High Museum Gets Major Gift of African-American Artworks

Photo

The acquisition includes Thornton Dial’s “Crossing Waters” (2006-2011), which refers the trans-Atlantic slave trade and was the largest painting he ever made. Credit High Museum of Art, Atlanta; Photo: Stephen Pitkin/Pitkin Studio

The High Museum of Art in Atlanta has the largest collection of Thornton Dial works in the world. It’s now about to get bigger, thanks to a major acquisition of artworks courtesy of the Souls Grown Deep Foundation.

A total of 54 works by contemporary African-American artists from the South make up the gift and purchase. Thirteen of those are by Mr. Dial, a self-taught artist who used scavenged materials to depict black struggle in the South. The acquisition includes “Crossing Waters” (2006-11), which refers to the trans-Atlantic slave trade and was the largest painting ever made by Mr. Dial, who died last year.

With the acquisition, the museum will also receive 11 quilts by the women of Gee’s Bend, a remote community in Alabama renowned for its beautiful quilting. In a 2002 review in The New York Times of a Gee’s Bend collection at the Whitney Museum, Michael Kimmelman called them “some of the most miraculous works of modern art America has produced.”

The collection also includes works by Lonnie Holley, Ronald Lockett and Sam Doyle. To showcase the new pieces, the museum will increase the space in its folk and self-taught art galleries by 30 percent, as part of a permanent collection reinstallation planned for 2018.

“We’re thrilled to death. It’s a collection that fits hands in glove with our existing collection,” said Randall Suffolk, the museum’s director. “It deepens the number of works we have in relation to these artists, but also fills in some gaps for us.”

The Souls Grown Deep Foundation was created by the scholar and collector William S. Arnett to raise the profile of art by self-taught African-Americans. The foundation has been donating works to major arts organizations around the country, including the Metropolitan Museum of Art in 2014.

Correction: April 25, 2017

An earlier version of this article about the High Museum of Art in Atlanta’s acquisition of 54 artworks from the Souls Grown Deep Foundation referred imprecisely to the type of acquisition. The works are part of a gift and purchase; they are not simply a gift.

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High Museum Acquires 54 African-American Artworks

Photo

The acquisition includes Thornton Dial’s “Crossing Waters” (2006-2011), which refers the trans-Atlantic slave trade and was the largest painting he ever made. Credit High Museum of Art, Atlanta; Photo: Stephen Pitkin/Pitkin Studio

The High Museum of Art in Atlanta has the largest collection of Thornton Dial works in the world. It’s now about to get bigger, thanks to a major acquisition of artworks courtesy of the Souls Grown Deep Foundation.

A total of 54 works by contemporary African-American artists from the South make up the gift and purchase. Thirteen of those are by Mr. Dial, a self-taught artist who used scavenged materials to depict black struggle in the South. The acquisition includes “Crossing Waters” (2006-11), which refers to the trans-Atlantic slave trade and was the largest painting ever made by Mr. Dial, who died last year.

With the acquisition, the museum will also receive 11 quilts by the women of Gee’s Bend, a remote community in Alabama renowned for its beautiful quilting. In a 2002 review in The New York Times of a Gee’s Bend collection at the Whitney Museum, Michael Kimmelman called them “some of the most miraculous works of modern art America has produced.”

The collection also includes works by Lonnie Holley, Ronald Lockett and Sam Doyle. To showcase the new pieces, the museum will increase the space in its folk and self-taught art galleries by 30 percent, as part of a permanent collection reinstallation planned for 2018.

“We’re thrilled to death. It’s a collection that fits hands in glove with our existing collection,” said Randall Suffolk, the museum’s director. “It deepens the number of works we have in relation to these artists, but also fills in some gaps for us.”

The Souls Grown Deep Foundation was created by the scholar and collector William S. Arnett to raise the profile of art by self-taught African-Americans. The foundation has been donating works to major arts organizations around the country, including the Metropolitan Museum of Art in 2014.

Correction: April 25, 2017

An earlier version of this article about the High Museum of Art in Atlanta’s acquisition of 54 artworks from the Souls Grown Deep Foundation referred imprecisely to the type of acquisition. The works are part of a gift and purchase; they are not simply a gift.

Continue reading the main story RankTribe™ Black Business Directory News – Arts & Entertainment

First Lady of Jazz: Ella Fitzgerald’s 100th anniversary of birth

It all began with her voice. Everyone who heard it was immediately entranced. Her soft, crystal-clear tones would swing through dance halls, gliding up and down the scale.

As a performer, Ella Fitzgerald combined a certain childish naiveté and playfulness with feminine charm. With her unique talent, she first conquered audiences in New York, and later the whole world. One of the greatest jazz singers ever, she remains immortal.

Humble beginnings

It all began quite modestly, in the town of Newport News, Virginia, where Ella Jane Fitzgerald was born on April 25, 1917. Her father left the family shortly after her birth, so Ella’s mother Tempie bought her up alone.

At the time, millions of African-Americans were moving from rural areas to big cities as part of the Great Migration movement. The small Fitzgerald family also moved to New York in the early 1920s, where they settled in the suburb of Yonkers, near Tempie’s sister.

The house was apparently always filled with music. Little Ella soon discovered a passion for pop music, especially by Arthur “The Street Singer” Tracy and the Boswell Sisters.

Ella Fitzgerald (Getty Images)She suffered from stage fright throughout her career

Tempie encouraged Ella’s musical talent with a few piano lessons, despite not having much money available to afford them. However, Ella Fitzgerald never had any formal music education.

The girl next door

The young Ella actually wanted to become a dancer.

In the early 1930s, she and her friends would watch street performers in Harlem. The girls also discovered the most popular Black musicians playing in larger clubs during the weekend. On weekdays, these concert halls, such as the Apollo Theater and the Harlem Opera House, invited amateurs to take the stage. During those amateur nights, musicians, singers and dancers could compete for the favor of the audience and win prize money, along with the hope of being discovered one day.

Ella dreamed of this, too, when she signed up to take part in one of those amateur nights as a dancer. It was quite a risk for the shy girl, as audiences wouldn’t hesitate to boo a performance they didn’t like.

When the curtain rose for her number, she was paralyzed by stage fright. She couldn’t dance, and her knees were like pudding. The audience was growing restless and Ella spontaneously decided to sing a song by the Boswell Sisters. As the orchestra started accompanying her, she became more and more confident and completed the song to the enthusiastic applause of the crowd.

The 16-year-old Ella Fitzgerald had found her destiny.

First steps

From then on, she regularly participated in such amateur nights and began attracting the attention of people in the music industry.

One evening she was offered the chance to sing for the drummer Chick Webb. He needed some convincing at first, because he didn’t want a singer in his band. Yet Webb was so impressed by Ella’s voice that he hired her. He quickly became her mentor; when Ella’s mother suddenly died, he took over the guardianship for the still minor singer.

Webb only progressively introduced his protégé to the music world, as he knew that sudden success could be just as quickly forgotten. At first, he restricted her repertoire to pop songs. In March 1936, Ella demonstrated she was capable of more when she replaced the already successful Billie Holiday to record a ballad with Teddy Wilson. From then on, her mentor agreed to let her sing ballads as well.

Becoming a jazz icon

When Chick Webb died in 1939, Ella Fitzgerald took over the direction of his orchestra for a while. She then started her solo career in 1941. During World War II, she recorded with several musicians, among which the Ink Spots.

Her career only really took off after the war. In 1951, she had the opportunity to record with her great idol Louis Armstrong, and her collaboration with one of the initiators of bebop, Dizzie Gillespie, was extremely successful.

In the 1950s, she found a new mentor and supporter: Norman Granz, the founder of the famous Jazz at the Philharmonic concert series. He became her manager and founded the record label Verve especially for Ella.

CD cover of The Complete Song Books by Ella Fitzgerald (Verve)CD cover of “The Complete Song Books”

That’s where Fitzgerald finally wrote music history by recording through the mid-1960s her Great American Song Books, a series of eight studio albums in which she interpreted the classics of the American musical canon, with songs by Cole Porter, Irving Berlin and the Gershwin brothers, among others. Ella Fitzgerald thereby contributed to intercultural exchange during the Civil Rights era.

