Structural racism is a driver of health inequities that has left Black communities in America dealing 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 starkly exposed as treatment deficits and deaths disproportionately impacted Black communities. Even before the pandemic, data showed that life expectancy for a Black person in the United States is seven years less than for non-Black individuals, on average, while Black mothers are 3.5 times more likely to face maternal death than non-Hispanic White women, and three to four times more likely to experience complications of pregnancy and childbirth.
But the health crisis in Black communities isn’t solely due to lack of access to care. Much of it also stems from well-documented racial disparities and biases, such as biases around pain perception and treatment recommendations. As recently as 2016, a study found that a shocking number of first- and second-year medical students falsely believed Black people have higher pain tolerances and thicker skin than non-Black people, leading many to downplay symptoms and fail to treat Black patients equitably.
These attitudes and inequities don’t just affect Black families at birth and death—they create lifetimes of deficits with lasting impacts on future generations. Poor health resulting from social, economic, environmental and behavioral health determinants, exacerbated by the chronic stress of perpetual, systemic racism leads to educational challenges and setbacks for children and difficulty maintaining employment due to health problems as well as decreased life expectancy.
It is 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 keep Black people and Black communities from realizing their full potential, and they drive high reliance on community-based social services for basic needs, preventing communities from achieving parity.
While improved access to quality social care is critical to move the needle, true change has to come from system transformation and the collective will to invest in historically underserved populations. Large-scale systems change requires implementation of new policies and programs, and 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 have major economic impacts as well. In 2009, racial disparities cost $60 billion in excess medical costs, a figure that was expected to reach $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 history behind racist policies and practices harming the Black community today.
Racial disparities and inequities didn’t happen by accident. They happened by design, as Black citizens were systematically excluded from society. For example, Long Island is one of the most segregated places in the country due in part to Robert Moses’ 1920s city planning and infrastructure design that saw Black communities literally torn from the ground to make way for parks, bridges and roads, often cutting off public transportation to those 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 inequities at the individual and community levels, while less attention is paid upstream at a macro level to address the structures that perpetuate inequities today.
Collect data to define the problem.
While many of us see these inequities every day, to drive change we must be able to prove the devastating outcomes they create to policymakers, healthcare providers and other stakeholders. To do that, we must use systems to track additional contextualized data related to utilization of social care services, and measure and evaluate the effectiveness of interventions.
It’s critical to ensure that communities have the resources and infrastructure to collect these data and then compare them against what’s happening in nearby or comparable communities to prove and fully define the discrepancies.
Translate that data for the layperson.
Data analysis tends to be an academic discussion that often creates barriers for individuals who could make a difference if they were armed with the proper insights. We need to do more work to include communities in translating and providing contextualized information to ensure that community health data are actionable, meaningful and can be used by all stakeholders to address the needs and priorities of the communities they serve.
There are still a surprising number of people who think racism isn’t a problem in America. We must overcome those misconceptions with clear, evidence-based insights.
Re-earn trust in the healthcare system.
Black communities have a deep-rooted mistrust of the medical system and for good reason: Aside from race-based biases and misconceptions, they’ve suffered unspeakable atrocities as the subject of inhumane experimentation. As a result of mistrust—and because of the crisis-level existence in many communities—Black individuals are more likely to delay or avoid healthcare, therefore driving higher ED utilization and perpetuating long-term health concerns.
As we work to re-earn the trust of Black communities with fair and equitable treatment, we should also prioritize the delivery of quality social care services that are needed to provide added support, and redirect clinical spending to invest in housing, outdoor spaces, school and youth services, employment opportunities and much more.
It’s well established that 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 wellness potential and economic and professional growth opportunities. Everything from income and access to healthy food, to neighborhood infrastructure and transportation access affect our ability to thrive.
To overcome race-related health and social care inequities, we must focus on improving SDoH in Black communities to support the critical role they play in nurturing health and well-being across the entire lifespan. If we can deliver better quality and more equitable physical, mental and social care from the beginning, we can nurture lifelong well-being and help disrupt the cycle that drives perpetual poor individual and community health outcomes. While we can’t undo the past, we can improve options for the future.
Photo: Angelina Bambina, Getty Images