McKinley D. The message public health missed: black music parallels too support equity and innovation in public health HPHR. 2021;39. DOI:10.54111/0001/MM6
The institution of public health can do a better job heeding the messages from Black voices. Though Black perspectives are critical to timely and innovative public health action, those perspectives are not equitably valued. In response, this article positions Black musical contributions as a metaphor for Black voices in order to highlight the value of Black knowledge in innovatively contextualizing the social determinants of health. Further, this article positions Black musical traditions, including call and response, as metaphors to support the institution of public health in more timely and equitable responses to marginalized voices so that messages aren’t missed. Together, this unconventional and cross-cutting article aims to shift how the institution of public health considers expertise and moves toward equitable application of knowledge.
Toni Morrison said, “My parallel is always the music because all of the strategies of the art are there. All of the intricacy, all of the discipline. All the work that must go into improvisation so that it appears that you’ve never touched it. Music makes you hungry for more of it. It never really gives you the whole number. It slaps and it embraces, it slaps and it embraces. The literature ought to do the same thing”.1
Like Morrison, my parallel is music. In a way, at least. I see the parallels between society’s uncritical demeaning of Black intellectual contributions in public health and Black music. Whether theories and projects or jazz and hip hop, Black voices have been muffled by society like a trumpet mute, and yet, a sweet sound reverberates from the margins.
From those margins, Black musicians have used style and content molded from their circumstances and unique world views to pioneer foundational American genres including, but not limited to, Gospel, Blues, Jazz, Rock & Roll, and Hip Hop. Well, what if the field of public health is similar in that, influence from Black voices on the American or global experience might bring public health its’ Gospel, Blues, and so on; it might bring public health innovation.
Black people have long recognized and voiced the omnipresence, unjustness, and racism of their social determinants of health (SDOH), while simultaneously being ignored or even demonized by institutions charged with protection. In music, this lineage includes songs such as Marvin Gaye’s 1971, Inner City Blues, which begins with the policy recommendation, “Rockets, moon shots./Spend it on the have nots.”2 Or Tupac’s 90’s track, Brenda’s Got a Baby, where he contextualizes how the morbid manifestations of maternal-child health social determinants “affects our whole community”.3 Or the narrative-countering odes to Black aesthetics from the Queen of Salsa, Celia Cruz’s 2001, La Negra Tiene Tumbao, to the Queen Bey and Blue Ivy’s 2019 Brown Skin Girl.4
One song that stands out in that lineage is Grandmaster Flash and the Furious Five’s 1982 hit, The Message. Published two decades before the World Health Organization’s Commission on Social Determinants of Health and the proliferation of SDOH policy statements, The Message cemented its legacy as a pioneering quasi-environmental scan that illuminated the impact and complex interplay of the SDOH. The Message, identified by the often-referenced hook, “Don’t push me ’cause I’m close to the edge/ I’m trying not to lose my head”, represents the often inescapable circumstances created by the social, economic, and environmental factors that create a metropolitan “jungle”.5
Unfortunately, despite the legacy of The Message as well as the global reach and commercialization of Black voices in music, Black communities struggle to have their voices heard and health needs addressed by public health professionals. Power disparities between health practitioners and the populations they serve, refusals to center the margins, and racism in the form of inaction in response to Black populations’ health needs reinforces the neglect of public health practice and innovation for, and from, Black voices; undermining effective responses to the SDOH and delaying progress toward health equity.6-8 Additionally, according to the largest public health workforce survey in the nation, a third of public health workers report a gap between the importance of cultural competency in their role and their ability to perform the skill.9 Further, the industry looks down on qualitative research which allows study populations, often marginalized, to speak for themselves and have their thoughts published. That differs from quantitative research in who decides or puts meaning to a person or groups’ life and circumstances.
Problems in medicine also threaten the contributions of Black voices. Research demonstrates that physicians consider Black patients unintelligent and trust them less when compared to White patients.10 This disregard of Black voices and ultimate denial of appropriate medical care has received attention recently in discussions around America’s opioid epidemic and Black patients being under-prescribed, in part, due to physician mistrust.11-13 This dismissal of pain, which no physician can feel but are responsible for treating, is eerily similar to dismissals of anti-black racism from physicians who won’t ever feel it. This institutional devaluing of Black knowledge is not limited to patients, as institutional racism against Black physicians has been confirmed by an institution itself with the American Medical Association’s apology in 2008 for a century’s worth of systemic racism.14
Annotating an excerpt from The Message, highlights the value of community knowledge in innovatively contextualizing social needs and revealing the SDOH. This annotation is relevant to public health given that community assessment is one of three categories for essential public health function and that an environmental scan is an effective method for assessing Black communities due to its potential to be a resourceful and inexpensive tool for initiating public health action.15 Further, observing The Message in retrospect allows for an unconventional juxtaposition against empirical SDOH findings in the field of public health since its publishing. To bring further into a health context, I will refer to the song’s primary subjects as patients; countering traditional views of knowledge holding, patients are experts of their own experiences under this paradigm.
