You don’t usually associate racism and the killing of African Americans by police with health disparities, but many in the nation’s health professions, especially those in public health, know that the effect is all too real.
This is not a new idea, nor is it new as it applies to the African-American community. For years, health leaders have evaluated the threat that racism poses to the health of the black community, usually discussing it in terms of health disparities faced by black patients. Those racial disparities include measures of infant mortality, life expectancy, obesity, incidence of cancer and other diseases, mental health, and many other health outcomes. The term “health care disparity” is usually used to describe issues such as access to care, insurance coverage, vaccination rates, and quality of care. But both factors contribute to overall health disparities.
Much has been written about those topics, and regular statistics are collected and published by academics, private groups studying health care, and the Centers for Disease Control and Prevention. The vast amount of data is too much (and too complex) to summarize in this short space, but here are a few examples (latest available figures, 2014) from the CDC:
- Life expectancy in years: White men, 76.5; black men, 72.0. White women, 81.1; black women, 78.1.
- Infant mortality rates per 1,000 live births: Whites, 6.9; blacks, 11.1.
- Hypertension rates by percentage: White men, 30.2; black men, 42.4. White women, 28.0; black women, 44.0.
But killings of unarmed black men by police add a new wrinkle to the problem of disparity and public health. Yet even that isn’t new. It’s just getting more attention.
“Black Lives Matter: A Commentary on Racism and Public Health” is a commentary in the August 2015 American Journal of Public Health. Here’s an excerpt:
In 1998, the American Public Health Association (APHA) released a policy statement on the disproportionate impact of police violence on people of color. This statement recommended strategies for reversing the trends; however, to date, there has been no record whether these policy recommendations have been implemented. The relevance of the 1998 APHA statement to the most recent incidents of racialized police violence is chilling. Yet, almost two decades later, explicit conversations about racism remain glaringly absent from most mainstream public health discourse.
“Racism is a Public Health Problem,” reads the headline of an editorial in the January 2015 issue of the Harvard Public Health Review.
Eric Garner died after a police officer violently compressed his neck and chest. This officer’s actions severely limited his ability to breathe, which already had been compromised by asthma, obesity, and hypertensive cardiovascular disease—diseases that occur at substantially higher rates among Blacks than Whites. As the Institute of Medicine (IOM) has noted, the role of racism in undermining Black health is undeniable.
In other words, the added stresses of racial discrimination exacerbate already-present health disparities. Here’s another example from The Atlantic:
Racial profiling is not only a danger to a person's legal rights, which guarantee equal protection under the law. It is also a danger to their health.
A growing literature shows discrimination raises the risk of many emotional and physical problems. Discrimination has been shown to increase the risk of stress, depression, the common cold, hypertension, cardiovascular disease, breast cancer, and mortality.
For those who find health data more understandable from a non-academic source, here are some examples of other effects of racism and how it affects health in the African-American community. This from a story on Think Progress, with its explanations compressed:
Racial discrimination puts black Americans at risk for long-term health problems.
According to a new study, black teens who experience racial discrimination in adolescence are more likely to develop stress-related health issues that could put them at risk for chronic diseases later in life. Specifically, researchers found that they were more likely to have higher levels of blood pressure, a higher body mass index, and higher levels of stress-related hormones once they turned 20. The psychological toll that racism takes on adults has also been well-documented, and racial discrimination has been repeatedly linked to high blood pressure.
The majority of doctors harbor “unconscious racial biases” toward their black patients.
A 2012 study found that about two-thirds of primary care doctors harbor biases toward their African-American patients, leading those doctors to spend less time with their black patients and involve them less in medical decisions. Although doctors typically aren’t aware that they’re treating African-American patients any differently, this ultimately creates an environment in which black people often don’t feel welcome in the medical system — and may start avoiding it.
Black scientists are systematically underfunded.
According to a recent analysis of grant data from the National Institute of Health (NIH), black scientists — and not other types of minorities — are less likely to receive government funding for a research project, even when they have the same credentials as their white peers. In fact, a black researcher’s chances of winning an NIH grant is 10 percentage points lower than a white researcher’s chances.
Disparities in the health care sector continue to hit the African-American community the hardest.
Thanks to structures of racism and poverty that stretch back for generations, black Americans are still more likely to lack access to surgical and emergency medical care, more likely to patronize hospitals that employ less-experienced staff, and much less likely to receive high-quality primary care.
Besides the health costs in people’s lives, health disparities have an economic cost to society. “The Costs of Racial Disparities in Health Care” is from the Oct. 1, 2015, Harvard Business Review:
Racial health disparities are associated with substantial annual economic losses nationally, including an estimated $35 billion in excess health care expenditures, $10 billion in illness-related lost productivity, and nearly $200 billion in premature deaths. Concerted efforts to reduce health disparities could thus have immense economic and social value.
An online newsletter for the American Public Health Association features a recent interview with APHA President Camara Jones, MD, MPH, PhD. Here is an excerpt from that Q&A.
Q: You’ve helped APHA identify the impacts of racism on the health and well-being of the nation. Why does the United States have an urgent need for a national conversation on racism?
A: Many in this country consider racism to be a thing of the past. They see the progress in race relations that has been made on some fronts, including the election of our nation’s first African-American president, and conclude that racism was just an unfortunate chapter in our nation’s history that has no relevance today. However, recent events have reminded us — again — that racism is very much alive and well in this country.
But it is crucial to recognize that racism is NOT simply an individual character flaw or a personal moral failing.
Racism is a system of structuring opportunity and assigning value based on the social interpretation of how one looks — which is what we call “race” — that unfairly disadvantages some individuals and communities, unfairly advantages other individuals and communities, and saps the strength of the whole society through the waste of human resources.
It is very important to acknowledge that racism is a SYSTEM that involves structures, policies, practices, norms and values. Our laws and our customs, even our inaction in the face of need, perpetuate historical injustices without the need for identifiable perpetrators. Racism manifests as more than the unjust killing of black men by a few “bad apple” police officers. It manifests as structures which do not include citizen review boards for police oversight; policies that require grand juries for indictments of police officers; practices like the over-policing of black communities; norms like the blue code of silence; and values that do not recognize the basic humanity and worth of black men.
The United States has an urgent need for a national conversation on racism — not simply race — because racism is sapping the strength of the whole society through the waste of human resources. But conversation is just the starting point, not the goal. We need to clearly name racism as a threat to the health and well-being of the whole society, but then we need to organize and strategize to act.
The APHA offers a four-part webinar, “The Impact of of Racism on the Health and Well-Being of the Nation,” that is available to listen to online. The organization also has an online survey for webinar participants.