MoMilli – Where is Hip-Hop’s “Harry and Louise”?
Despite political threats to Medicaid expansion and state health exchanges opening, grassroots support for the Affordable Care Act is clearly growing. Could one credit the success of the exchange enrollment websites to a viral amateur rap by the Oregonian collective Lifesavas? Is it thanks to the baby animals anchoring the Adorable Care Act campaign? Or is it more due to prominent celebrity endorsements via the #GetCovered social media hashtag, including a pro-Obamacare parody of Scandal featuring Jennifer Hudson for Funny or Die?
In fact, where in all this buzz are the Affordable Care Act’s most longstanding allies: hip-hop nation?
Success in the music industry hardly guarantees artists or their collaborators quality health insurance. Just last year, Grizzly Bear’s lead vocalist Ed Droste told Nitsuh Abebe of New York magazine that he at one point received health insurance through his husband even after the success of Grizzly Bear's second album Veckatimest, which sold over 200,000 copies. The injustice is not limited to struggling indie rock artists, though, nor to those who, like Grizzly Bear, have been endorsed by Jay-Z: In the November 2013 “Power” issue of Vanity Fair, Jay-Z followed in a long tradition of high-profile rappers and music critics who complained about the lack of education artists receive in how to manage sudden wealth.
Most casual fans are familiar with bankruptcy horror stories of R&B and rap crossover artists as once ubiquitous as MC Hammer and Toni Braxton. They may even have heard about the premature deaths of hip-hop legends like Big Pun, Nate Dogg, Heavy D, Guru, or J-Dilla, who died of complications from lupus and had a foundation started in his name. Among those artists with health troubles who survived, there are advocacy campaigns on diabetes from Phife Dawg from A Tribe Called Quest, or kidney disease from DJ Kool Herc, the first Bronx turntable artist from the mid-Seventies who later almost went broke in his struggle to avert medical bankruptcy. These artists all struggled with chronic diseases endemic to the African-American and Latino communities: stroke, hypertension, obesity, diabetes. So where have their stories ended up during healthcare reform, which was supposed to lift up not just the middle class, but their neighborhoods?
Their health care complaints, and those of innumerable other hip-hop artists, have never been absent from the canon. Until very recently it’s been hard to measure the quantitative impact of their words on the subject of American healthcare. Last week, the song lyrics interpretation website Rap Genius launched RapStats, with which users can search its lyrics database for the popularity of any word or phrase in hip-hop tracks from 1988 to the present. Rap Genius editor-in-chief Shawn Setaro, who once worked the medical records department at Bellevue Hospital in New York City, has said that he hopes resources like RapStats serve as ethnographies for readers interested in the social history of rap. (I helped found Rap Genius during my first year of medical school and wrote a brief lecture about medical tropes in hip-hop.)
Using RapStats, Sunlight Foundation Labs director Tom Lee found a parallel pattern in references to Obamacare in hip-hop and references to Obamacare in Congress using his own lab’s software Capitolwords. RapStats also shows that the frequency of references to “healthcare” in rap has been rising since Obama’s election in 2008.
Though there are few if any references in rap to Obamacare specifically, there is a rich history of references to Medicaid. And they’re not limited to “political” or “backpack” rappers’ catalogs: The more rappers talk about “sick” (and not just sick flow), the less they talk about “health.”
Is that why the word “hip-hop” is becoming a more frequent buzzword in community-based participatory research in preventive medicine? In a 2006 review article for The Future of Children, a Princeton University and Brookings Institution summary report on antiobesity initiatives in low-income communities of color, Shiriki Kumanyika, an epidemiologist at the Perelman School for Medicine at Penn and Sonya Grier, a professor of marketing at American University, pointed out that ethnic minority children are exposed to more mass media hours overall than their white age and gender equivalents. They cited research suggesting these populations are more responsive to targeted food advertising with African-American characters. Then they proposed that public health campaigns might use the same advertising strategies to promote countering antiobesity behaviors.
Along those lines, there has been much interest in creating chronic disease interventions, including support for expanded health care coverage for these communities, through a hip-hop brand. Such a declaration may strike fear into the heart of any casual medical information Internet seeker who has had the pleasure to land on viral videos of parody raps written by well-meaning if “mad corny” doctors. A few of those who try, say, ZDoggMD, have goodwill and decent flow.