A living legend

In the 1970s and 80s, the aging diva’s popularity was a strong as ever and she was showered with awards and honors. Fans also rediscovered her early works through new re-releases.

Health problems, however, imposed longer recovery phases in her otherwise tightly scheduled tours. Still, even a heart bypass surgery in 1986 couldn’t keep her away from the stage for too long: Her fans’ love was like medicine, she once said.

She gave her last concert in New York in 1991, in the city where it all began. On June 15, 1996, Ella Fitzgerald died at the age of 79 in her house in Beverly Hills.

‘It’s still a miracle, and it always will be’

Sylvester McRae has delivered about 10,000 babies, most of them here in Columbus.

As a career OB/GYN physician, he sees life from the very beginning. He recently sat down with Ledger-Enquirer senior reporter Chuck Williams and photographer Robin Trimarchi to talk about it — and a lot of other things.

At 63, he can begin to see retirement. As a doctor, he understands the Affordable Care Act in a way many don’t.

He moved to Columbus in 1985 and has grown found of the city.

Here are excerpts from the interview, edited for length and clarity:

Q: Your last name’s McRae, you grew up in McRae, Ga. What’s going on there?

A: Oh, do I have a history! My people are actually from South Carolina: my grandfather William McRae, who interestingly enough was born approximately 1854, and his wife was born in 1863. So those years, of course, have significance. So …

Q: So your grandparents were born slaves?

A: Absolutely. So, my grandfather was actually a slave, my grandmother was actually a slave. Around the turn of the century they moved to Telfair County. So, when my father left the farm and went to Philadelphia and came back, he and my mom settled in Helena, which is contiguous with McRae, but he had brothers who lived in McRae and when my brothers went to school, even though they were actually from Helena, they got a kick out of being McRae from McRae.

Q: How do you get from there to med school over two generations?

A: Well, somehow, growing up in Helena and McRae, it was always “be the best that you can be and, of course, make an honest living.” Now, my dad was very smart. He made us do manual labor, we’d pick cotton, pick the watermelons, get construction work. He said you need to see what the other side is like should you choose not to get an education. It was not looking down on those but, he said, these are the kinds of work you do.

Q: So, you obviously were a pretty smart guy.

A: I’m all right.

Q: OK. How did you decide on Fort Valley State?

A: That’s interesting. I had an older sister who was actually 17 years older than me — and now she was smart!

Q: Were you the youngest?

A: No, there was one younger than I. There was no genetic counseling about what age you should stop having kids. It was about having kids when the Good Lord saw fit. So, she was 17 years older than me. She went to Fort Valley and she was an educator and ended up getting an educational doctorate before she expired. Then I have an older brother who is now a dentist, who went to college and didn’t have a clue as to what he wanted to do. Initially thought, “Man, perhaps teaching,” and then … we had a good pre-med program, had great advisers at Fort Valley. He and one other young man were the first African-Americans to be accepted to the Medical College of Georgia, Dental School. Yeah, Matthew. Matthew went to dental school, and then …

Q: So, you were seeing higher education modeled, right?

A: Yeah, that’s a good way to put it. Well, whether it was modeled or not, I knew what hard work was like, so I wanted to see what was on the other side. I went there with an idea of, I knew I’m not going to teach, but I knew I didn’t have the patience to teach and I thought perhaps I’ll work in the lab somewhere. The brother who’s three years older— who’s actually smart, a genius — went to med school at the Medical College of Georgia and he just interestingly enough happened to be No. 2 in his class. He was the first to do medicine and I said, “I don’t think I want to work in anybody’s mouth, I’ll do the medicine thing.” And that’s how I got into medicine.

Q: So, your parents raised two dentists, two physicians, and an educator with a doctorate?

A: Yup.

Q: That’s 5 for 5 where I come from.

A: Yep, wish I could do as well.

Q: I mean, in two generations that is a phenomenal change.

A: Absolutely.

Q: Is it something you think about sometimes?

A: We do, and the interesting thing is there’s a book written by Dr. Russell Mootry called “Diamonds.” In that little town, in that little area that was challenged economically, there’s probably, let’s see … six or eight doctors, and maybe five to seven dentists that came out of that environment. Russell Mootry realized that this is exceptional and actually wrote a book that basically highlighted the accomplishments of these poor kids from this challenged background.

Q: Sounds like the dirt was good there.

A: The dirt was good. And the teachers were your foster parents. They made sure you stayed on track.

Q: As somebody who delivers babies for a living, how do you describe the wonder of life?

A: Well, it’s still a miracle. Now, the tort systems and the courts have tainted it, but it’s still a miracle every time one comes, and sometimes we make a difference — you know, we stick a hand in and help in some way, form or fashion — but it’s still a miracle, and it always will be.

Q: What do you think when you hear that first cry?

A: Again, I mean … in a quiet moment, you realize that you are allowed to participate in something special.

Q: Obviously it’s more than participating. In a good situation, everything’s normal, but things can get out of line in a hurry, right?

A: That’s why we’re trained, and that’s why we try to deliver in a controlled environment for those rare times when it doesn’t. You know, usually we are able to intervene and make a difference, and that’s what the training is about, and that’s why we’re here.

Q: When you started, where it was essentially you and a nurse and maybe the father in there, now there’s birth photographers — I mean, it’s all changed, hasn’t it?

A: It has changed.

Q: For the better or worse?

A: It’s good. It’s good, yeah. The dads need to be there, the family needs to be there. But, I mean, you don’t need to have half the town, you know — so many folk you need bleachers.

Q: You are 63. Can start to see the end of your career now?

A: Absolutely.

Q: How much longer can you deliver babies?

A: As long as I feel good. You know, I just had my knees replaced in November, I took eight weeks off. I call it my maternity leave. … As long as the work environment is good and the Good Lord is giving me the strength and ability, you know, I might not deliver 30 babies a month but I might do five or 10.

Q: So how many are you doing now?

A: Probably, I’d say … 12 or 15.

Q: How many kids have you delivered over the years?

A: Oh, over 10,000. I started delivering babies in my junior year which would have been around ’77, so ’77 to 2017, that’s about 40. …

Q: Do you consider it a privilege to be able to be in on the most intimate part of somebody’s life?

A: Absolutely, yeah. But this is, I think, what I was put here to do. In time of frustration I would joke and tell my buddies, “You know, I would have made a great forest ranger.” I love the outdoors, I love the animals, and here I am. I think, this is my calling.

Q: Let me ask you about St. Francis. The hospital obviously went through tremendous financial issues, ended up being sold. How difficult was it going through what St. Francis went through when the financial situation reached what it did?

A: It was difficult, and it sounds mushy, but I feel probably more for the folks who dedicated their lives, the families here, that … this place means so much to them.

Q: The philanthropic side, right?

A: Yeah, yeah, I really have been impressed. They’ve given it their all — I mean, their time, their money. They love this place. They love it. Now, I hate it for them, that even though they are still involved, that bond, that brand … and LifePoint (Health) was great in coming to rescue the institution, but those folks … long before I came here, this was their baby. And I admire that.

Q: This was a community asset, owned by the community.

A: Absolutely.

Q: How has that changed in the last year-and-a-half with LifePoint in here?

A: There are services that were once the highlight of St. Francis. … The cardiovascular-thoracic program, I mean, it’s probably second-to-none, so that has had to undergo some retooling. You know, some of the guys just got older and just didn’t feel like doing the intense operations anymore, and there were people who came, and when things started to change, they left. So the cardiothoracic program, which was kind of like a branding for this hospital, is getting back up to where it needs to be, but there was a time when it really suffered.

Q: Is the short-term pain of what happened over?

A: There are still challenges, even with LifePoint being in place, and for the financial resources that is poured into it, there are still challenges. In today’s economic situation, it is difficult for hospitals to break even, let alone generate income, so you have to look at every service, and it’s recognized that some services will never make money, you just try to control how much they lose. There are other services that you hope will do well enough that will offset the losses from our other services, but it’s a slippery slope.

Q: Where’s obstetrics fall in that matrix?

A: Now, typically obstetrics, with young people short-staying in the hospital, typically obstetrics is a money-maker, for lack of better terms.