“Broken glass everywhere
People pissin‘ on the stairs, you know they just don’t care
I can’t take the smell, can’t take the noise
Got no money to move out, I guess I got no choice
Rats in the front room, roaches in the back
Junkies in the alley with a baseball bat
I tried to get away but I couldn’t get far
‘Cause a man with a tow truck repossessed my car…”5
Without formal public health training, the patient guides us in understanding a microeconomic link to the inescapable toll of pollution in the community. This toll would be empirically demonstrated over the decades that followed the release of these poetic field notes. For example, the impact of noise is multifaceted and may amplify health disparities given the racial disparities in noise exposure, especially when observed with factors of socioeconomic position.16 To illustrate, noise-induced sleep quality reductions may compromise the immune system, increase mental health issues like those alluded to in the song’s hook, or decrease work and school performance.16,17 The resulting decrease in health and performance can impact socioeconomic status via job termination, occupational injuries, or a suboptimal education experience that could limit advancement opportunities.
When describing housing concerns, the patient stigmatizes addiction by using the term “junkies”. For health practitioners, knowledge of such stigmatizing terminology or trending colloquial health descriptors is health literacy and may support de-stigmatization efforts. However, this knowledge is generally acquired through consistent community engagement.
In the closing vignette of verse one, economics reinforces inescapability because the patient’s car was “repossessed”. Examining further, one can explore interactions of racism, economics, and policy that maintain health inequities. For example, the repossession could be a result of lost wages arising from the aforementioned ramifications of noise-induced sleep deprivation. Simultaneously, the repossession could be the result of the common practice of racial discrimination in auto loans that leads to more expensive loans for Black borrowers.18 That type of inequitable economic burden on Black populations can negatively impact health outcomes and access to care, especially when left unchecked. Though racial discrimination in car loans was deemed illegal in 2013 through guidance from the Consumer Financial Protection Bureau, that guidance was repealed in 2018.
Considering Black music parallels, how might the institution of public health be more timely in appreciating and responding to Black voices so that messages aren’t missed?
For health gatekeepers, the literature points to a history of undervaluing Black thought and innovation in structure. One example, featured in the New England Journal of Medicine, described jazz in its infancy by stating that “Discord has been substituted for harmony as the ideal. The culmination — jazz — may be called a musical crime”.19 Contrary to that statement, if music is any indicator, Black knowledge leads to innovative trendsetting in structure, style, and content. As such, public health institutions that serve to build the knowledge base should reconsider rigid policies that prescribe the structure of knowledge sharing.
In Classical music, one generally falls in line and plays exactly as the sheet music mandates. That is antithetical to several Black music practices. One of those practices is the expectation that you do your own thing. That practice works in concert with what composer Olly Wilson labeled, “the heterogeneous sound ideal”, which is defined as an African and African American approach where “a kaleidoscope range of dramatically contrasting qualities of sound is sought after”.20 Further, improvisation elements such as the jazz solo, ballroom chant, or freestyle in rap, allows space for one to be creative within the context of a larger structure or even outside of that structure, called “playing outside” in jazz. A final practice, the swing of a jazz band, was described by acclaimed musician Wynton Marsalis as “a metaphor for finding, valuing, and nourishing common ground.”21 But even as Marsalis, a nuanced traditionalist, espouses the virtues of swing, he can’t vibe with some contemporary Black musical innovations; leaving him teetering between critical curator and rigid gatekeeper.
