Op-Ed | A shade off

by Anthony J. Cortese

Imagine you sit on the admissions committee of a major medical school where only one slot remains available for the 2023 entering class. You must select between two candidates: one Latino, one white—both qualified.

Liam, the white student, is the son of an affluent lawyer. He scored 507 out of a possible 528 points on the MCAT; his GPA is 3.76. The son of a poor immigrant from Mexico, Jesse has the same MCAT score and GPA. Liam graduated from UCLA in four years with a pre-med major and a minor in business. Jesse graduated from Cal Poly San Luis Obispo in five and a half years with a biology major.

Whom do you choose? Do you expand the opportunities for minorities to compensate for previous discrimination?

“Affirmative action is reverse discrimination,” one person opines. “We should select the most qualified person. We should not discriminate against an applicant simply because he’s affluent.”

“I’m disgusted with these social programs that liberals are shoving down our throats,“ remarks another. “The government has no right fiddling in the business of private schools. Liam graduated from one of the nation’s most prestigious universities while Jesse matriculated through an obscure school and took much longer to graduate. ”

“But Jesse has had fewer opportunities than Liam,” another remarks. “Given the same entitlements, he would have scored higher than Liam. I’m sure Jesse took longer to graduate simply because he had to work to help support his family.”

“Since there are fewer minorities in the healthcare field,” someone states, “We must give Jesse this opportunity.”


“It bothered me to hear stereotypes about minorities.”

Someone who had yet to speak finally chimes in, “Let’s use a mile footrace as example: Two runners, one white, one black. The race begins. The white runner dashes out for an early lead. The black runner, as it turns out, has a 20-lb. iron ball attached to a chain around his ankle. He can barely move; yet he perseveres. Someone yells, “That’s not fair!”

“The official unlocks the ball and chain but even so the black runner remains far behind. It’s still not fair even though both runners now are unfettered. Equal treatment is not enough. We must compensate for previous inequality.”

The argument continues, the dialogue full of passion, adamancy and outrage. No consensus emerges.

The “committee members” are actually SMU students role-taking in my “Minority-Dominant Relations” class offered through the Sociology Department and Ethnic Studies program. We examine ethnic groups with unequal power in the US. In order to delve into social inequality, students scrutinize their own assumptions, stereotypes and prejudices.

“It was a tense and painful discussion,” says a Black female. “Some of us carried on our debate after class and into the next day at the student center. Some began to recognize attitudes in themselves that they didn’t know existed. “

“It bothered me to hear stereotypes about minorities,” states a Latino on the football team. “But that’s part of the learning process in this course.”

As students debate, I remain in the background, walking quietly among discussion groups, watching, listening, taking mental notes. I have engaged in such observation all my life, as the son a Mexican American mother whose family is from San Miguel de Alto, Jalisco and a father who had immigrated to the US from Sicily and had never graduated high school.

Democracy is more than majority rule— more than a mama puma, her cub and a white-tailed deer voting on what to have for lunch. It is also the protection of minority rights to prevent dominion of the minority by the majority. Diversity ensures respect for distinctive identities and protects those at greatest risk of being displaced and alienated internally within the US. On September 17, 1787, the Constitution's framers codified minority rights by structuring equality between states in the Senate (and representation of state populations in the House).

Apparently, SCOTUS never seemed to mind that affirmative action for white males has traditionally prevailed in society’s economic, political, military, educational, law enforcement and criminal justice institutions. Legacy admissions continue affirmative action for white males. Large, pervasive and disproportionately high rates of student loan debts perpetuate social stratification.


Diversity is not a zero-sum game. Society suffers when diverse elements are excluded from decision-making processes and leadership positions.

Lack of diversity harms both individual victims of exclusion and society at large. The harm to individuals, especially children, includes damage to psyches (depression, internalized anger, lowered self-esteem). There are also physical harms (high blood pressure, rapid shallow breathing, insomnia). Finally, lowered monetary and social opportunities pressure minorities to recoil from exclusive and discriminatory settings and become guarded and vigilant. If you do not have a seat at the table, you are probably on the menu.

Diversity is not a zero-sum game. Society suffers when diverse elements are excluded from decision-making processes and leadership positions. The most serious harm is at the macro societal level. Societies have used affirmative action for white males to stereotype categories of people as unintelligent, dangerous, or menacing. Such labels have been used to justify slavery, segregation, removal of indigenous people and genocide. Lack of diversity is perhaps most treacherous when its effects are slow-developing, largely unnoticed and toxic like carbon monoxide.

The lack of diversity is dysfunctional; it silences and marginalizes minorities depriving communities of their voices and contributions. The goal of the First Amendment is to energize speech and dialogue. A society without diversity curtails the spirit of the debate of ideas. It reveals to minorities nothing of which they are not already aware. It censors minorities and emboldens the majority with entitlement. Lack of diversity has damaging consequences, conveys exclusive uncertainty for youth, and desensitizes a society with ramifications that can extend from crucial injustice to outright atrocity. If we fail to take affirmative steps, the social unrest and violence proceeding the murder of George Floyd while in police custody will inescapably pale in terms of what lies ahead.


Anthony J. Cortese is Professor Emeritus of Sociology, Dedman College of Humanities and Sciences, SMU, Dallas Texas and sits on the Board of Directors of SMU’s Retired Faculty Association. Cortese has served as Director of Chicano Studies, Colorado State University and Director of Ethnic Studies and Director of Mexican American Studies at SMU.