Q: How has medicine changed since 1985, in the 40 years you’ve been doing it?

A: Oh man, by leaps and bounds. When I was in training, one of the things that gynecologists were starting to do was something called laparoscopy, where they would, under general anesthesia, put a tube in a lady’s abdomen and look around to try to determine what the abnormality might be. If women had surgery, if they didn’t have vaginal surgery, most of it was done open. Tubal ligations would stay in the hospital. I remember one of my attendants, who was an excellent surgeon, he said, “You might have damaged a bowel and didn’t recognize it, so you have to keep them overnight.” Now my hysterectomies go home on the same day.

Q: That was unheard of 30 years ago, right?

A: Yep. So, most of the surgery that we do, the majority of what I do — probably 95, 90 percent of them — go home the same day.

Q: Is the doctor still in charge?

A: No. No. The financial entities are in charge. You know that colleague who will probably say, “Why did you stay like that?” But we’re employed. We have a boss. Now, it might not be as stringent as working on some other jobs, and you could try to dress it up and say we are affiliated, or we have an association, but at the end of the day you have a contract, and you have some entity to which you have some … I still applaud the guys who are in private practice. Up until 2010, I was in private practice, so I know the challenges, and I feel for those guys who are still out there battling. The things that have occurred, sometimes I wonder if it was not done to push us out of private practice. And I don’t mind telling you this, when I was paying my malpractice premium, as a solo practitioner I was paying $66,000 per year. As I am affiliated with St. Francis, my premium went to $16,000 a year. So that’s $50,000, and my question is, “How do you explain it?” Well, it’s because you’re part of a larger group. I said, “I’m still practicing the same medicine, and I’m still doing these complex things; how can you insure me for $50,000 less than when I was in private practice?” Why is it that?

Q: Did you get a good answer to that?

A: Oh, no. As an individual in private practice my supplies cost one thing, where if I’m a part of a big entity, we’re group buying, and I guess if a big enough group got together and went to Winn-Dixie, or Publix, or whatever, you could get discounts. The groups get the discounts. I’m limited as a solo person as to how much input, or how much bartering, for lack of a better term, I could do in terms of contracting with some entity, but as a group, that’s power.

Q: That’s real money.

A: Even for Donald Trump.

Q: You brought it up. You did it to yourself. What do you think about the debate over the Affordable Care Act?

A: Well, I’m going to say some things that you might have to come help guard me. In America, we do well enough that everybody ought to to have access to some type of health care. Now what disturbs people is that not everybody is going to get the same level of care. Some people have difficulty with that, so how do you design a system where, if not everybody, but most folk have access, but you have tiered care? Some people go to work and make $200,000 a year, some make $20,000 a year. So if you’re offering a service, should the person who makes $200,000 a year be limited to what the person that makes $20,000 a year (gets)? So let’s have a basic service, and if you want to go above and beyond, then if that person’s willing to pay, let them pay. I don’t know how you build that into a system. Now, affordable care. … And I say that to say that Obamacare was a step in the right direction. Does it need work? Yes, it needs a lot of work. Do you need to pull it off the table? Probably not. Fix it. You know, you Democrats and Republicans, all y’all do is go up there and fight. Come together and fix this thing, because we got, what, 20 million folks who now have insurance who didn’t have it before.

Q: Are some of those your patients?

A: Some. But the interesting thing, I was in a meeting this past weekend with a physician who said, “I had Obamacare and I had to give it up.” And this was a physician. She said, “My premiums, my co-pays were just going through the roof.” She said, “I couldn’t afford it anymore.” So, let’s insure as many people as possible, but let’s make sure that it really is affordable. So, what needs to happen? They need to stop the bickering and figure out how to fix it. They could do some things to make it work, I think — I think.

Q: What is it about Columbus you really like, and what is it about Columbus that frustrates the heck out of you?

A: Well, I still think of Columbus, you know, metro Columbus is, what 250, 275 (thousand)? Columbus is a big country town, and all the ills that you find in a great metropolitan area we may have to a degree, but nowhere near that magnitude. So when I left Florida, I was looking for a place that had diversification and industry, and there were a significant number of physicians that suggested to me that they might be returning in five or 10 years. And if it was Georgia, you know, start around Columbus. I had no idea what Columbus was like — even in Fort Valley with the way the road system was and limited transportation, I didn’t have a clue until I visited back in, oh, what was that, maybe ’83, ’84. I’d never been to Columbus.

Q: Are you glad you found it?

A: Oh, man, best thing that could have ever happened.

Q: What is it you like about Columbus?

A: I don’t know, it’s a country town. I fish, I hunt. …

Q: So, you’re a country boy?

A: Oh, I’m a country boy. Yeah, yeah, when I moved to Florida, the black guys used to tease me because I had a truck. Within the next week or so they were all wanting to borrow it.

Q: So, I asked you earlier, and I’ll kind of ask you again in a little different way, so you see yourself doing this for a few more years then, huh?

A: Absolutely.

Q: What’s retirement look like for you?

A: When I had my first knee surgery, I was down for about nine days, and I learned something about me. I don’t sit at home well. You know, after a few days I’m only going to read so much, I’m only going to watch so much Netflix, and the same thing, I was out two months this time. I’m not a stay-at-home person, and I can’t see myself gardening. I love golf, I’m going to play golf everyday, and I love fishing. …

Sylvester McRae

Age: 63

Hometown: Helena/McRae, Ga.

Residence: Columbus

Job: Physician, OB/GYN Physician Partners

Education: Telfair County High School, 1971; Fort Valley State University, degree in zoology, 1975; Medical College of Georgia, 1978.

Family: Rose, wife of 40 years; children Sylvester II, Kevin, Joe and Kimberly; one grandchild, Sylvester III.

Legislative complaint seeks to expel Miami lawmaker from Senate over ‘racist rant’

Forced by Florida Senate leaders to show contrition, Miami Republican Sen. Frank Artiles stood on the chamber floor Wednesday morning and told his colleagues he was sorry for using curse words and a racial slur.

“I extend a heartfelt apology to my colleagues and to all those I have offended,” Artiles began, reading from prepared remarks.

It was not enough.

Three hours later, as calls for Artiles’ resignation mounted, Democratic Sen. Perry Thurston of Fort Lauderdale filed a formal complaint on behalf of the Florida Legislative Black Caucus seeking Artiles’ expulsion over his “racist rant.”

“The shadow he has cast over our chamber deserves the most severe punishment available,” Thurston wrote to Republican Sen. Lizbeth Benacquisto of Fort Myers, who heads the Senate Rules Committee charged with dealing with Artiles’ misconduct.

Artiles, already an outcast among many Senate colleagues, immediately lost a Senate chairmanship. He didn’t show up for an afternoon hearing to seek passage of a bill requiring Miami-Dade County to elect a sheriff. Groups in Florida and across the country joined the chorus of demands that he resign, and Miami-Dade Democrats planned to picket his Miami Senate office Thursday.

He was the talk of Tallahassee, but no one rushed to Artiles’ defense.

Punishment could range from a formal reprimand to removal from the Senate. Either would require support from two-thirds of the GOP-controlled body. Wednesday afternoon, the Senate appointed its general counsel, Dawn Roberts, to lead the Artiles investigation and report to Benacquisto by Tuesday. Artiles told Politico Florida he intends to hire an attorney and fight, even if it means deposing black lawmakers.

A check of Senate records indicates that as far back as the 1880s, no senator has ever been expelled. A House member was expelled in 1961 for sending an indecent note to a 12-year-old messenger.

The Senate’s daily session began with Artiles offering a direct apology to Sen. Audrey Gibson, a Jacksonville Democrat he had called a “bitch” and a “girl” in an alcohol-laced tirade two days earlier. He also used the words “fucking asshole,” either referring to Gibson or himself.

“My comments to you were the most regretful of all, because they injured you personally,” Artiles said. “No one deserves to be spoken to like that.”

During the apology, Gibson kept her back turned to Artiles. She did not look at him once.

