Structural racism is a driver of health inequities that has left black communities in America with an inordinate share of suffering and poor health outcomes.
Predominantly black neighborhoods have less access to quality care than white communities – a fact that Covid-19 has made clear as treatment deficits and deaths have had a disproportionate impact on black communities. Even before the pandemic, data showed that the life expectancy of a black person in the United States was seven years lower than that of non-black people, on average, while black mothers were 3.5 times more likely to cope with a maternal death than non-Hispanic white women. , and three to four times more likely to experience pregnancy and childbirth complications.
But the health crisis in black communities is not only due to the lack of access to care. Much also stems from well-documented racial disparities and biases, such as biases regarding pain perception and treatment recommendations. As recently as 2016, a study found a shocking number of first- and second-year medical students mistakenly believed that black people had higher pain tolerance and thicker skin than non-black people. -Blacks, which has led many to downplay symptoms and not treat black patients fairly. .
These attitudes and inequalities not only affect Black families at birth and death, they create lifelong deficits with lasting impacts on future generations. Poor health resulting from social, economic, environmental and behavioral determinants of health, exacerbated by the chronic stress of perpetual systemic racism, leads to educational challenges and setbacks for children and difficulties in maintaining employment due to problems health and reduced life expectancy.
It’s an understatement to say that the lived experiences of black people tend to be more stressful than those of their non-Hispanic white peers. Structural biases and discrimination influence health and health outcomes. These stressors prevent black people and black communities from realizing their full potential, and they result in a heavy reliance on community social services for basic needs, preventing communities from achieving parity.
While greater access to quality social care is key to moving the needle, real change must come from system transformation and the collective willingness to invest in historically underserved populations. Large-scale systemic change requires the implementation of new policies and programs, as well as a new infrastructure that values social care, advances health equity and ultimately dismantles systemic structural racism. .
Health disparities not only affect individuals and communities, but also have major economic impacts. In 2009, racial disparities cost $60 billion in excess medical costs, a figure that is expected to rise to $363 billion by 2050.
Here are some strategies to consider as we work to advance health equity and address poor health outcomes rooted in structural racism:
Expose the story behind the racist policies and practices that harm the black community today.
Racial disparities and inequalities did not happen by accident. They happened on purpose, because black citizens were systematically excluded from society. For example, Long Island is one of the most segregated places in the country, in part because of the urban planning and infrastructure design of Robert Moses in the 1920s that saw black communities literally uprooted from the ground to make make way for parks, bridges and roads, often cutting off public transport to these neighborhoods and preventing access to public parks and beaches for the very people who lived there.
Structural racism exists today because of specific choices made both in the past and in the present. Often, our attention is focused on addressing disparities and inequalities at the individual and community levels, while less attention is paid upstream at the macro level to addressing the structures that perpetuate inequalities today.
Collect data to define the problem.
While many of us see these inequalities every day, to drive change we must be able to prove the devastating results they create to policy makers, healthcare providers and other stakeholders. To do this, we need to use systems to track additional contextual data related to the use of social care services, and to measure and evaluate the effectiveness of interventions.
Ensuring that communities have the resources and infrastructure to collect this data, and then comparing it to what is happening in neighboring or comparable communities, is essential to prove and fully define the discrepancies.
Translate this data for the layman.
Data analysis tends to be an academic discussion that often creates hurdles for individuals who could make a difference if armed with the proper knowledge. We need to do more work to include communities in translating and providing contextualized information to ensure that community health data is actionable, meaningful and can be used by all stakeholders to meet needs and priorities of the communities they serve.
There are still a surprising number of people who think racism is not a problem in America. We need to overcome these misconceptions with clear, evidence-based insights.
Regain trust in the health system.
Black communities have a deep-rooted distrust of the medical system and for good reason: in addition to racially based prejudice and misconceptions, they have suffered untold atrocities as the subject of inhumane experimentation. Due to mistrust – and due to the existence of a level of crisis in many communities – black people are more likely to delay or avoid healthcare, leading to higher utilization of healthcare services. emergency and perpetuating long-term health problems.
As we strive to regain the trust of Black communities with fair and equitable treatment, we should also prioritize the provision of quality social services that are needed to provide additional support and redirect clinical spending to invest in the accommodation, outdoor spaces, school and services for young people, employment opportunities and much more.
It is well established that the social determinants of health (SDoH) – the conditions in which we live, work, learn, play and pray – play a critical role in our current health, our potential for well-being and our opportunities for growth. economical and professional. Everything from income and access to healthy food, to neighborhood infrastructure and access to transportation, affects our ability to thrive.
To overcome race-based inequities in health and social care, we must focus on improving SDoH in Black communities to support the critical role they play in promoting health and well-being throughout life. If we can provide better and more equitable physical, mental and social care from the start, we can promote well-being across the lifespan and help disrupt the cycle that drives individual and community health outcomes perpetually. mediocre. Although we cannot undo the past, we can improve the options for the future.
Photo: Angelina Bambina, Getty Images