“People fail to get along because they fear each other; they fear each other because they don’t know each other; they don’t know each other because they have not communicated with each other.” – Martin Luther King, Jr.
What are Health Disparities?
The term “health disparities” is not a light-weighted word. It holds so much weight, so much power, so much strength. Specifically, health disparities are systemic differences among particular population groups in attaining full optimal health, resulting in unequal health outcomes (e.g., differences in the incidence, prevalence, and burden of diseases and other conditions). Health, the ability to lead a whole productive life, can be indicated by various measures, including life expectancy, fitness, and nutrition. Disparities in health range from racial and ethnic, to socioeconomic and monetary factors, but they can be grouped under what’s called: the social determinants of health, which are factors directly related to the unequal distribution of social, political, economic, and environmental resources. These social determinants of health can emerge from poverty, geographical or environmental threats, inadequate access to proper healthcare, educational inequalities, and identity status. An overview of social determinants of health is summarized in the table below, by Kaiser Family Foundation and National Health Service Department, but please note that these are only the simplified versions of it, and there exists such a big variety of disparities in health, especially today.
So we understand health disparities. But what is meant by racial disparities?
Racial disparities are racial or ethnic differences in the quality of healthcare that are not due to access-related factors or clinical needs, preferences, and appropriateness of intervention. They generally include implicit bias that exists between individuals, groups of people, or institutions. If you don’t know what implicit bias means, it is defined as “associations outside one’s awareness that lead to a negative evaluation of a person on the biases of characteristics such as race or gender that are not relevant to the situation.” In healthcare, implicit biases frequently occur between physicians and hospital institutions, and patients.
Don’t all doctors promise to treat all patients equally under the famous Hippocratic Oath?
In order to become a physician, all medical students must swear by the Hippocratic Oath. According to William C. Shiel Jr., MD, the Hippocratic Oath is one of the oldest binding documents in human history. It was originally written by Hippocrates and is revered as sacred by physicians today. Aspiring doctors and medical students must take the oath to swear they will “treat the ill to the best of one’s ability, to preserve a patient’s privacy, to teach the secrets of medicine to the next generation, and so on.” There are many versions of the oath, but a modern one states:
“I swear to fulfill, to the best of my ability and judgment, this covenant: I will respect the hard-won scientific gains of those physicians in whose steps I walk, and gladly share such knowledge as is mine with those who are to follow.” (Read more on MedicineNet!)
In summary, doctors take an oath of promise to treat patients equally, no matter their race, ethnicity, or identity. Regardless, not all patients are treated equally today. In fact, health disparities are an exacerbating issue in many countries around the world, including the United States. These implicit biases of racism and discrimination are so entrenched in the social, political, and economic aspects of our current society, that we, ourselves, do not even recognize the stereotypes that exist between groups of people. If you are wondering what racial stereotypes look like, here are some common examples that you might be familiar with:
Dating it back to history.
The origins of racism and discrimination in healthcare can be traced back in history. Here are some major historical events or contexts of racism in healthcare and medicine from previous centuries:
Dr. J. Marion Sims was long credited as the “Father of American Gynecology” in the United States. In the 1890s, his “brilliant achievements” in the surgical field were so praised by many, that his very own statue was installed across the New York Academy of Medicine in 1934. However, only a few years ago, his pedestal was officially removed. The reason behind this was explained by Vanessa Northington Gamble, a physician, and historian of medicine at the George Washington University. In an NPR’s Hidden Brain podcast in 2016, Gamble revealed how Dr. Sims spent years operating on twelve enslaved African women between 1844 to 1849 to discover a treatment for Vesicovaginal fistula. The surgical operation was conducted without anesthesia because according to Dr. Sims, black women were incapable of feeling a strong degree of pain in comparison to white women. (Read more at 2016 Study at the University of Virginia)
According to Elizabeth Nix from History.com, the Tuskegee Experiment began by the Tuskegee Institute and the U.S. Public Health Service in 1932 as a motive to discover a treatment for a contagious venereal condition called syphilis. Specifically, the study was operated on a large group of nearly 600 black men, where 399 were diagnosed with syphilis and 201 were unaffected. While the real intent of this study was to study the evolution of the health condition until death, the researchers falsely assured the testees that they were being treated for “bad blood” including ailments like syphilis, anemia, and fatigue and that they could receive free medical exams, meals, and burial insurance in return. In addition to this false claim, the experiment was proceeded with no informed consent for over 40 years. Check out these additional links for more information: Tuskegee Experiment Revealed, Tuskegee Timeline by CDC.gov, Tuskegee Experiment by History.com)
During the Jim Crow Era in the late 19th to early 20th centuries, racism and segregation prevailed in America, including the healthcare system. In 1896, the Supreme Court ruled in the Plessy v. Ferguson Decision, that the racial segregation of African Americans from Anglo-Saxon Whites did not violate the Fourteenth Amendment’s Equal Protection Clause of the U.S. Constitution. The Court upheld the constitutionality of racial segregation in public facilities, as long as the segregated facilities were ‘separate but equal.’ As a result, African Americans were not only excluded from public facilities like schools and transportations, but also in medicine and healthcare. In particular, hospitals in the South almost entirely excluded African Americans, while hospitals in the North established separate wards for different races. Black students aspiring to become doctors were even barred from entering medical schools and receiving education to practice medicine. Further efforts to prevent racial integration boomed during the Jim Crow Era.