Artiles also apologized to Thurston, who witnessed Artiles’ exchange with Gibson on Monday night at the members-only Governors Club and tried to get Artiles to reconsider his language before the conversation got out of hand.

gibson 1

Florida Sen. Audrey Gibson of Jacksonville

The Florida Channel

Artiles’ refusal to apologize to Gibson in person Tuesday prompted Senate leaders to get involved. By then, most of Artiles’ remarks to Gibson and Thurston — including deriding Senate President Joe Negron of Stuart as a “pussy” and lamenting that “niggas” in the GOP caucus elected him — had been made public. Both Gibson and Thurston are black.

Artiles said sorry in person late Tuesday only after Negron asked Majority Leader Wilton Simpson of Trilby to ensure an apology took place. A reluctant Artiles was accompanied to ask for forgiveness by incoming Senate President Bill Galvano of Bradenton.

Negron said he later telephoned Artiles and told him he would bring up the incident as the first order of business Wednesday — unless Artiles wanted to say something himself, essentially forcing the Miami senator to request a “point of personal privilege” to address his colleagues.

Wednesday morning, Negron stripped Artiles of his chairmanship of the Senate Communications, Energy and Public Utilities Committee, a symbolic move of little practical consequence, given the late session date.

Negron said Artiles had “accosted” Gibson. But asked if the lawmaker should resign, Negron said that’s between “him and his constituents.”

“I owe you an apology,” Artiles told Negron on the floor, asking forgiveness for the first time for his “crass and juvenile comments.”

“I realize that my position does not allow me for the looseness of words or slang, regardless of how benign my intentions were,” Artiles added.

As for using the n-word, Artiles argued the slur (which referred to Republicans who, in fact, aren’t black) was aimed at “no one in particular.”

His excuse for using it is “inadequate,” the Cuban-American lawmaker conceded, but he gave it anyway:

“I grew up in a diverse community,” he said, referring to his hometown of Hialeah, which is actually not diverse but 95 percent Hispanic. “We share each other’s customs.”

negronjoe_041917_2

Senate President Joe Negron, R-Stuart, speaks with reporters after Miami Republican Sen. Frank Artiles formally apologized on the chamber floor Wednesday for insulting and using a racial slur against two black senators.

Kristen M. Clark kclark@miamiherald.com

Hialeah Republican Sen. René García later issued a statement asking Artiles to apologize to city residents. None of his fellow Republicans publicly demanded his resignation.

“He has to pray about it,” said Miami Rep. Carlos Trujillo. “Talk to his wife. Talk to his children. Talk to his colleagues and talk to his constituency and do whatever is in their best interest.”

To reporters, Artiles blamed his tirade on “frustration” with the slow-moving pace of legislation. Some of his priorities were either stalled or being killed before his outburst.

“If every time a senator made a mistake or someone made a mistake and were to resign, we’d have half the Senate gone,” he said.

He dismissed questions about a possible pattern of aggressive behavior as a sign that his district is competitive in elections.

“The Democrats are looking to target the seat,” he said.

Senate Minority Leader Oscar Braynon scoffed at the suggestion, saying it’d be better politics to leave the “flawed” Artiles in office and attack him during his reelection campaign. Braynon called Artiles an “equal-opportunity offender.”

Artiles, who will turn 44 on Saturday, is an ex-Marine and a licensed public adjuster, appraiser and contractor. He is married with two children.

He served for six years in the House and was elected to the Senate last November in a redrawn district that covers a large part of Southwest Miami-Dade. He defeated former Democratic Sen. Dwight Bullard in the Democratic-leaning 40th District — which, Artiles knows, the GOP is eager to keep.

In 2014, Artiles was secretly recorded at a West Kendall polling place using the word “hajis,” a slur directed at Muslims and Arabs.

Artiles acknowledged Wednesday his style at times turns people off.

“He’s a bully,” said Democratic Rep. Kamia Brown of Ocoee, a freshman lawmaker who made the motion at a black caucus meeting to begin the process of removing Artiles from the Senate.

Two years ago, a college student said Artiles punched him in the face at a bar near the Capitol in Tallahassee. Artiles denied throwing a punch and said: “If I had hit somebody, they’d be in the hospital.”

“As many of you know, this incident is not the first — nor do we believe it will be the last,” Thurston said Wednesday.

Earlier, Gibson told Democratic senators she never intended to talk publicly about Artiles’ remarks, but his tirade was witnessed by enough people that the story hit the press.

“There is a firestorm, and it’s an unfortunate circumstance,” she said. “But words have consequences in no matter what setting you’re in.”

Even the Southern Poverty Law Center weighed in, calling Artiles’ “racist and sexist language unacceptable” and undignified. And though he was visiting the White House, Republican Gov. Rick Scott couldn’t avoid getting wrangled into the controversy Wednesday, though he said it was up to Artiles to determine his political future.

“It’s disgusting what he did. I’m disappointed that he did it,” Scott said of Artiles’ tirade, adding that he’d telephoned Gibson to console her earlier in the day. “Nobody should be called names like that. Nobody should be treated like that.”

In seeking Artiles’ removal, the black caucus followed calls for Artiles’ resignation from the Florida Democratic Party and three leading contenders for the party’s 2018 gubernatorial nomination.

So, will Artiles step down?

“Absolutely not,” a defiant Artiles told reporters.

He pledged instead to file soon for his 2018 reelection — and win.

Herald/Times staff writers Michael Auslen and Mary Ellen Klas contributed to this report. Times Washington Bureau Chief Alex Leary also contributed.

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An Outside-the-Doctor’s-Office Approach to Health Care

(Photo: Skeeze)(Photo: Skeeze)

It’s a perfect day in Pensacola, Florida, and the Blue Angels, based at the nearby air station, are doing their weekly exercises over the Gulf. A drive inland along Palafox Street starts at the upscale town square and passes freshly painted colonials, esthetic surgery clinics, boutiques, and banks. But all this changes at Cervantes Avenue: Suddenly the trappings of wealth disappear, replaced by foreclosure signs, dialysis centers, thrift stores, and check-cashing outlets.

This is still Pensacola, but not the one that snowbirds and tourists see. As Sandra Donaldson, a native of this second Pensacola, explains, “There is an invisible divide between here and there.”

Blocks later, I park in front of a professional brick building, not unlike community clinics that I have worked in during my medical career. Inside, I am surprised to find that Chandra Smiley, executive director for the Escambia Community Clinic network, is working right next to the waiting area busy with coughing patients, beeping toys, and CNN blaring on a wall-mounted TV.

“Being this close to the patients helps me understand what’s really going on,” Smiley says. “I don’t want this to be just another community clinic; I want it to be the community’s clinic.” Her emphasis on the possessive might at first pass seem like an unimportant distinction, but, in fact, it represents radical thinking. Traditionally, safety net clinics like Escambia offer medical services to low-income and underserved patients who access their facilities, but Smiley and her team are trying to expand this role by improving the quality of life in the surrounding community. “Our goal,” Smiley says, “is to help fix things that get us sick in the first place, like substandard housing, unhealthy food, and lack of opportunity.” Escambia, along with four other clinic sites that dot the Gulf Coast, is part of a two-year health care experiment called the Community Centered Health Home (CCHH) demonstration project, which is funded through the Deepwater Horizon Medical Benefits Class Action Settlement, a result of the 2010 BP oil spill off the coast of Louisiana. If it succeeds, this experiment could help redefine the role of community clinics in the United States.

The idea that health care can be an engine for community change is not entirely new. In the mid-1960s, physician Jack Geiger opened clinics in the impoverished rural South, with a mission to go beyond treating patients to address the social determinants of health. Instead of simply recommending better diets, he helped his patients obtain tractors, seeds, and farmland so that they could grow healthful food. While Geiger is credited with starting the first community clinics, his more radical idea to use organized medicine to address the root causes of illness never caught on.

Recently, Geiger’s ideas are getting more attention. The Affordable Care Act, also known as Obamacare, has created a series of mandates and incentives to cut health care costs while expanding health care access and improving quality. Since the United States spends more than twice per capita on health care as countries like Germany, France, and Switzerland but lags far behind in health outcomes, most would agree that these are worthy goals. There is less agreement on how to accomplish them.