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Air quaity becoming a growing risk for premature CVD death and disability worldwide

by The American Heart Association

DALLAS — The impact of particulate matter air pollution on death and disability is on the rise worldwide, according to new research published today in the Journal of the American Heart Association, an open access, peer-reviewed journal of the American Heart Association.

Previous research established the association of particulate matter (PM) pollution to CVD death and disability. However, questions remain about the worldwide impact from this type of pollution and how it has been changing over time, the study authors noted.

“We focused on examining the burden globally because particulate matter pollution is a widespread environmental risk factor that affects all populations worldwide, and understanding its impact on cardiovascular health can help guide public health interventions and policy decisions,” said Farshad Farzadfar, M.D., M.P.H., D.Sc., senior author of the study and a professor of medicine in the non-communicable diseases research center of the Endocrinology and Metabolism Research Institute at Tehran University of Medical Sciences in Iran.

The researchers analyzed PM pollution as a risk factor for death and disability using freely available data from 204 countries collected between 1990 and 2019 and detailed in the Global Burden of Disease (GBD) study. Exposure to PM pollution was estimated using a tool from the 2019 update to the GBD study that incorporated information from satellite and ground-level monitoring, computer models of chemicals in the atmosphere and land-use data.

Among the many types of heart disease, the current analysis of cardiovascular disease is restricted to stroke and ischemic heart disease (a lack of blood and oxygen supply to portions of the heart, usually due to plaque build-up in the arteries) because the 2019 GBD study on the global burden of disease attributed to PM pollution only examined these two diagnoses. The Institute for Health Metrics and Evaluation (IHME), which provides the GBD estimates, only reports data for a certain risk factor if there is a large body of evidence about its association with a disease, Farzadfar noted.

“Until now, only the association of PM pollution with ischemic heart disease and stroke has been demonstrated in a large number of studies,” Farzadfar said. “The IHME may include other CVDs in the future. Moreover, ischemic heart disease and stroke contribute to a significant majority of CVDs, and our estimates, despite having limitations, may be used as a good estimate of PM pollution burden on CVDs.”

The investigators analyzed changes over time in years of life lost due to premature death (YLLs), years lived with disability (YLDs) and disability-adjusted life years (DALYs). DALYs is a measure that considers both the loss of life and the impact on quality of life to assess the full impact of a health condition on a population. The cardiovascular disease burden was assessed both overall and with age standardization, which compares health outcomes across a population with a wide range of ages.

The analysis found:

  • The total number of premature deaths and years of cardiovascular disability from cardiovascular diseases attributable to PM air pollution rose from 6.8 million in 1990 to 8.9 million in 2019, a 31% worldwide increase.
  • The increase in overall deaths was unevenly distributed, with a 43% increase among men compared to a 28.2% increase among women.
  • Between 1990 and 2019, there was a 36.7% decrease in age-standardized premature deaths attributed to PM pollution, meaning that while fewer people had died from cardiovascular disease, people are living longer with disability.
  • Regions with higher socioeconomic conditions had the lowest number of lost years of life due to cardiovascular disease attributed to PM pollution, yet also the highest number of years lived with disability. The opposite was true in regions with lower socioeconomic conditions, with more lives lost and fewer years lived with disability.
  • Between 1990 and 2019, changes in the cardiovascular impact of PM pollution differed between men and women. In all measures, increases in disability and death from ambient PM air pollution were higher in men than women, while declines in disability and death from household PM air pollution were lower in women than men.

“The declines in deaths may be considered positive news, as they indicate improvements in health care, air pollution control measures and access to treatment. However, the increase in disability-adjusted life years suggests that although fewer people were dying from cardiovascular disease, more people were living with disability,” Farzadfar said.

The researchers also found that between 1990 and 2019, age-standardized CVD death and disability attributed to outdoor PM pollution rose by 8.1%, while age-standardized cardiovascular death and disability attributed to household PM pollution, which is produced by solid cooking fuels such as coal, charcoal, crop residue, dung and wood, fell by 65.4%.

“The reason for the decrease in the burden of household air pollution from solid fuels might be better access and use of cleaner fuels, such as refined biomass, ethanol, liquefied petroleum gas, solar and electricity. Moreover, structural changes, such as improved cookstoves and built-in stoves, chimney hoods and better ventilation, might be effective in reducing pollution exposure to solid fuels. Finally, the effects of educational and behavioral interventions should be considered,” Farzadfar said. “The shifting pattern from household air pollution due to solid fuels to outdoor, ambient PM pollution has important public policy implications.”

In a 2020 scientific statement and a 2020 policy statement, the American Heart Association details the latest science about air pollution exposure and the individual, industrial and policy measures to reduce the negative impact of poor air quality on cardiovascular health. Reducing exposure to air pollution and reversing the negative impact of poor air quality on cardiovascular health, including heart disease and stroke, is essential to reducing health inequities in Black and Hispanic communities, those that have been historically marginalized and under-resourced, and communities that have the highest levels of exposure to air pollution.

The study has several limitations. Because the assessment of exposure to particulate matter pollution in the study is based on regional estimates, it may not accurately reflect individual exposure. In addition, results from this analysis of the association between particulate matter pollution and cardiovascular outcomes may not be generalizable to other health conditions or other pollutants.


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