These are only a few examples. Regardless, it is evidently clear how racism and discrimination prevailed since early American history.
How do racial disparities look like currently amidst COVID?
Surprisingly (or more like, evidently), the ongoing coronavirus pandemic exactly mirrors racial disparities in the United States. Researchers reveal that people of color are dying at three times the rate that white Americans do. Blacks, in particular, are one of the most severely affected racial groups by coronavirus than any other race in the country.
In general, blacks are 74% more likely to contract coronavirus than their percentage of the state. A notable example is Louisiana. Although blacks only represent less than ⅓ of the state population, they accounted for over 70% of coronavirus deaths. This was over the majority standpoint and is more than enough to prove that racial disparities do exist today.
Why do racial disparities exist?
Today’s racial disparities can be grouped into two major factors: micro-level and structural factors.
1) Micro-Level Factors
As the name suggests, micro-level factors embody the “small-scale interactions between individuals or group dynamics,” including assumptions, implicit biases, and racial biases in medical treatment. There is also a racial empathy gap in perceived pain tolerance. In physician-patient interactions, Black patients are mostly spoken to rather than listened to. For instance, French doctors commented that potential COVID-19 vaccines should be tested on poor Africans, similar to how the AIDS drugs were tested originally on black prostitutes. There is also a long colonial history in the United States and European nations during the Colonial Period. Black bodies were often used as scientific and medical guinea pigs rather than treating them as human beings. This evidence reveals the medical mistrust and racial health disparities in the United States.
2) Structural Factors
BMC Public Health defines structural factors as the “economic, social, policy, and organizational environments that structure the context in which risk production occurs.” Three of the most relevant are neighborhood and climate, employment and workforce, and criminalization.
- Neighborhood and Environment: Blacks are more likely to live in neighborhoods with a lack of healthy food options, green spaces, recreational facilities, lighting, and safety. These household and neighborhood divisions can be dated back to the history of redlining in the United States. This was a federal program explicitly designed to increase America’s housing stock through segregation. The national government denied financial and housing services to residents of certain locations based solely on their racial and ethnic identities through redlining. In turn, Black people were refrained from purchasing homes and building their wealth status. Today, redlining still exists, though banned over 50 years ago. Minority residents inhabit close to two-thirds of dangerous neighborhoods, usually black or Latino Americans, and these cities face greater economic inequality. With the additional issue of gentrification, formerly redlined residents are now pushed out of their neighborhoods, increasing this environmental accessibility. Blacks are more likely to live in densely populated areas, which increases their potential contact with other people. As of 2020 data, blacks represented ¼ of all public transit users in the United States. Additionally, blacks are less likely to have equitable healthcare access as hospitals are farther away, pharmacies are in subpar conditions, and urgent prescriptions take longer days of waiting. Overall, the inadequate healthcare access and resources of blacks further contribute to their racial health disparities.
