By just about any measure you’d care to use, Birmingham is among the best places in the world to get sick. Our community is home to some of the best medical facilities, the finest doctors and most cutting-edge medical and scientific research to be found anywhere in the world. People trek to Birmingham from across the globe for treatment, care and curing of what ails them, making us something of a latter-day Lourdes, except that the miracles here — and we have more than our share of them — are wrought by the hands and minds of men and women and the limitless wonders of science.
Which makes it all the more tragic that Birmingham also rates high, at least in the developed world, among the places one is most likely to get sick, and to stay that way. As detailed in this issue’s cover story — the latest installment in Weld’s ongoing series on poverty in Birmingham — our community has been historically, and so remains, a haven for diseases and conditions that are mostly preventable, or at least controllable. Given the seemingly endemic dichotomy of our status as a world-class medical center and the appalling number of our own citizens who do not have adequate access to treatment and care for what ails them, one might be forgiven for concluding that it will take a miracle to cure it.
As if the persistent division — by location, by income level, by racial and ethnic background, by social class — of our less fortunate citizens from the rest of the population were not cause enough for dismay, the historic obstacles to good public health in Birmingham are heightened at present by our misfortune at having in the governor’s mansion in Montgomery a man to whom the plight of the poor means less than nothing. Since his election Alabama Gov. Robert Bentley has been steadfast in his refusal to expand the state’s Medicaid system as mandated by the federal Affordable Care Act, thereby denying access to healthcare for more than 300,000 Alabamians who currently do not have health insurance.
The governor’s reasons for this are purely political: he does not like Barack Obama (he also is running for re-election this November, but his victory in blood-red Alabama is so assured that he could get away with doing the right thing, if he cared to be a leader instead of an empty Republican suit). To be blunt about it, people are dying because of Bentley’s callous intransigence — perhaps as many as 500 per year, according to some estimates. But the governor, a self-professed Christian — so much so that, within an hour or so of finishing his inaugural address in January 2011, he said in a speech to a smaller audience that anyone who doesn’t believe in Jesus cannot be his “brother or sister” — doesn’t have to attend their funerals, and so has no problem subverting the needs of his constituents to his desire to thumb his nose at the Democrat in the White House.
To be sure, word on the street is that once he is safely re-elected, Bentley will find a way to take the billions the federal government will provide to pay the bulk of Medicaid expansion costs — most likely the “Arkansas option,” whereby he will not actually expand Alabama’s Medicaid system, but instead obtain a waiver from the feds to use the Obamacare money to purchase health insurance for all uninsured Alabamians on the private market. In my book, that only compounds his mockery of Christian principles, though I’d feel better about him if he then would visit each of the families of those to whose deaths he has contributed and explain to them personally why it was so important that he wait.
I have mentioned Gov. Bentley and his twisted idea of morality for two reasons: First, because Medicaid expansion — and, more importantly, providing universal access to healthcare by any means necessary — would be an important component in efforts to address the glaring health disparities in Birmingham. Second, because it seems to me that the existence and persistence of these disparities, and the human toll they exact on our community, make their elimination a moral imperative.
I was confirmed in this feeling during my interviews of two of the people to whom I spoke in researching this week’s cover story on public health. I did not ask them about their religious convictions, and did not share mine with them, but found myself very much moved by certain comments made by each.
“How could you blame poor people for feeling helpless?” Dr. Frank Franklin asked at one point in our conversation. “The way we treat poor people is a spiritual and emotional issue that gives them a poor outlook on life.”
Going a step further, Franklin mused about all we could accomplish as a community, all of the resources that could be made available for positive things — if only we can make strides in public health.
“If we have less ill health, less unemployment, less disability, less crime, fewer drug problems, then we’ll have lot of money left over to promote real economic growth,” he said. “What unity would we achieve if the large economic forces in the community — UAB, Alabama Power, Children’s Hospital, the big banks — joined in a coordinated effort to create opportunities for improving public health? I think the impact would be tremendous.”
Ryan Hankins, the executive director of M-Power Ministries in Avondale, runs a faith-based organization, so his comments were more “religious” in nature than those offered by Franklin. But to my ears, his point was exactly the same — and in words that I wish could find their way straight to Robert Bentley’s ears and heart.
“Our vision is that all people have enough,” Hankins told me. “And I think that here in Birmingham, we have to keep asking ourselves what it means to live in a community that is so overwhelmingly religious, and so overwhelmingly Christian, and how it is that we reconcile what we profess to believe with the conditions that we see around us.”
Amen, brother.