All things being equal...
Updated: Jan 4, 2021
Racism in America is very much a public health issue. Why? Because when you look at access to quality healthcare and the health outcomes of racial minorities in America, it is almost always lesser than that of whites.
Health and healthcare are very interdependent upon a number of social determinants. Social determinants of health are conditions or environments where people live, learn, play, work, etc... including housing, geography/environment, education and income. (HealthyPeople.Gov) Notice I didn't include genetics or family history. That's because across all chronic conditions (from diabetes to cancer), genetic factors only account for 20% of the attribution. (ODPHP: Office of Disease Prevention and Health Promotion) Let's dig a little deeper into the other 80%.
Why is it that an individual living in one zip code is far less likely to have diabetes than an individual living in a different zip code? I can think of 100 reasons, but I'll just share four:
1) Per capita income. More money means more options for quality healthcare providers and access to better healthcare facilities.
2) Neighborhood. Individuals that reside in safe, walkable neighborhoods are more likely to engage in physical activity and other positive health behaviors because their environment allows for it and condones it. (Did you know there is a correlation between the number of broken windows in public housing and STDs?!)
3) Education. Individuals with higher education are more proactive in their engagement with healthcare professionals, and also have higher literacy and health literacy, which yields a better understanding of health information.
4) Access to healthy foods. Many lower income and/or rural areas are food deserts
a food desert is a geographic area where residents' access to affordable, healthy food options (especially fresh fruits and vegetables) is restricted or nonexistent due to the absence of grocery stores within convenient traveling distance
Now, we all know (yes?!) that institutional racism and discriminatory constructs have caused a disproportionate number of Blacks and other minorities to have lower socioeconomic status (education, occupation, income, geography). So, the above four examples help explain why racial minorities are more likely to have poorer health outcomes. But what happens when you "make all things equal"? Meaning, you compare a Black person with a white person that is the same age and gender, and has comparable education, occupation, income, and geolocation?
Let's take maternal mortality as an example. Black women are 5x more likely than their white counterparts to have a pregnancy-related death. And when you compare a Black woman to a white woman with equivalent income and education, the Black woman is still 2-3 times more likely to die from pregnancy complications or during childbirth.
The truth of the matter is, even when our systemic racism isn't at play, our implicit bias is. Black patients often experience discrimination from healthcare providers, due to lack of cultural awareness and inherent biases. Moreover, there is underrepresentation of Blacks in the healthcare sector, with Black doctors only comprising 5% of all doctors (AAMC, Diversity in Medicine), and yet Blacks comprise over 13% of Americans.
More recently, we've seen COVID-19 disproportionately affect communities of color, with morbidity and mortality rates much higher for Blacks and Hispanics than other races and ethnicities. Again, socioeconomic status for Blacks and Hispanics is disproportionately lower than that of whites; resulting in higher infection rates and case fatality rates. (CDC Health Equity) But, when we compare Blacks with whites of comparable income and education, the infection and fatality rates still remain higher for Blacks. Prince George's County, Maryland is a naturally occurring social construct of this phenomenon.
As one of the nation's most affluent Black communities, Prince George's County has experienced more COVID-19 cases and deaths than almost every other DC-Metro area County. Despite the per-capita income of Prince George's County being relatively high, there has been little investment or infrastructure in place for public health measures like access to healthy foods or sufficient healthcare providers and facilities. It's a prime example of institutional racism and structural discrimination.
Not only does our nation have a long ways to go in making "all things be equal" but even then, we need to work on ourselves and check our implicit biases. What are you doing to bridge the racial divide individually and on the community level? I'd love to hear from you.
In good health,