Initially, programs promoted by the ACA prioritized expanding insurance coverage and retooling medical services, but it has since become evident these efforts are necessary but not sufficient to change health outcomes for vulnerable communities — hence more outside-the-box approaches such as the one being tested by the Escambia Clinic. If Obamacare in its entirety is repealed, these innovative efforts could also fall by the wayside.

Two days before visiting Pensacola, I met Eric Baumgartner at his office in the Louisiana Public Health Institute in New Orleans. Baumgartner, a pediatrician and public health expert, is directing the Gulf Coast CCHH demonstration project.

Early in his pediatric residency, Baumgartner became frustrated by the fact that much of the illness he was seeing in his young patients was a product of their social situation and their physical surroundings.

“I decided that I wanted to understand interaction between biology and nurturing environment,” he says.

He became an early champion of what is sometimes referred to as the ZIP code effect, a reference to a series of studies showing that one’s address has a far greater impact on health and life expectancy than genetic risk or the quality or accessibility of medical treatment. Baumgartner also contends that individual behaviors, such as diet and exercise patterns, are a product of ZIP code rather than willpower, which may explain why most public health education campaigns have little impact on health outcomes.

I asked Baumgartner to describe what takes place in a Community Centered Health Home.

“It’s more a state of mind than a set of activities,” he says. “And the clinic, which is typically a service delivery organization, has a responsibility to use its position of influence within the community to act as partner in improving the social, environmental, and economic conditions that determine health.” He describes clinic patients of a CCHH as not just representing themselves but being “sentinels for the community in which they reside.”

Later, at C.A. Weis Elementary School in Pensacola’s Pinecrest neighborhood, first-graders stream out the double doors and settle on the brand-new playground structure like a flock of migrating birds. It’s a generic-looking playset, one that could be found in any public school around the country. And yet, as I hear how it came to be, I understand that this plastic-and-metal structure is a catalyst for improving neighborhood health. 

When it comes to almost every health indicator, the Englewood area (ZIP code 32505), where many Escambia clinic patients reside, has been dealt a crummy hand. Within the context of greater Pensacola, this zone has unusually high rates of violent crime, unemployment, housing foreclosures, drug abuse, and preterm births. Recently the Urban Institute gave it a high inequity score, meaning that it is a place where the poorest 10 percent and richest 10 percent of Americans live in extreme proximity. Another report identified Pensacola as one of a few cities (along with Tampa and Knoxville, Tennessee) where the life expectancy gap between the richest and poorest has increased in the past decade. When Chandra Smiley learned that her clinic had been chosen to be a part of the CCHH experiment, she felt more anxious than enthusiastic. How could she and her colleagues possibly make a difference in the face of such daunting socioeconomic problems? She shared her misgivings with Baumgartner during a CCHH orientation meeting, and he gave her a strategy that was simple yet actionable.

“This is our serenity prayer,” Smiley recalls him saying. “You don’t have to solve all the problems. You just have to get involved.”

Smiley got involved.

She and Sandra Donaldson, director of special programs in the clinic, attended neighborhood gatherings, met with civic leaders, and asked community members what they wanted.

“We put on our tennis shoes and we went door to door,” Smiley says. Her team avoided the typical health surveys that focus on disease risk and medical conditions such as asthma or diabetes. Instead they invited residents to discuss all the factors that affected their well-being.

A common concern: the 600 children at C.A. Weis Elementary School.

At that time, Weis was faring no better than its surrounding neighborhood. It had few financial resources, low parent participation, and high principal turnover. During the 2015–16 school year, the state gave Weis an “F” for its student test scores on the Florida Standards Assessment. All the students qualified for free or reduced-price lunch, and many were eligible for a program that sends children home on Fridays with a backpack of food to tide them over for the weekend. According to data collected by the Escambia Clinic, Weis students were more likely to start life in the local neonatal intensive care unit than kids in other ZIP codes, and they missed scheduled medical appointments and visited the local urgent care center at disproportionately high rates.

It is not surprising, then, that Escambia Clinic’s first CCHH partnership was with the Weis School. What may be surprising to outsiders, however, is that their first project was a playground. After all, the standard medical response would be to expand clinic services to at-risk families. But Weis did not have a real playground, nor was there one in the surrounding neighborhood, and this was of paramount concern to everyone.

Smiley acknowledges that there are other projects that might have a more immediate impact on health, but the playground was what the community wanted. “After all,” she adds, “I knew that in the end, everything has to do with health.”

The Escambia Clinic, along with the University of West Florida and The Children’s Home Society, partnered with the school’s newly arrived principal, Holly Magee, and a handful of volunteers to apply for a grant from the local chapter of Impact 100, a women’s charity where members pool their money for a worthy cause.

Weis mom Ashley Parish, who had never spoken publicly, stood up in front of an audience of 400 funders and said: “My kids stay inside. We have no safe place to play.”

Impact 100 awarded them $106,000 to build the playground.

Then something happened that Smiley had not anticipated: Even before the ribbon-cutting ceremony a year ago, the playground triggered a series of events.

“We showed we cared, and it was like all the doors suddenly opened, and everyone was asking us how they could partner with us,” Parish recalls.

The school district offered to maintain the playground. The Children’s Home Society asked Smiley to staff a clinic at the school so that children could easily access medical services. The managers of Oakwood Terrace, a federally subsidized housing project and home to many Weis families, partnered with Escambia Clinic on a series of wellness initiatives to improve living conditions, offer job training, and address issues of food insecurity. Escambia is also in the process of becoming a residency site for obstetrics, internal medicine, and pediatrics, which will expose doctors-in-training to the CCHH model. Finally, as the ultimate recognition of its value, the clinic received more than $8 million, from both federal funds and local investment, to build a new clinic as well as a community center, teaching center, and garden in what is now an abandoned elementary school.

Within Weis big changes have begun to take place, and Principal Magee attributes much of it to the clinic’s involvement. She says that when she arrived, there was a sense of hopelessness but now there is a will to succeed. Parents and neighbors are more involved, teachers want to stay, and all of last year’s first-graders passed the standardized benchmark test. Magee has completed her second school year at Weis and has no plans to move on.

“All this,” says Smiley after listing off the changes happening around her, “is what I would call a Community Centered Health Home.” She pauses.

“Even if I had to pay cash for that playground, it would have been worth it. After all, look at all that it has given us.”

***

Some 200 miles away, in a baking-hot parking lot in New Orleans, Rosamar Torres opens the side of her mobile vegetable market to display bins of carrots, snap peas, strawberries, and peppers. The market, funded and operated by a nonprofit called Sankofa, makes the rounds of the city and accepts farmers market coupons and cards from nutrition assistance programs such as WIC and SNAP. Seemingly from nowhere, customers, mainly elderly and African American, begin to appear with shopping bags in hand. Soon the truck is mobbed.

Standing nearby are Chenita Le Blanc and Stephenie Marshall, who are spearheading the CCHH project at the Daughters of Charity (DOC) Clinic in New Orleans’ Gentilly neighborhood. Back in the day, Marshall says, when people heard you were from Gentilly they thought you were fancy. That ended with the economic downturn of the 1980s. “My neighborhood began to have the same problems as anywhere,” she said, listing crime, unemployment, and high rates of chronic disease.

When Hurricane Katrina hit more than a decade ago, Gentilly, located next to Lake Pontchartrain, was underwater. The facade of almost every house in the neighborhood is still emblazoned with the iconic Katrina “X code,” a spray-painted marking left by first responders to record the level of destruction and the number of people found alive or dead in that home.

Similar to what is taking place in Pensacola, the CCHH experiment has allowed the DOC clinic to become a key player in improving health conditions in the community. Their partnership with the Sankofa mobile market is a good example.

Initially Sankofa’s vegetables were going to waste because no one knew about the mobile market, but DOC solved this by referring patients to Sankofa and handing out coupons.

“They wanted customers, and we had customers,” said Marshall. “And we wanted free [food] for our patients, and they had free.”

The DOC clinic has piggybacked on the efforts of other community organizations — most notably Dillard University — to address issues as diverse as job retraining, fair wages, blocking predatory businesses, and building parks and exercise paths.

