Moving beyond anger in Ferguson: A health journalist’s perspective

Published on
September 11, 2014

Editor's Note: Robert Joiner has had a distinguished journalism career in St. Louis since the 1970s, most recently writing for the St. Louis Beacon. A former USC Annenberg National Health Journalism Fellow and Dennis Hunt grantee, he wrote this essay on Ferguson for Reporting on Health. 

The police shooting of Michael Brown in Ferguson and the sight of his limp body sprawled for hours in the street have provoked an intense debate that reveals our nation’s deep divisions when it comes to questions of race and justice.

Even as a St. Louis County grand jury investigates the shooting of the unarmed black youth, most Americans have already made up their minds about what happened. Reactions have included both a vigorous defense of police procedure and a show of support for Darren Wilson, the white officer who shot and killed Brown on August 9. Others regard the disturbing scene of Brown’s body in the street as exemplifying police disrespect for many black men like Brown, in life and in death. That view might explain the voices that rose in protest in peaceful demonstrations as well as the rioting, looting and arson following the shooting.

To understand that street violence, otherwise inexcusable and inexplicable to many, I found myself turning to the Rev. Dr. Martin Luther King, who once called such unruly behavior  “the language of the unheard.”

Many African American residents have shared how disenfranchised they feel in Ferguson, where blacks are woefully underrepresented at every level of government, from the police department to the city council. African Americans in Ferguson have yet to flex political muscle in relation to their growing numbers. They now account for two out of every three residents – a transformation from a majority white community that has occurred just since 2000. The city of Ferguson and St. Louis County government have struggled to play catch-up – making little progress in addressing health disparities, the shortage of job skills and the housing needs that accompanied this dramatic demographic transformation.

Calling attention to race and quality-of-life needs of poor residents

While the Brown case has come to symbolize popular disillusionment with finding justice for all, we can also understand it as being about quality-of-life issues and resources for poor residents in places like Ferguson, a majority black suburban city where, in the last decade, poverty has become rampant.

The connection between race and well-being has been lived by many in Ferguson over the last decade, at a time of shifting demographics and diminishing economic opportunities. A study by the St. Louis Regional Health Commission documented these disparities at least 16 months before Brown’s death. The study showed that in the first decade of the new century, the St. Louis area made significant progress in improving outcomes for those with several serious chronic diseases. But it also revealed an alarming pattern of deepening poverty in Ferguson and many other communities mostly in the northern part of suburban St. Louis County, as well as many examples of disparities – where African Americans fared significantly worse than whites, such as in rates of uncontrolled asthma, rates of avoidable hospitalizations and rates of uninsurance. 

A recent analysis by Elizabeth Kneebone of the Brookings Institution reached some of the same conclusions, finding that Ferguson represents just one example of growing suburban poverty nationwide. Experts here and elsewhere also note there is nothing unique about Ferguson’s problems or the tension and mistrust that Michael Brown’s death revealed. What’s new today is simply that a tragedy has forced us to hold a national conversation about these uncomfortable truths.

An opportunity to reexamine neglected concerns

The shooting “opens up the whole notion of police training, police that will work with their community and not be seen as occupiers. This gives us an opportunity in the St. Louis region to examine that question,” says Terry Jones, a professor and chair of the Department of Political Science at the University of Missouri at St. Louis. On a larger level, he says, “those who thought our racial division days were behind us got a real big reminder that this isn’t really the case.”

Chris Krehmeyer, president and CEO of Beyond Housing, a community development organization serving north St. Louis County, says that division persists in part because it’s hard for some whites to understand the social unrest and why blacks can’t uplift themselves and become self sufficient. “There is a great disconnect,” he says.

Conditions chronicled by the St. Louis Regional Health Commission take on new meaning with the shooting and subsequent unrest in Ferguson. Tom Fee, manager of the St. Louis County Youth Resource Center, says conditions were already challenging in Ferguson, where the county’s leadership had not equipped itself to serve the influx over the last decade of black families to Ferguson and other communities in the northern part of St. Louis County. The Brookings’s Kneebone and others have called attention to how dramatic the migration has been. Ferguson was 85 percent white in 1980 and is now 67 percent black.

The black families who moved in have not been as well off as whites who left, and officials were caught “off guard” by the level of services needed to accommodate the newcomers, says Fee.

“Services haven’t followed people or followed where the needs are,” he says. “Many of the social service agencies are based in St. Louis. But the suburbs are where the need has increased.” He says his department is constantly trying to address that issue because “transportation is a challenge for many at-risk residents, and the goal is to shift more services out of central offices and to sites closer to where people live.”

Where do we go from here?

