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|Photo by Slobodan Dimitrov|
Dr. William Cunningham is revolutionizing medicine, and overseeing perhaps the most important medical-research program in Los Angeles. But first he has to get to his car — no small task, considering a rapist described only as an "African-American male" has been prowling the campus. After working late into the night at his UCLA office, Cunningham finds himself scaring every woman he passes. To solve the problem, he puts on his lab coat, and wears it until he gets to his car.
Billy Cunningham is a man who solves many social problems by donning a lab coat.
A medical professor whose specialty is health-services research for people of color, Cunningham is one of only a handful of researchers in the United States who systematically collect data with the goal of eradicating race-based disparities in medical treatment and results. His research, which is renowned among colleagues for being prolific and meticulous, has altered the U.S. government's approach to health care for minorities; he is a grass-roots revolutionary in an establishment lab coat forcing changes on a stagnant system in which inequalities in medical care have become part of the country's institutional fabric.
Policymakers used to believe that if people of color had more money, they would get better medical treatment. But thanks to researchers like Cunningham, we know that's only a small piece of the puzzle. It is not merely poverty or the inability to pay for medical care that results in the inequality. In some studies, upper-middle-class people of color in the United States have been shown to be 37 percent more likely to have poor health than upper-middle-class whites. Vietnamese women of all social strata are five times more likely to die from cervical cancer than white women. The death rate for African-American babies has been double that of white babies for hundreds of years, and the gap is currently increasing. And as new medical issues arise, they fall quickly into old patterns: People of color die much more often than whites from cardiovascular stress, obesity and HIV.
With the largest population of people of color in the United States, Los Angeles is at the center of this country's health-care crisis. One-third of adults in Los Angeles are uninsured — the worst record of any major city in the industrialized world.
In 1999, David Satcher, U.S. surgeon general under President Clinton, announced that the government would no longer accept the widening chasm in medical care between whites and minorities. It was the first time government officially acknowledged that minority health care is a problem. That same year, then-President Bill Clinton funded the 2010 REACH program to systematically collect data from populations of people of color in order to determine root causes of disparity. President Bush, however, promptly killed the funding for REACH once he took office.
At Cunningham's Santa Monica house, I sit in the living room with his Israeli wife, Sharon Vidal, his dog, Riley, and his papers. Everywhere. In piles on the floor, on the sofa, on the countertops, and if I peek around the corner, I see they have, in fact, taken over a whole room. "That was Sharon's idea," Cunningham says. He spent weeks moving his papers into the one room before Vidal moved in. Then, as Vidal tells the story, new papers just started showing up in the living room, kitchen and dining room. Vidal moves some papers from the cushion next to Cunningham and scoots over to him. She says, "Billy works harder and more passionately than anyone I know."
As with most people Cunningham meets, my first reaction to his specialty was, "Why can't we just give people of color more money?"
He says, "A layperson would say that, but that's not the whole story."
I ask for an example.
He says, "You should take my class. Health Services 100."
I imagine showing up in his class. And failing.
"Could you explain it to me now?" I ask.
"I just know," he says. "You have to approach a problem scientifically. There's a ton of data out there, and it points to disparities greater than income."
Cunningham himself has a back problem. While we talk, he stands up and sits down. Shifts. Stands. Sits. Cunningham is a man who cannot stay still.
He continues: "The scientific process makes for slow, steady progress, and eventually the weight of the evidence shines through. Remember the trouble Galileo had when he said the Earth was round?"
Cunningham is part researcher, part heretic. His work is hard to articulate. Because he and his researchers work by isolating and analyzing a single group and one disease at a time (African-Americans with sickle cell anemia; Latinos with heart disease), his work is painstakingly slow and methodical. But the process is essential to achieving parity in medical outcomes.
In his study of Latinos who are hospitalized for HIV, for example, Cunningham "controlled" for socioeconomic factors — that is, he compared Latinos to whites whose lives were similar socially and economically. And still he found that Latinos were twice as likely as whites to die of AIDS after hospitalization. Studies of cardiovascular disease find that the disease affects African-Americans more frequently than whites, even controlling for socioeconomic factors. (Cunningham himself swims regularly to counteract the statistical likelihood that he will have heart trouble.)