Seeing in color

I am old enough to remember black and white television.

Color TVs didn’t become affordable until the mid-1960s, and I recall getting our first one at home in 1969. Seeing actors in full color made a difference. While I can’t put my finger on the actual difference it made to me, I believe it had to do with being able to see the details of people more clearly.

Along these same lines, I recently had the opportunity to see one of my sons “in color,” or at least more clearly.

I had a conversation with one of my four adult sons about how people’s perceived skin color compelled America’s civil rights social policy, in which federal legislation helped make important progress toward racial equity. He was decidedly concerned.

He reminded me that he and his brothers learned from me they shouldn’t treat their school friends or teammates differently just because they had different skin colors. This wasn’t always the case with some of his friends. In his way of thinking, since he was taught color or ethnicity should not influence how he treats others, he didn’t understand why laws and regulations were still necessary that specified color. He wondered why we must still recognize color.

My initial response came in the form of a short vignette about racial health equity. I’m comfortable talking with him about this topic, having devoted most of my professional life as a physician and health care executive to this issue.

I shared with him how just before the pandemic, health equity researchers described how American women were dying more frequently from pregnancy-related medical complications when compared to previous years. From 1999 to 2002, the rate was 9.65 deaths per 100,000 births; from 2018 to 2021 it jumped to 23.6 deaths per 100,000 births.

“This disturbing trend, much worse for women of color, is peculiar given life-saving health care advancements.”

There is still no consensus as to why this changed. This disturbing trend, much worse for women of color, is peculiar given life-saving health care advancements for medical conditions much more complicated than childbirth.

My son and I both agreed that child-birth related mortality should be rare in such a well-resourced country like the United States and racial health inequities should have been eliminated, or at least diminished, long ago.

I thought I had been clever to choose this example, since he recently married and now had more curiosity about family planning.

He expressed some surprise to hear me speak of these racial inequities for maternal and child outcomes. He said they seemed significant because he had heard many of these types of examples over the years given that his mom, my wife of 43 years, spent her career as a pediatrician in low-resourced areas of Dallas.

I added that some evidence points to the COVID pandemic pushing the mortality numbers up since 2020. I then emphasized that Black women have been dying at more than twice the rate as white women. This is a well-known statistic among those interested in trying to understand the drivers of maternal mortality differences.

I said, “In the wake of the Dobbs Supreme Court decision, women’s health care has become a hot topic everywhere.” We both had seen the Texas Legislature develop a curious interest in women’s reproductive health, recently allocating an additional $118 million to the state’s 2024-25 budget for “women’s health care.”

“Amid the political changes, disproportionately higher rates of pregnancy-related deaths for Black women remain.”

Some attribute this interest in women’s health as a symptom of a larger phenomenon, the increasingly politicized “culture wars.” But I emphasized that amid the political changes, disproportionately higher rates of pregnancy-related deaths for Black women remain.

Our discussion was stimulating, and I felt assured my wife and I had raised a thoughtful young man, guided by his faith. I then drew him back to my key point: “There remains a disproportionately higher rate of pregnancy-related deaths for Black women, and I believe we have a moral and ethical obligation to move forward to reduce or eliminate this inequity.”

We agreed all deaths related to pregnancy are tragic for the newly orphaned children and their families. Then, he again questioned my recommendation, saying I had missed his point about the potential merits for moving to “colorblind” social policies. His worldview still saw race-based policies opposing the principle he was taught and tried to live by, that he should not see people’s color. He should be “colorblind.” In short, he should just see people.

Trying to make my point clearer, I responded this time with what I thought would be a more helpful example from my decades working in health care equity.

I shared with him that during the COVID pandemic, Black Americans suffered and died in far greater percentages than other Americans. Further, the elderly and people with severe chronic illnesses from all races experienced similar inequitable trends. The inequity of COVID deaths for these populations was too large to ignore. So, when vaccinations became available, the country’s public health leadership’s response was to vaccinate those at the highest risk first.

“The inequity of COVID deaths for these populations was too large to ignore.”

The maternal mortality issue could utilize the same principle, applied to Black women at the highest risk to suffer pregnancy-related death. In case he missed the point, I emphasized: Because of the persisting racial disparities, policies that include “not seeing color” would put people at the risk of indifference to the inequities.”

He asked if all my physician colleagues would agree with me.