Le Blanc and Marshall feel that their clinic for the first time is actively preventing disease. Patients and community now view them more favorably, and medical providers are more interested in being a part of their organization. (The Louisiana Public Health Institute is in the process of studying these outcomes and will publish the data at the end of the two-year period.)

Despite the enthusiasm, everyone I spoke with at LPHI and in the clinics seemed uncertain about how to finance the CCHH model once the funds for the two-year experiment run out.

“We don’t want to start programs we can’t continue in this community. We have 180 years of doing good work,” Michael Griffin, the CEO of Daughters of Charity, says. He points to the ACA’s Community Benefits program, which requires nonprofit hospitals to spend a percentage of their proceeds on the surrounding community, as a possible source of funding. But with Obamacare now in jeopardy, it is unclear whether this funding source will continue. No insurance, public or private, he adds, has agreed to pay doctors and clinics to keep a community healthy.

Insurers are set up to reimburse for discrete services such as a lab test, a surgery, or a clinic visit. The CCHH model is a complex set of partnerships and activities rather than one defined service and therefore hard to bundle under a single billing code. How does a clinic bill for helping to create jobs, playgrounds, community gardens, or walkable streets? The dollars and lives saved by this new approach might not be measureable for decades and, even then, it will be hard to prove what actually made the difference.

But talk to the researchers, administrators, doctors, and community members affiliated with the Gulf States CCHH project, and they will argue that this approach is critical to curb runaway health care expenditures while improving health outcomes for communities like Englewood and Gentilly. Smiley, Baumgartner, Griffin, and others made it clear that health care must impact conditions outside clinic walls in order to close the survival gap between the richest and poorest.

“Business as usual has not worked for us,” Smiley says. “We have to do this work and take a leap of faith because the return will come.”

Perhaps no one was able to describe this potential return more clearly than Ashley Parish, the parent volunteer at Weis who helped Smiley make the funding pitch for the playground structure.

“It’s important for health care to get involved in all kinds of things,” she says. “We want our children to be happy because when you are sad, you get sick, and your blood pressure goes up, and you get diabetes. One day these babies are going to be adults, and they are going to say, We had that playground.”

Why Do Black Americans Have Such High Rates of Alzheimer’s?

Michelle Agaston, 63, of Pittsburg, knows all too well how quickly things can change when an elderly parent develops Alzheimer’s disease.

“We started noticing little things,” Agaston says. Her mother was diagnosed at the age of 72, twelve years ago, which instantly put her family on the journey of learning about the disease and caregiving. Her mother passed away in October of 2016.

Agaston was also a caregiver for her uncle, her mother’s brother, during the same time period she and her siblings were caring for her mother. Alzheimer’s seems to run in the family — her grandfather also died from the disease.

Alzheimer’s continues to take a toll on more African-American families every day.

Her family is not alone. According to the Alzheimer’s Foundation, there are over 5.4 million people currently living with the disease. And African-Americans have the highest rates of Alzheimer’s of any racial or ethnic group. They are also two times as likely to develop late onset Alzheimer’s, like Michelle’s mother, and her uncle—more than their white counterparts. But is it genetic?

Image: A patient is monitored in an examination room inside the Clinical Decision Unit (CDU) at Kaiser Permanente's Capitol Hill Medical Center in Washington, DC. Image: A patient is monitored in an examination room inside the Clinical Decision Unit (CDU) at Kaiser Permanente's Capitol Hill Medical Center in Washington, DC.

A patient is monitored in an examination room inside the Clinical Decision Unit (CDU) at Kaiser Permanente’s Capitol Hill Medical Center in Washington, DC. Brooks Kraft / Corbis via Getty Images

A study from researchers at the Mayo Clinic, published in the February issue of the Journal of Alzheimer’s Disease, may show some insights into the genetics of the disease in Black Americans who develop the disease after age 65.

The study’s senior investigator, Dr. Nilufer Ertekin-Taner, M.D., Ph.D., a neurogeneticist and neurologist at Mayo Clinic’s Florida campus says that while the reasons for these high rates of Alzheimer’s in the Black community remains unknown, there could be multiple reasons. She cites “higher vascular risk factors such as hypertension, diabetes, high cholesterol, as well as differences in genetics and/or differences in socioeconomic factors.”

“It is likely that the reason is some combination of these factors, all of which require further exploration,” Dr. Ertekin-Taner adds.

Alzheimer’s is the sixth leading cause of death in the United States, but for older African-Americans it is the fourth leading cause of death. And currently there is no cure, or no real slow down in the progression of the disease. One of the challenges has been a lack of research on African-Americans.

Related: Verlando Brown Wants to Keep Black America Healthy

While the study points to more clues as to what causes the disease in African-Americans, Dr. Ertenkin-Taner says, “it is not conclusive and there needs to be more research and other studies to establish a definite risk mutation.”

But before you run out to get genetic testing for yourself and your family members, Dr. Ertenkin-Tanner suggests that unless there is strong family history of early-Alzheimer’s disease in multiple generations, “we do not advocate genetic testing for the known early-onset familial Alzheimer’s genes.”

Also, according to Dr. Ertenkin-Taner, findings from such genetic screens are unlikely to change the management of patients or the prognosis. “This situation will likely change when we have more targeted therapies for Alzheimer’s disease,” she says.

Age is a key risk factor in all racial and ethnic groups. More than ten percent of all persons over the age of 65 and nearly half of people over the age of 85 have Alzheimer’s. The number of African-Americans over 65 will reach 6.9 million by 2030. The number of African-Americans over the age of 85 will increase to 638,000 in 2030, and will reach 1.6 million in 2050.

Dr. Ertekin-Taner adds that “despite being the largest published study of this type in this population to our knowledge, this study is still much smaller than similar ones being conducted in Caucasians.”

High Economic and Emotional Costs

The economic impact of Alzheimer’s not only places a burden on families like Agaston’s, but also on the troubled health care system, as well. It is estimated that the cost of care for an individual patient runs somewhere around $20,000 per year. It doesn’t begin to capture the lost wages of caregivers. And the annual costs related to the disease currently run somewhere around $200 billion for patients in the U.S.

Agaston was fortunate enough to be able to manage the financial cost of care. But she says the constant juggling and the emotional toll of seeing her mother and uncle slip away can’t be measured.

“There is no question that it was so hard,” she says. “But I am so glad I could care for them.”

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Too Many Black Women Die From Breast Cancer. Why?

Breast cancer is not color-blind. Although it strikes women (and less commonly, men) of every age and race, black women are more likely than white women to die of breast cancer. Why?

Researchers have been aware of the disparity for decades, but it has resisted easy explanation. And today, the stakes are higher than ever. That’s because breast cancer rates in black women are rising, even as they are dropping for white women. White women were about 15 percent more likely to be diagnosed with breast cancer than black women 15 years ago, probably because they were more likely to be screened, typically had children later, and took more postmenopausal hormone supplements, which feed the types of breast cancer more common in white women. Now, as many women have chosen to cut out those postmenopausal hormones, the lines have converged, with women of both races equally likely to develop the disease. But on average, black women are diagnosed at a younger age (median age is 58 for black women, 62 for white women) and die at a younger age than white women (median age is 62 for black women, 69 for white women).

Illustration of an African-American woman with pieces of her body floating away

Researchers at BU’s Slone Epidemiology Center are building on a two-decade legacy of black women’s health research to understand the breast cancer survival disparity. With support from the National Cancer Institute, they are combining expertise in genetics, biology, and epidemiology and the social factors that influence health to search for answers that will illuminate how breast cancer takes hold and proliferates in the body—and how we might be able to prevent and treat it more effectively, not just in black women, but in everyone.

“Black women have a 42 percent higher rate of death from breast cancer than white women or most other groups in the United States, and we don’t know the reasons for that,” says Julie Palmer (SPH’85), a School of Public Health professor of epidemiology and Slone Center associate director. “What we do know is that it can’t be attributed to poor care or coming to diagnosis later. There’s clearly something going on that’s different.”

