University of Maryland Graduate School

I most recently relocated to Baltimore in May 2020 to begin my preventive medicine residency. As part of my program, I took a graduate course in Health Equity and Social Justice (PH 630). The course was an eye-opener, and has sensitized me to the long history of injustice, as well as the legacy of resilience and activism that characterizes this vibrant and complex city. I have gotten greater insight into the economic, social, political and cultural underpinnings of the issues disadvantaged communities in Baltimore face.

I particularly valued the session on the atrocities created by the slave trade, and how blacks remained victims of institutionalized discriminatory policies that perpetuated racial inequality, even after the reforms initiated by the emancipation and civil rights movement. I was horrified to learn about the residential segregation bill that forbade African Americans from moving into better neighborhoods. It was sad to note that even after these laws were reversed and the Fair Housing Act was passed, restrictive and discriminatory lending practices, have kept many blacks in substandard housing for decades. The governmental response by undertaking housing developments projects, and selling at reduced cost have not benefited urban residents living below the poverty line, who still cannot afford these prices. On the contrary, it has led to gentrification, increased property taxes and rents, at the detriment of low income residents. It has also led to the displacement of many disenfranchised families. The housing situation remains deplorable, and it is clear no change can be accomplished by “painting over the dilapidation”, but by changing the underlying problems.  This has strengthened my resolve to combat the upstream factors that plague communities disproportionately burdened by poor health and social ills.

It has been heartbreaking to visit different neighborhoods in Baltimore, and observe the marked gap in life expectancy, which epitomizes the disparity between the socioeconomic classes. Many communities are in close proximity, yet worlds apart, with differential access to quality education, healthy food, safe living conditions etc. As an example, funding for public schools come from property taxes, thus poorer communities have less funding. This translates to lower quality education, and culminates in lower educational attainment, lower paying jobs, and precarious employment. It is my aspiration to attain policy making positions and advocate for equitable investment in public schools and other areas, to break this vicious cycle of poverty.

Learning about the devastation of the Great Baltimore fire and life-threatening conditions which disadvantaged groups could not escape, is deeply rooted in my mind. More than a century later, marginalized populations are still trapped in heart-breaking fires of social injustice. It is my hope to contribute to the extinguishing of this fire, and advocate for inclusiveness and equity.

Baltimore continues to make national headlines for homicide, crime and police violence. I vividly remember the civil unrest in the city following the untimely death of Freddie Gray, after being critically injured from police brutality. Several years later, a cursory look at the local newspapers, shows that the intersectional class of impoverished minority groups continue to experience pernicious stereotyping by the law enforcement, resulting in disproportionate criminalization. This translates into disenfranchisement of this community, as criminal records/incarceration confers an enduring status that results in diminished life chances. This city also has a higher crime rate, which may be attributable to living in neighborhoods with reduced educational and employment opportunities for advancement, resulting in a higher incentive to engage in crime. These reflections point to the great need for advocacy, to promote interventions that will lead to a city where all residents can look to the future with optimism.

Over the years, there have been positive efforts to advocate for equity and I continue to be amazed by the resilience, survival, and struggles for justice. Baltimore NAACP has a legacy of mobilizing urban communities to address the dynamics of implicit and institutionalized oppression. A careful study of successful interventions in the city that achieved transformative change show that it is vital to engage those most directly impacted by injustice, solicit their perspectives and expertise, and build resilient grassroots power. Social justice proponents have spearheaded a drive for an increase in minority participation in city governance, which helps political leaders reflect the community they are representing. Media outlets, such as the Baltimore Afro-American newspaper, have created an increased awareness of racial, gender and economic injustice, that is energizing .  This has shown me the potential of utilizing social media and other forms of media coverage, as an opportunity to address the power dynamics perpetuating disparities. I intend to adopt these strategies as an activist.

In particular, as a physician, it is my aspiration to promote population health, and contribute to the elimination of discrimination in health care, whether based on race, gender, socioeconomic status, ethnicity, religion, gender identity, immigration status or any other category. I hope to emphasize the dire need for ongoing training in cultural competence and quality improvement for health practitioners, as a powerful way to improve health outcomes, as well as rebuild trust underserved populations in Baltimore have in health practitioners.

I have found a key aspect of social justice is contemplation, because it keeps us in tune with our ethical responsibilities. The reflections I have done have been an eye-opener to the heartbreaking injustice some communities live with, and led me to understand that we either actively endorse an oppressive system, passively accept, or actively oppose it.  I am eager to engage actively in making significant contributions to social justice, and this experiential course in Health Equity and Social Justice (PH 630), has helped me redefine my personal mission statement. For me, the first step is in caring and advocacy. What about you?

Dr. Eseosa Fernandes, Preventive medicine resident and Masters student in the Clinical research program at UMB