Yet the effort to incorporate hip-hop’s cultural pull into chronic disease prevention is evidence-based, and not just #based like Oakland mixtapes. A simple search for “hip-hop” on PubMed’s medical research database—whose funding was, of course, limited by the government shutdown--obtained at least seven large-scale long-term study interventions based in American cities on both the East and West Coast. These study cohorts receive hip-hop education with health literacy materials to educate at pediatric populations in prevention of chronic diseases in impoverished populations.
Such academic physician allies promote this new school of clinical practice explicitly as "hip-hop health." With the help of Doug E. Fresh and Easy A.D. from the Cold Crush Brothers, the New York City neurologist Oladjide Williams discusses stroke prevention on a hip-hop public health podcast and mixtape. Family medicine specialist Rani Whitfield, an advocate for chronic disease prevention in African-American communities in the South, has branded himself as ‘Tha Hip Hop Doc,’ with regular appearances on MSNBC’s Politics Nation with Al Sharpton to discuss disease prevention.
But are individual clinical investigations still enough?
Community organizers have long tied themselves to artists to support political efforts to create a public option for health care, ideally something like an expanded, improved Medicare-for-All (or "single payer health care," the one payor being the federal government). Perhaps the most high-profile hip-hop activist on behalf of such issues, Hip-Hop Summit Action Network leader Russell Simmons, was a prominent presence at Occupy Wall Street. The Hip Hop Caucus, a community organizing initiative founded by the Rev. Lennox Yearwood Jr. in 2004, “equates the health care reform fight to the battle against Jim Crow segregation.” In July 2009, Yearwood and Simmons, along with J-Dilla’s mother Maureen Yancey and Malik Taylor and the Service Employees International Union (SEIU), hosted the Health Care Remix (video) for the Health Care for America Now coalition of the Campaign for America’s Future.
That is not to say the artists themselves have held back, though we rarely hear about their opinions on American health care on music websites like Rap Genius when they don't. In a big coup for the single payer health care movement, Nicki Minaj tweeted President Barack Obama to demand a single payer health care system at the height of the Afforable Care Act bill passage controversy. As the economic reporter Maureen Tkacik characterized the exchange in Gawker, it was not her characteristic outlandishness, but rather more targeted moral outrage. Lupe Fiasco occasionally receives this level of attention when he calls the Obama administration to radicalize for economic justice like universal healthcare, but the more political he gets, the more he is pilloried like his onetime mentor Kanye. Then again, Kanye never got kicked out of an antiwar inauguration ball performance.
So most existing efforts to secure health insurance for hip-hop artists seem quieter and neighborhood-focused rather. Kangol Kid from the Eighties rap and breakdancing group UTFO founded the Mama Luke Foundation for victims of breast cancer, then partnered with the New York City Health and Hospital Corporation to start ArtXChange, through which local performers would use their talents to help within the health care system in direct exchange for health services. Unfortunately, his efforts were shuttered in 2012 when it became too expensive to operate the program without taxing the rappers seeking the insurance, thus ending the program before it got off the ground. Another New York City initiative started by Rodney C (featured in the seminal 1983 hip-hop film Wild Style), Hip-Hop Pioneers Medical Health and Dental Care Campaign, started in 2007 to organize more than 25 first-generation hip-hop artists who were uninsured or underinsured. These organizers are proud of their outreach to those Kangol Kid calls hip-hop’s first senior citizens, but could others from the younger generation be doing more to ensure they, and all, get covered?
And is it feasible to expect a health care reform direct action from the hip-hop community with the profile of P. Diddy’s “Vote or Die” campaign? In fact, that campaign already exists: It’s in the music itself, and has been for decades. A hip-hop artist campaign for health care coverage could even prevent cute misunderstandings like the time Connecticut exchange CEO Kevin Counihan told Arielle Levin Becker of the Connecticut Mirror that he met the rapper T.I. at a concert promoting Obamacare and called him I.T. At least Counihan is self-aware enough to realize that he does not speak for the hip-hop voter—but then who will?
“The hip-hop voter has no true representative speaking for such Hiphop Summit Action Network agenda issues as reparations or universal health care,” former Vibe and XXL magazine editor Miles Marshall Lewis wrote in his memoir Scars of the Soul are why Kids Wear Bandages when They Don’t Have Bruises (Akashic Books, 2004). If hip-hop voters have a Harry and Louise waiting in the wings, he or she must mix up the medicine from within.
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