A letter in the mail

In 1995, a woman named Vi Brown got a letter in the mail. “Dear Friend,” it began, “We are delighted to inform you that the US National Institutes of Health has recently provided funds for the largest ever long-term study of the health of African-American women. There has been little previous research, and this study will provide much-needed information on causes of illness.” On the left was the seal of the Boston University School of Medicine, on the right, the shield of Howard University College of Medicine, and between them, in bold, double-underlined type, the name of the new project: The Black Women’s Health Study (BWHS).

Folded inside the letter was a 14-page survey dense with questions about the recipient’s medical history (Had she every been diagnosed with cancer? Heart disease?), her life story (Did she have any children? If so, had she breastfed them?), and lifestyle (Did she smoke? Drink? Eat vegetables?). The letter went out to more than 100,000 women, and Brown was among the 59,000 women who returned it.

Julie Palmer, Professor of Epidemiology at the Boston University School of Public Health and Associate Director of the Slone Epidemiology Center

Julie Palmer, an SPH professor of epidemiology and associate director of the Slone Epidemiology Center, is a leader of the Black Women’s Health Study.

Then in her mid-30s, she had actually read about the study in Essence magazine. “I never knew back then that they had not done a comprehensive health study on African-American women,” she says. “I thought, well, gee, why not?” Brown, who now works as a business and engineering consultant and owns her own company, reached out to the organizers, and the letter arrived shortly after.

When she volunteered, she had never had any serious health problems. But just two years later, she was diagnosed with early stage breast cancer. She is now celebrating nearly 20 years of being cancer-free, and is encouraged by the move toward personalized medicine informed by a patient’s gender, race, and background. “The more we know, the more specific we can be in making sure the person is getting the right treatment,” Brown says.

Today, the study, the nation’s largest and longest running examination of black women’s health, is still going, led by Palmer, Slone Center senior epidemiologist Lynn Rosenberg (GRS’65), an SPH professor of epidemiology, and Lucile Adams-Campbell of Georgetown University’s Lombardi Comprehensive Cancer Center. It has far outlived its original five-year commission, and researchers keep up with their volunteers via new surveys that go out every two years. The BWHS has also teamed up with three other such projects under the umbrella of the AMBER Consortium (African American Breast Cancer Epidemiology and Risk), which is supported by a grant from the National Cancer Institute. Combined, the projects include some 5,000 African American women with breast cancer, plus 10,000 healthy control volunteers, giving researchers more possibilities of revealing potentially subtle effects influencing black women’s risk of getting, and prospect of surviving, breast cancer.

Doctors once thought that all breast cancers were the same. We now know that breast cancer is actually a multiplicity of diseases, manifesting in different tumor types that are driven by diverse genetic defects. These varied breast cancers can be roughly divided into two classes: estrogen receptor positive (ER-positive) breast cancers, which feed on estrogen and can be knocked down by antiestrogen therapies like tamoxifen, and ER-negative tumors, which don’t respond to estrogen. (ER-negative cancers include a rarer class of tumors called triple-negative cancers, which lack receptors for progesterone and the HER2 protein as well as estrogen.) Women diagnosed with ER-negative breast cancer, treated with the blunt weapons of chemotherapy and radiation, are less likely to survive than those with ER-positive tumors.

For reasons scientists are still trying to understand, black women are more likely than women of other races to be diagnosed with difficult-to-treat ER-negative breast cancer. “There’s a big difference in the prevalence of those types of tumors in black women and white women with breast cancer,” says Palmer. “In black women, the cancer is twice as likely to be ER-negative than in all other groups.” This partly explains the survival disparity, but it raises another question: why are black women more likely to be diagnosed with ER-negative cancer in the first place?

No just “black” or just “white”

Slone epidemiologist Edward Ruiz-Narváez, an SPH associate professor of epidemiology, is using genetic data collected by the BWHS and other studies within the AMBER Consortium to search for genetic changes that could help explain the difference.

“We’re interested to know what parts of the genome are conferring higher risk,” says Ruiz-Narváez. Although whole-genome sequencing gets lots of media attention, it remains expensive and time-consuming, so Ruiz-Narváez turns to shrewd shortcuts that can point to areas of the genome that may hold answers.

One of those shortcuts exploits the fact that no one is really just “black” or just “white.”

“We are humans; we are a mix of different populations,” he says. Using a technique called admixture mapping, he identifies areas of the genome that have relatively more or less African ancestry. He then compares that ancestry map with breast cancer risk. His target: parts of the genome that tip toward both African ancestry and heightened breast cancer risk. These areas might contain genetic variations that are responsible for cancer types that are more frequent in black women.

“We are screening the whole genome,” says Ruiz-Narváez. “We are not making any a priori hypothesis about where in that genome are variants affecting risk of breast cancer.”

Ruiz-Narváez’s admixture mapping work has already uncovered two such regions. When he and his colleagues examined one of those regions letter-by-letter, they found a one-letter change that seems to increase breast cancer risk by almost 50 percent and is 14 times more common in people with African ancestry than in those with European roots. The research was published in the journal Frontiers in Genetics in September 2016.

One advantage of ancestry mapping is that it is an agnostic approach. “We are screening the whole genome,” says Ruiz-Narváez. “We are not making any a priori hypothesis about where in that genome are variants affecting risk of breast cancer.”

But the opposite approach—taking what’s known about cancer biology and using it to take an educated look at particular parts of the genome—is also paying off. Last year, Ruiz-Narváez, Palmer, and a team of colleagues examined 26 genes that work together to transmit signals from a cell’s outer membrane to breast cancer–related genes in its nucleus. The trail led them to gene called FGF1 and a single letter change found only in people with African ancestry that seems to dramatically hike the risk of getting ER-negative breast cancer. This finding, published in Breast Cancer Research and Treatment in 2016, is a tantalizing start, Ruiz-Narváez says, but will need to be replicated before he and his colleagues are confident that the mutation is as important as it looks.

Genetic differences may partly explain why black women with breast cancer are more likely to die than women of other races, but they are not the whole answer. “Genes don’t act in a vacuum,” says Ruiz-Narváez. The environment changes the way genes are expressed—meaning that genetic destiny is sometimes open to revision.

Researchers are tapping the BWHS data to uncover which environmental factors might be most potent at tipping the breast cancer odds. Last year, a team led by Slone epidemiologist Kimberly Bertrand (SPH’05), MED’s Dahod Breast Cancer Assistant Professor of Medicine, found that carrying extra fat around the middle, getting pregnant for the first time later in life, having more children, and forgoing breastfeeding were all linked with a higher risk of getting ER-negative breast cancer before age 45. Those cancers tend to be particularly aggressive, hit younger women, and are less likely to be found on routine mammograms, which are typically done only after age 40.

Boston University Slone Epidemiology Center researchers, Traci Bethea, Edward Ruiz-Narváez, and Kimberly Bertrand

Slone epidemiologists Traci Bethea (SPH’11) (from left), Edward Ruiz-Narváez, and Kimberly Bertrand (SPH’05) are studying why black women are more likely than white women to die of breast cancer.

Bertrand is especially interested in how breastfeeding may reduce the risk of getting this type of cancer. She says that breastfeeding may be an especially powerful barrier against ER-negative cancers: in the study, younger women who had breastfed even a little were about 40 percent less likely to be diagnosed with ER-negative cancer than women who had never breastfed. But black women are less likely to breastfeed than women of other races, notes Bertrand, and this may be because black women have different cultural attitudes toward breastfeeding and may have less access to the support they need to make breastfeeding work.

“They may be more likely to work lower-income jobs, where they don’t have a maternity leave, and they may not have workplace policies that support breastfeeding,” she says. Health care workers may also assume that new mothers who are African-American are less likely to breastfeed, and so offer them less encouragement postpartum: fewer visits from a lactation consultant, for instance, and more baby bottles and cans of formula.

But Bertrand sees the news as encouraging. “I think it points to potentially modifiable risk factors for breast cancer in black women. Breastfeeding, adiposity: these are things that, in theory, can be changed,” she says, even as she acknowledges that making those changes is not easy.

Not every risk factor is changeable. The strongest predictors of getting breast cancer are sex and age, after all. But Bertrand is also studying a third factor, called breast density (the ratio of fibrous and glandular tissue in the breast relative to fat in the breast), that could help women better understand their risk of getting breast cancer. “Women who have very high breast density have four to six times the risk of breast cancer compared to women with primarily fatty breasts,” she says. But those figures come from studies of white women, and not much is known about how they translate to black women. Using digital mammograms from women in the BWHS, she is looking to see if the relationship between breast density and cancer risk extends to black women.

