that might possibly cause a drop in abortion rates. The hope is that by adding another threat to abortion providers, the increased in terrorem effect will be enough to drive more of them away from helping women to realize the full range of their options.
Now it’s true that black women abort their fetuses at a much higher rate than do white women. The Radiance Foundation brought forth the numbers on Georgia here, but their effort to dismiss this report by the Guttmacher Institute doesn’t work. The plain fact is that a higher incidence of unintended pregnancies, which is itself caused by deep and systemic inequalities plaguing the African-American population, is a sufficient and much more plausible explanation for the disparity. The author of the analysis had this to say:
Antiabortion activists in minority communities who are trying to protect African American women and Latinas from themselves by restricting access to safe and legal abortion have it backward. They should instead focus their efforts on reducing the disparities in access to quality health care and in health outcomes more broadly. And if they are most concerned about the disproportionately high abortion rates, they should begin by advocating for improved access to high-quality contraceptive services to reduce the disproportionately high rates of unintended pregnancy in these communities.
But the Operation Rescue crowd will take whatever allies, and whatever arguments, they can get.
Distrust of public health shouldn’t lead to an abandonment of the scientific and population-based tools that public health uses; principally, epidemiology. But the inability or unwillingness to use public health where convenient is common. Let me finish this long post with a quick note on another disturbing case, this one from Iowa. Here is a statement from the President of The Iowa Family Policy Center:
“The Iowa Legislature outlawed smoking in an effort to improve health and reduce the medical costs that are often passed on to the state,” said Chuck Hurley, president of the group. “The secondhand impacts of certain homosexual acts are arguably more destructive, and potentially more costly to society than smoking.”
He continued: “Homosexual activity is certainly more dangerous for the individuals who engage in it than is smoking.”
Hurley was relying on a recent CDC report on the disturbing incidence of HIV and syphilis on MSM (men who have sex with men). And these statistics are disturbing. But will his solution — rolling back marriage equality in Iowa — do anything to fix the problem? And is he right on the smoking comparison? No and no. And this shows that talking-head ideologues should try public health only at home, to twist a well-worn phrase.
Gay men in stable relationships are less likely to have multiple partners than those who aren’t in such relationships. The more partners, the higher the likelihood of STDs. Marriage improves stability, as its proponents tirelessly remind everyone. (And by the way, he makes no case against lesbians.)
As for the smoking comparison? He has no evidence — none — for the assertion that homosexual activity is certainly more dangerous to the individual than smoking. But who needs evidence when demonization will do?
- As the survey shows, they’re not the only ones with this belief, but the percentages are highest among African-Americans, and, according to some studies, Latinos. ↩