Because of rigid traditionalist in public health who are more the mythical Sir Nose D’voidofunk than Star Child, there’s rarely any playing outside in public health publication. This rigidity exists to position who can contribute and legitimize knowledge. Though scientific writing is about progress and challenge, ironically, you have to do it while falling in line with the decades-old Introduction, Methods, Results, and Discussion (IMRaD) structure in “Standard English” or it’s a wrap. The result of such mandates is that structural innovation is prohibited and equitable knowledge contribution is compromised because you can’t do your own thing; as if IMRaD stands without needing a remix. As such, traditionalist notions around knowledge sharing, like mandating the IMRaD structure, should be reconsidered in favor of what might be called a heterogeneous knowledge formatting ideal. However, like the evolution from P-funk to G-funk, the balance between tradition and innovation will require finding, valuing, and nourishing common ground among a kaleidoscope range of perspectives.
Call and response or “perfected social interaction” is an African and African American practice that “embodies communality rather than individuality.”22 When responding to a call, you don’t always wait until the final note for praise, encouragement, and action. Sometimes you respond while the act is still ongoing. That response might even be disruptive. The institution of public health would benefit from heeding the message of call and response because it responds to issues of power dynamics in that, for call and response, “there is no sharp line between performers or communicators and the audience, for virtually everyone is performing, and everyone is listening.”22
Call and response can vary in form, venue, purpose, and impact. In the examination of “the intricacies, diversity, and multi-directionality of calls and responses in the Black Church”, Dr. Gillian Richards-Greaves argues that 12 call and response categories exist in a matrix of verbal or non-verbal, audible or inaudible, direct or indirect actions.23 Among category explanations, Richards-Greaves details the pointed request of a Verbal Direct Call like “Say, ‘hallelujah,’ somebody!”, the interjecting affirmation communicated in a Verbal Audible Direct Response like “Sing!”, and how a Non-Verbal Inaudible Response may be reflected through what’s called a “quiet shout” where a performer causes one to be “introspective, silent”, as I suppose Kirk Franklin and the Family alluded to when they sang, “sometimes we may be crying, when nothings even wrong”. 23,24 Richards-Greaves also asserts a notion of a secondary call where “affirmations, which emerge from the pew in response to a performance, are not just responses, but… facilitate other responses”.23 The cooperative and transformative power of the secondary call is demonstrated by singer Mahalia Jackson who shouted from the March on Washington crowd, “Tell ‘em about the dream, Martin!”, likely prompting Martin Luther King Jr. to change course from his prepared remarks to deliver the “I Have a Dream” speech.25
Just as a secondary call promotes action, so too should the knowledge building process in public health, where researchers or presenters spark something in a receiver whose actions then inspire others to respond in cooperative and transformative ways. For public health, a call might be a song like The Message, a journal article, or the potential of a Black mentee. Among responses, a letter of recommendation for that mentee could be considered a response to the call from potential. Additionally, a non-verbal inaudible response may be taking a moment to be introspective when someone tells you, from studied and lived experience, about the circumstances of their marginalized communities. Further, a verbal response exists in the interjecting affirmation in phrases like, “That’s a good idea!”, when said in a praise so public that it’s disruptive. Public Health work in response to the messages from Black people should also include citing, awarding, promoting, reading, retweeting, and recognizing the messages from Black people.
Much like public health, “Black music and the cultural sphere around it has consistently been tuned towards the ethical project of a better future.”26 But unfortunately, society seems stuck dancing to the same old tune as racism continues to press pause on that better future. So the question remains, is the fate of equitable knowledge contribution in public health similar to that of Disco Demolition Night at Comiskey Park where the makings of marginalized maestros see a cataclysmic end as their intellectual property is ceremoniously destroyed through crowd sourced hate; bringing an end to whatever momentum you thought was started? If so, even if public health does see innovation resulting from Black knowledge, history suggests that it may be commodified, have its soul diluted, and not reap equitable benefits for those most integral to the creation and most in need, and deserving, of the rewards.
Though The Message, which features lyrics by Melle Mel and Duke Bootee, shows Hip Hop’s prowess for socio-environmental commentary, health practitioners should not randomly listen to rap or any genre like a training. This exploration positions The Message as an example of experiential knowledge and looks at Black music practices to challenge the institution of public health. Additionally, public health practitioners’ efforts to be culturally competent collaborators with Black communities should not look like its acknowledgment of Hip Hop so far; focused on negative perceptions and novelty versus inherent value. Instead, an approach with cultural humility that is sensitive to the complex lives of marginalized populations and allows their voices to be the focus will be important in this paradigm shift.27
Duane McKinley is a public health professional interested in the intersections of culture and health. He received his Master of Public Health from Florida A & M University and a Bachelor of Science from Florida State University.