Breaking the Fine Rain of Death: African American Health Issues and a Womanist Ethic of Care Book

The topic of medical care injustice is opened with a reflection on the lamentation in the Book of Joel. The author uses lament as a theme, to point out that the entire community suffers when the health care system is broken. Therefore, the entire community must recognize the tragedy, lament and rise to action, refusing to accept defeat. Communal lament is formative in creating communal response, because response requires acknowledgement. Justifiable response requires visibility.

Chapter 2 provides an overview of U.S. health care - up to 1998, when the book was first published. Health care costs affect the poor to a much greater extent than those with larger incomes. A large percentage of those in poverty do not have insurance and those who do often struggle with copays, transportation and other social determinants of health. As a result, care is often put off until the need and condition are dire. Poor people of color are affected more than whites, because of the additional burden of bias they encounter. Many of her assessments and comments were true in 1998 and are still serious issues, but some things have changed for the better. Anyone reading this should keep in mind that it was published 20 years ago. The bottom line is that the system was and is a mess, no matter how you slice it. For the patients, the system is so complicated that it is difficult for a well-educated person to navigate.

The history of African-American health and public health in Chapter 3 reveals a long slow transition. The poor treatment of African-Americans developed long ago during the time of slavery and assumptions about them and their culture, by the dominant white majority, have persisted.

Chapter 4 reviews efforts of Black medical professionals to improve the health of Blacks and how their approach considered the psychosocial aspects of individuals and their communities. At that time, public health officials thought that the high incidence of certain diseases in African American segments of the population was due to racial genetic differences. They did not take environmental and social differences into consideration. This sets the stage for a long look at the Tuskegee Syphilis study; how it began and how it went awry.

Chapter 5 concerns women's health and the exclusion of women from research studies until the late 1900s. Chapter 6 discusses HIV/AIDS and how the mistrust generated as a result of Tuskegee has persisted and contributed to suspicion and conspiracy theories about HIV treatment protocols. The author attributes this to a lack of adequate discussion of the Tuskegee study with the public. She also connects issues regarding HIV to sexually repressive attitudes in U.S. society and sexual objectification of the African body.

The next chapter turns to a discussion of the community. Townes laments that we no longer lament for our community, because individualism and entitlement have replaced our sense of community. (p 151) She then discusses the interplay and intersectionality of the individual, cultural norms and health. Health is a product of culture and environment. We create our culture in response to our environment. Therefore, we must attempt to understand both.

Her overriding message is: Do not be afraid. Be in the community. Move among the people. Listen. Watch. Connect spiritually. Ask about the need for daily bread and offer the Bread of Life.