Returning to the data last week, the co-chair of the St. Louis Regional Health Commission’s study, Dr. Dolores Gunn, who also heads the county’s Health Department, talked about the shooting and described the challenges facing those living in “a thousand, literally a thousand, apartment units, families who are lower middle class or are working at the poverty level, are at risk” and struggling to make ends meet.

For young men growing up in such communities, she says, one big challenge is to pair them with credible mentors. “First of all, you have a communication problem,” she says. “If you have a CEO do a mentorship program that doesn’t have input from people he is going to impact, the program isn’t going to be successful. And the programs need to start early when young people are in middle school.”

Robert Freund, CEO of the Regional Health Commission, which issued the report that reviewed health issues over the decade, acknowledges the disparities in places like Ferguson, but notes that factors other than medical care account for the differences in health outcomes among residents in the St. Louis region.

“Ferguson and some of those other north county neighborhoods have become poorer over the last 10 years,” he says. “The unemployment rate has gone up. The percentage of high school graduates has gone down. All those are high predictors of poor health long term. So while access to medical care has improved, I can’t say the situation for health in those neighborhoods has necessarily improved in 10 years.”

Expanded health care coverage represents progress

One health initiative that both Dr. Gunn and Freund are proud of is the Regional Health Commission’s success in helping St. Louis and St. Louis County get a federal waiver that has allowed many at-risk residents to obtain Medicaid coverage connected with the Affordable Care Act. This is happening even though Missouri has refused to approve a law to expand Medicaid across the state.

Residents in north St. Louis County and elsewhere have been impacted by other cuts in spending. An example is programs for more access to mental health services, says Paulette Fuerster, vice president of program services for Lutheran Family and Children’s Services of Missouri. This is a crucial issue for needy young adults, she says, because mental illness is often diagnosed between the ages of 17 and 25. “I am not trying to say all young men have those health issues. But it’s a very complex problem, and there needs to be more intervention.”

Other help for mental health is available for some groups because St. Louis County residents agreed to tax themselves a few years back to set up a Children’s Service Fund, notes Dr. John N. Constantino, head of the division of child and adolescent psychiatry at Washington University School of Medicine in St. Louis. “Many of my patients come from Ferguson, and many of the mental health services we provide are delivered to children in those areas,” he says. Life for his patients wasn’t easy during the turmoil, he says, mentioning patients “being up all night with tear gas coming into their homes.” While the program offers a significant amount of services, he says there is a shortage of psychiatrists to deliver the services. Residents also suffer due to the lack of funding for parenting education, prevention programs and transportation, he says.

The well-being of poor blacks and poor whites in the St. Louis area

Jason Q. Purnell, an assistant professor at the George Warren Brown School of Social Work at Washington University, led a team of Washington University and Saint Louis University researchers who undertook a highly regarded study earlier this year of the well-being of African Americans in the St. Louis area. Following release of the study, researchers joined community groups in a discussion of the findings and to get a sense of the kind of research that the community thinks researchers should undertake. Purnell sees that kind of interaction as a way for researchers to stay grounded and build ties to residents in places like Ferguson.

Meanwhile, policymakers are waking up to changes in the face of suburbia in communities like Ferguson. These demographic shifts need not create a crisis. Proactive housing strategies can promote healthy communities by discouraging heavy concentrations of poor blacks or poor whites in neighborhoods, communities and census tracts.

We tend to forget that the St. Louis region also is home to plenty of poor whites facing some of the same social and economic challenges we associate almost exclusively with black residents. These whites are less visible because they aren’t concentrated in impoverished islands. They are dispersed throughout the St. Louis region to the point that we feel less overwhelmed, less stressed by their presence and really believe that, yes, it’s still morning in America.

Now comes the hard work that visionary leaders in communities like Ferguson must undertake: the development of integrated neighborhood and communities that address conditions that breed poverty. One such condition is the absence of health care, which is why the Medicaid expansion is essential in Missouri. Another is job training and jobs. One promising step in that direction comes from Centene Corp., which will place a claims processing center in Ferguson, a decision that will bring 200 new jobs to a city suffering from double-digit unemployment.  

Long before Centene’s announcement, Beyond Housing’s Krehmeyer talked about how difficult it is for people to have conversations about race. Still, he sees some hope and excitement growing out of the tragedy in Ferguson. Says Krehmeyer: “I hope it doesn’t dissipate.”

Perhaps our biggest challenge will be ensuring that we learn from Ferguson and that civic leaders keep focused on steady improvements. Communities can suffer from attention deficits by their political leaders. Time will tell whether that will be one of Ferguson’s next afflictions.

Photo by Shawn Semmler via Flickr.