- Employment and Workforce:
COVID-19 has taken an apparent toll on the American economy, dividing up the workforce into three main groups:
- Those who have lost their jobs and face economic insecurity
- Those who are classified as “essential workers” and face health insecurity as a result
- Those who can continue working from the safety of their homes
Blacks are more likely to be part of the new “essential” workforce, representing 30% of bus drivers and 20% of all food service workers, janitors, and stockers. These “essential” jobs force them to risk their own and families’ health to earn a living. In other words, more African Americans are choosing poverty over health. As a result, black workers and their families are over-exposed during the coronavirus pandemic. Unlike most of us, who had the privilege of staying at home during quarantine last March of 2020, most African Americans did not have the opportunity to remain home. They were constantly working to make a living and provide for their families. One example is Leilani Jordan, who was a 27-year-old grocery store worker from Lagro, Maryland. Leilani continued her job during quarantine to ensure that people had their essentials and food sources for lockdown. Due to overexposure, she eventually passed away from the coronavirus.
One of the greatest structural factors widely seen today is criminalization. Black men are constantly stopped in stores by the police for wearing personal protective equipment (PPE), including surgical masks. In one video, a white police officer told two African-American males who entered a grocery store that it is a “presidential and city order” to prohibit people from walking around in masks in the store, as they might be suspected criminals. Though a mask should signal health precaution and safety measures, it is more likely to come off as potential criminal behavior if the person wearing the mask is Black and usually male. This over-policing during COVID-19 leads many Black Americans to be less likely to use PPE and wear masks, putting their safety from coronavirus contraction more at risk.
So what does this mean to us?
The COVID-19 pandemic warrants the critical need to promote the health and well-being of people of color, especially African Americans.
“While we know that COVID-19 doesn’t discriminate by race, this pandemic certainly has highlighted the racial disparities within our society, as it disproportionately impacts communities of color,” says David J. Brown, M.D., an associate vice president and dean for health equity and inclusion at Michigan Medicine. “This task force is crucial as we search for solutions for these inequities.”
Through the assistance of the U.S. federal government and other institutions, effective, immediate, and long-term policy solutions in high demand address racial health disparities in the coronavirus pandemic. Interventions must be implemented to bring systemic changes between individuals and adequately address racism and discrimination as a public health crisis. The recent murders of George Floyd, Breonna Taylor, Ahmad Arbery, and so many other African Americans (and people of color in general, including Asian and Latinx Americans) display the profound inequities long-persisted and fueled the health disparities for centuries in the United States. As apparent by health disparities in the COVID-19 pandemic, we all need to take a stance to focus on the importance of equity.
How YOU can take action for racial justice.
The recent murders and acts of violence towards specific racial groups have sparked a mass mobilization towards public protests and demonstrations. While those unifying movements are essential, here are some ways YOU can take action for racial justice and demand deep, structural change right at this moment.
- Choose to support racial justice each day.
- Educate yourself.
- Donate money for a cause.
- Get connected online.
- Have difficult conversations with other people. Here are some discussion questions:
- Which factor is most significant?
- How can the U.S. close the racial health disparities before it is too late?
- How can health inequity have such wide-reaching implications?
- How to support racial justice Black Americans
- Breaking down barriers to advance health equity
- Patient support advocacy to reduce disparities in healthcare
- CDC: healthy communities program for health equity
- Why Your Doctor Should Care About Social Justice
- Health and Social Justice
- Doctors Should Care for Patients and Social Justice
- A Dangerous View: Why its a Mistake for Medical Schools to Ignore Social Justice
- Covid exposed a racial health gap’ in America. Here are four ways to close it
- The Virus is showing Black People what they knew all along
- White People are getting Vaccinated at higher rates than Black and Latino Americans
- Covid-19, social justice and impact on women
- Why the pandemic is forcing women out of the workforce
- Why Covid-19 Vaccines pose an equity and social justice issue
- Who gets the vaccine first? Social justice must be a factor
THANK YOU FOR READING!!
If you’ve come this far, I am SO immensely grateful for your interest in my project on racial disparities in U.S. health and medicine and how this issue is further exacerbated with the ongoing pandemic. I believe we should all devote a substantial (or at least a little) of our time from our everyday lives to learn and educate ourselves about the presence of health disparities and how the coronavirus experience is not the same for everyone. Through empowering each other and choosing to learn more about this issue, we can hopefully alter the heavily ingrained stereotypes among certain racial groups in our community and lead the road to greater racial justice and equality for all. I highly advise you to take a little bit more of your time to check out some of the resources above. If you are interested in income-based health disparities in particular, please click on my article below. Above all, thank you so much for reading!