Bertrand hopes that her work will help inform better risk assessment for black women. Risk assessment isn’t just fortune-telling: it can help women make informed choices about when to be screened and qualify them for studies of experimental treatments that are open only to high-risk women. But today’s standard risk models are based on data from white women, and they fall down when applied to black women—possibly because the cancer subtypes that are frequent in black women are less common in white patients.

Difference between surviving and thriving

The neighborhood a person lives in, the kind of work she does, and her ability to make ends meet all affect her cancer risk, diagnosis, and outcome, as well, points out Slone epidemiologist Traci Bethea (SPH’11), a MED assistant professor of medicine. A person who has to travel miles by bus to reach the nearest grocery store may not be able to follow her doctor’s advice to fill her plate with leafy greens. A breast cancer patient choosing between paying for her apartment and paying for her prescriptions may forgo critical medicine. “These are complicated issues that can’t be solved solely in the clinical space,” Bethea says.

Affluence doesn’t necessarily buy good health, though. Combining data from the BWHS with neighborhood information from the US Census and the American Community Survey, Bethea, along with Palmer, Rosenberg, and Slone epidemiologist Yvette Cozier (SPH’94,’04), an SPH assistant professor of epidemiology, have uncovered a far more complicated picture, one that says where you live may be more important than what you earn. “For the BWHS we have a wide variability in education and also income,” says Bethea, which is uncommon among studies of black women’s health. “We have crossover: women of low socioeconomic status in neighborhoods of high socioeconomic status,” and vice versa. “Looking at the overlaps and contradictions is really important.”

“If we learn more about prevention, about behaviors, about survivorship, and giving people the tools to live healthier, and happier,” Bethea says, “we believe that will make a return not just for one person and her family but for the entire population.”

The result: when it comes to health, your neighbors’ income, employment, and education levels may be more important than your own. Their findings, published online in Ethnicity & Disease in April 2016, “suggest you can’t really earn your way out of where you’re living,” says Bethea. Black Americans “are more likely to live in disadvantaged neighborhoods regardless of their educational attainment or income,” she and her coauthors write, so understanding the connections between residential community and health is a key part of addressing health disparities.

More than 1,800 of the original 59,000 BWHS volunteers have been diagnosed with breast cancer since the study began in 1995. Bethea is particularly interested in what happens after that diagnosis: the factors that make the difference between living well with cancer and struggling to carry the physical, spiritual, and financial weight of the disease. In the coming years, she hopes to use the BWHS data to develop advice that will help breast cancer survivors live longer and healthier lives and reduce the odds of having their cancer recur.

Last year, Palmer and a team of researchers that includes Bethea and Bertrand took their first “after breast cancer” look at the BWHS data. They found a strong link between breast cancer mortality and type 2 diabetes, which also takes a disproportionate toll on black women. (African Americans are almost 75 percent more likely than non-Hispanic whites to have diabetes.) Women who had been diagnosed with diabetes at least five years prior to their breast cancer diagnosis were almost twice as likely to die of the breast cancer.

“Diabetes causes inflammation, and it has metabolic effects that could help tumors grow,” Palmer says. Although the exact biological connections are not yet clearly mapped, the researchers think that high rates of type 2 diabetes in black women could be a key factor in the breast cancer survival gap—meaning that preventing and managing diabetes could help save lives not just from diabetes, but from breast cancer, too.

“If we learn more about prevention, about behaviors, about survivorship, and giving people the tools to live healthier, and happier,” Bethea says, “we believe that will make a return not just for one person and her family, but for the entire population.”

Kate Becker can be reached at kate@spacecrafty.com.

Black men descend on the Capitol to push for big ‘yes’ vote on Lynch

10 middle schools compete in African American History Challenge Bowl

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What did Tahaka call himself?
Who was the leader of the Confederate Army?
Slaves were promised freedom if they fought for England in what proclamation?

Students from around Madison will try to answer these questions and more at the 100 Black Men of Madison’s 20th annual African American History Challenge Bowl that will be held Saturday in the McDaniel Auditorium of the Madison Metropolitan School District’s Doyle Administration Building.

The African American History Challenge Bowl is a contest for middle school students in a quiz show format where students are quizzed on questions from a prominent African American history book. The students represent their schools and compete for a chance to represent the Madison chapter at the national conference in Florida in June. Members from The 100 Black Men of Madison act as liaisons to each of the competing schools to ensure that the students understand the format and to be a source of support.

Longtime 100 Black Men of Madison member Enis Ragland has been involved with the Challenge Bowl since its inception 20 years ago. “I’ve been coordinating the History Challenge Bowl for 18 of those years,” Ragland told Madison365. “The event has evolved a little bit over the years. The rules of the organization are set by the 100 Black Men of America and so that hasn’t changed a lot. The book has changed a couple of times but other than that the format for how it operates has been the same.”

The 100 Black Men of Madison, Inc. was established in 1994 as a nonprofit civic organization with the mission to make a positive difference in the lives of area youth through mentoring, education, health and wellness and economic development programs. The 100 Black Men of Madison are affiliated with the 100 Black Men of America, Inc. The overall concept of “100” began in New York in 1963, when a group of concerned African American men began meeting to explore ways of improving conditions in their community. The group eventually adopted the name “100 Black Men Inc.” as a sign of solidarity.

Students study for months in preparation for the African American Challenge Bowl, which is really important because there are so many things about African American history that aren’t covered in the regular curriculum at schools.

“That’s one of the exciting and thrilling things about this competition is the knowledge that these kids soak in and bring to the competition,” Ragland said. “This is knowledge that they also use in school in their social studies or history classes. Many times, these kids will add to what the teachers are proposing or their lesson plans the knowledge they’ve learned getting ready for the Challenge Bowls.

“And, I’ve heard at times, they’ve even corrected the teachers on their historical facts,” adds Ragland, with a smile. “That’s always a good thing.”

Ragland said that he is loves to see young people excited about competing and learning.

“Even though the challenge is open to all students, it’s good to have our students of color competing at an academic level,” Ragland said. “We always learn to compete through sports, but rarely – unless it’s a spelling bee or something – do we compete academically. I think this is a great opportunity for all young people, but particularly young people of color.”

And how much African American history has Ragland soaked in over his 20 years being involved with the History Bowl Challenge?

“I know the book by heart,” Ragland said. “Over the years I’ve written questions for the challenge bowl, and, of course, I’ve been the emcee for a number of years. I was a history major, anyways, and I love history, so the History Challenge Bowl is something very near and dear to me.”

There will be 10 middle schools competing this year to win the coveted Michael McKinney trophy named after the former NBC-15 anchorperson, community activist, and longtime member of the 100 Black Men of Madison.

“Mike was one our members who was a strong supporter of the History Bowl,” Ragland said. “As a matter of fact, he was the emcee of the History Bowl for a number of years and we could think of no better way to honor him and his passing than to name a trophy after him. He was a good man for a good event.”

On top of the trophy, the MMSD middle school that wins the city-wide championship will earn an all-expenses-paid trip to the 100 Black Men National Competition in Hollywood, Florida., in mid-June.

Madison teams have had some success. Madison Middle School teams have won the national championship in 1996, 2008 and 2012.

“Our middle school teams have won the national competition three times in our 20-year history,” Ragland said. “They’ve made us very proud and that’s something that we hope to continue.”

The public is invited and encouraged to attend the event and to watch and cheer the students during this exciting competition.

“If you like Jeopardy and you like the old College Bowl and you like to see young people compete with their brains against each other, than you should come on out this Saturday,” Ragland said. “We also have a competition between the schools so whichever school brings the most supporters they can win gift certificates for $300, $200, and $100 that they can use for pizza parties or to support other activities at school. So that’s exciting, too. The crowd really gets into it at the event, so that’s fun, too.”

By the way, the answers to the opening questions are:
Emperor of the world
Robert E. Lee,
The Dunmore Proclamation.