When Dr. Mary Bassett was introduced as NYC Mayor Bill de Blasio’s Commissioner of Health in 2014, she quoted Dr. King. “Of all forms of inequality,” she said. “Injustice in health is the most shocking and inhumane.” By choosing those words, Bassett was in signaling her progressive view of healthcare and health policy—one she has advocated for since working in Zimbabwe after graduating from medical school, during her tenure with Doctors Without Borders and as Deputy Health Commissioner under Mayor Michael Bloomberg. She is dedicated to improving school nutrition, health and wellness education—especially among our poor and underserved communities and is s a voice for encouraging diversity in the medical and healthcare profession. Our Life And Times spoke recently with Dr. Bassett.

When you were introduced you said that public health has at its root the quest for social justice. Can you expand on that?

The roots of public health include having access to medical care; everyone deserves access to medical care, but the roots of good health are really much more expansive. They have to do with having a decent everyday life. And that means having a job that pays decently, having decent housing that you can afford, having access to healthy food and recreational activity and living in a neighborhood where neighbors are in the position to support each other. It’s not only material things that people need for a decent life, they need the cohesiveness of a neighborhood where people feel confidence and not fear. All of these things have to do with being healthy. There’s good data to show that only 10% of our health has to do with access to health care; all of these other things are very importantly rooted in the values of our society: a living wage, decent housing and investment in public infrastructure—all of these are things that have to do with our society’s commitment to equity.

What are the fundamental changes that we have to make to build healthier communities?

Just about every sector has a role to play. The importance of focusing on our neighborhoods is something that I can’t overstate. The neighborhood of Brownsville in Brooklyn—which is the first neighborhood I lived in as a kid in New York—is the neighborhood with the shortest life expectancy in New York. It has nearly an 11-year gap with a wealthier neighborhood that is just a short ride away. Tackling that requires the action of all of us and taking a long view of health, so that’s why starting with early childhood and supporting reinvestment in children is so important. Our society has lagged woefully behind in re-investing in childhood. It means understanding the importance of all the things that unions typically are engaged in fighting for and solidarity with other workers who aren’t unionized. I think that’s an important role and it’s one that 1199 has been involved in. That’s absolutely fundamental. This represents a real opportunity. And it’s also the opportunity to be healthy in the workplace. This would be great for unions to continue to talk about. We’ve been advocating for this. You’ll see our signs all over our office about walking up the stairs. We have walking workstations. I just spent half an hour looking at my email while walking. One of the thing I said at the opening press conference was that having a decent life for all is fundamentally a question of social justice, but I also talked about how the leading causes of death do not change with a change in administration, so that tobacco remains the leading cause of preventable death in New York City and the problem of obesity is one we must continue to tackle. Our workplace continues to play a role in that.

You’ve written that “obesity is the public health challenge of our time.” Why? What are some of the other ones?

The escalation in obesity in this country is remarkable. When you look at the maps you wonder why our continent isn’t sinking. Something like 60% of adults are overweight or obese and that proportion continues to rise. We’ve had a little bit of success in children, but 40% of children in our elementary schools are not at a healthy weight. We’ve slowed that rise, but it’s still way too high and obesity is driving the epidemic occurrence of diabetes, which has been rising as a cause of death and is attributable to the fact that too many people are overweight. On an individual level this means you’ve eaten more calories than you’ve burned off. But on a social level we have to think about what kind of food is available to people, the time they have, the money they have and how foods that are high in calories but low in nutritional value are marketed to our population. It’s not enough to frame it as a lack of personal control. We need to look more broadly at what has changed. A lot of it has to do with what has been so successfully marketed. It has too much salt and sugar. Unions need to support their membership in making changes. People need the opportunity to have decent lunchbreaks, not eat at their desks, to have the opportunity even for exercise. Several people here walk the stairs together. Modeling health activity is something unions can do and it’s something people can take home with them to their families.

Why is cultural competence so important for caregivers?

Something I think is really important is the problem of implicit bias. It’s one thing to acknowledge the variations in culture and show respect, but we need to go a step further and help people understand the ways in which they have absorbed the deep and historical legacies of racism in our society and their own biases, so that they can be mindful of ways in which they may respond. This is not a matter of blame; this is simply a fact of the society in which we live. They wrote in the companion piece to my article about the way care varies by race in our society and there is a problem: without realizing it, people respond differently to people of different races. It’s been done with gender as well: Victoria Jones doesn’t get the same job offer as Victor Jones when people do blind resumes. I think the recognition of diversity is really important and that cultural competency is really important and part of that needs to be an acknowledgement of what goes under the heading of implicit bias.

You wrote an article last year for The New England Journal of Medicine called “#BlackLivesMatter—A Challenge to the Medical and Public Health Communities.” It demands that we look at violence and other epidemics in our society in a new way. How are these public health crises as well as social justice issues?

I was called to write after having a meeting with some academics when I was talking about addressing the gaps in healthcare by race and income in our city. Some of them gathered round shortly after the decision had been made not to indict after the death of Eric Garner. There was a lot of pain among many people around the tragic death of Mr. Garner. I wanted to make a couple of points in that piece: we consider violence a public health issue and the impact of violence on Black men is something we need to discuss. We need to acknowledge the role of racism in our society, but I wanted to go further than that in the piece. If we’re serious about talking about the cost of racism and the lives of Black men in our country and the loss of life to premature death before the age of 65—the premature deaths are accounted for principally from heart disease, cancer and stroke; these are also conditions which are preventable, as is gun violence. We should not accept the terrible toll that premature mortality takes on Black men because it is preventable, so I wanted to call upon my colleagues in public health and the medical profession and challenge them to talk about racism. I lived outside the U.S. for many years. When I returned it was really noticeable to me that the conversation about race had almost vanished. People were reluctant to use the word racism. I wanted to challenge my colleagues to not only name the problem of racism, but to use our position and authority in society to chart a way to addressing it. There are a number of things we can do: one is say that it’s important to document the ways in which the experience of racism affects health. This is an area of growing research. The other is to look at our own institutions. The real problem is with who’s getting into medical schools these days and the dearth of Black men in medical schools. I met with medical students form the area—they had a diein as part of a movement called White Coats for Black Lives and according to the students they only had one Black student in their entering class last year. We need to do better and all health workers have a role to play.