I told him, “No, based on my experience, I suspect maybe 50% would agree with me.”

In the days between our two-weeks long conversation, I gained some additional insights from a friend and colleague, Charles Senteio. Charles and I have had a running conversation about racial health inequities over the last 20 years. I met Charles in the early 2000s as he was transitioning careers from IT strategy consulting to health care. He is one of those few people I have been fortunate to meet who possesses the remarkable brainpower and drive to continuously learn and act to make society a little better each day. He is now a health equity researcher and tenured professor at a top-tier state university. He also is a licensed therapist with a small private practice he maintains during his free evenings and weekends.

Charles, who is Black, had a different take on the word “colorblind.”

He categorically rejected the “I don’t see color” premise: “These declarations all too frequently are grounded in a negative association with color. Why should I or anyone else suppress any part of my or anyone else’s identities? All of us desperately need to understand where our biases lie, how they manifest, and to work to ensure that those biases are kept in check.”

He then sent me a Fast Company article, “What’s Wrong with Saying You ‘Don’t See Color’?”

Reading it, I recognized Charles’ perspective more clearly. It said, “From a common sense, philosophical point of view, people who ‘don’t see color’ are essentially trying to assert the fundamental equality of human beings. In today’s world, it is unrealistic and unfair to claim ignorance of the plain fact that we are not always equal — be it in the eyes of the law, the state, society, culture or even just our neighbors. Claiming to be ‘colorblind’ just means you’re blinding yourself to the realities of racism and racial prejudice in all its forms.”

“Charles exposed me to something larger than my, or my son’s, different concepts of ‘colorblind.’”

Charles exposed me to something larger than my, or my son’s, different concepts of “colorblind.” He suggested it is about acknowledging there is something outside of what we can see with our eyes, beyond the color of skin. To truly “see” or experience each other, we must arrest our assumptions, but we cannot choose to ignore the important history of the past. We must see our shared humanity, amid the differences between us.

My conversations with my son and Charles revealed at least three different ways of understanding the word and concepts behind the word “colorblind.” I suspect there are a number of other ways to think about it too.

Through the experience, I realized I have a choice to make not to default to my usual binary thinking trap, which leads to binary thinking of individuals as Black or white, good or bad, right or wrong when discussing complex, politically charged topics. More importantly, I realized there is a rich menu of options available for all of us when discussing the complicated social/political topics we confront, with binary absolutes anchoring the extreme ends along a continuum.

And then I clearly saw my son’s point. I heard him saying: “Dad, some people feel best sitting on the extremes of a continuum, and others feel more comfortable in the middle.”

His simple pearl of a message, tucked into his patience, has stayed with me for months now. I have found it helps me manage the day-to-day worry and anxiety-twisting social, and political, state that has evolved over the five decades of my adulthood. I’ve experienced a surprising peace of mind by simply seeing how many different spots people can sit on a continuum.

There also was an equally potent message from Charles’ unique perspective: “Seeing others ‘in color’ means seeing people more completely. An initial step to seeing ‘in color’ is seeing myself more clearly, that I have positive and negative biases about people different than myself, and the negative ones often evolve from insecurities I may feel about myself.

The second step is acknowledging my biases are activated when seeing someone different than myself. These biases emerge unconsciously, triggered by others’ various personal characteristics and/or identities, such as differing hues of skin color; sexuality; ethnicity; nation of origin; religion.

The third, and final part, is learning how to actively and accurately suppress my negative perceptions of others, as they come up, so I can more completely “see” them.

Or said another way, I tell myself: “Go on now, it is safe to get to know each other. There is nothing to fear. Even God is comfortable with them, since God made them.”

To see each other, we must “see in color.”

 

Jim Walton is a retired physician and health care executive whose strategy consulting work focuses on health inequality within America’s rural and urban communities. His 40-year history in health care included private internal medicine group practice followed by safety-net clinic development and physician-led accountable care organization leadership in the Dallas-Fort Worth metroplex. Since 2022, he has served on the U.S. Health and Human Services Physician-focused Payment Model Advisory Committee, recommending reforms for the financing and delivery of health care in America, focused on eliminating health disparities. He is a 1982 graduate of the University of North Texas Health Science Center, Texas College of Osteopathic Medicine and earned an MBA from the University of Michigan in 2009.