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Racism is an important aspect of our social environment that is increasingly discussed at both national and international levels. The effects of systemic racism are even felt today and appear to be an insidious part of the fabric of our society. In American History, voting bans on black people and denying them citizenship was deemed essential to the formation of the original union. However, hundreds of years later, though we claim to be anti-racist, we need to watch out for racism, especially its impact on health. Racial health disparity or health inequity is a term used to describe the differences and gaps in the quality of health and healthcare across racial, ethnic, and socio-economic groups. Analysis conducted by Institute of Medicine (IOM) showed objective evidence of significant differences and raised the specter of bias and discrimination regarding black populations having access to healthcare. It underscored the challenges experienced by them concerning access to quality health care and the role of bias that leads to health disparity. For instance, six medical conditions were studied. They showed that mortality due to these conditions was 86% more in blacks than whites. Further, what is disturbing is that up to 45% of deaths in the black population would have been avoidable if they had better evaluation, detection, and treatment had been available. The six conditions were: cancer (3.8%), heart disease and stroke (14.4%), diabetes (1.0%), infant mortality (26.9%), cirrhosis (4.9%), and homicide and accidents (35.1%).
During the COVID-19 pandemic, racial disparity has been brought into the spotlight. Nationwide, black people are dying of COVID-19 at a rate 2.5 times higher than white people. There are 40 more deaths in black people compared to white people per 100,000 people. This data highlights the racial differences and showed a higher number of cases and deaths in the black population, showing the difference in the care of patients based on their race. What steps can we take as a society to achieve racial equality in healthcare throughout our nation?
It is well known from previous epidemics that socially marginalized populations suffer disproportionately. As a society, our goal should be to eliminate such health inequalities, making it crucial to collect more data along these lines. In early media reports, COVID-19 data from cities of Milwaukee, Chicago, New Orleans, and Detroit showed evidence of racial disparity in healthcare. The data pointed towards resource-deprived neighborhoods that are composed essentially of lower income people, minorities and foreigners, and marginalized by the broader society. Additionally, there were also news reports about racial disparities in COVID related deaths in Washington, D.C. For example, neighborhoods in Queens and the Bronx were thought to have more deaths due to their density and racial composition.
Many factors have been implicated, including a biological explanation that genetics are specific to racial minorities and predispose them to higher disease rates. Other reasons are grounded on racial stereotyping about specific behavioral patterns that influenced a particular racial minority to a disease. For example, racialized characterization that blacks are more obese is common. In fact, obese patients are at higher risk for developing COVID. Broadly, racial health disparities are caused in black populations at three levels. At the first level, there are differences in exposures and life opportunities that create different levels of health and disease in this population. For instance, there is an uneven geographic concentration of respiratory hazards and toxic sites in black or minority-heavy populated areas. There is also disparity in educational opportunities leading to low socioeconomic status ultimately leading to difficulty in affording health care. Second, differences in access to health care leads to different health outcomes. For instance, there is an uneven distribution of preventive health care services in some geographic locations. Finally, at the third level, there is differential care within the healthcare system leading to these disparities in black populations. Analysis by the American College of Cardiology and other studies have affirmed that there are differences in treatment that blacks and whites receive having a heart attack or acute myocardial infarction. African Americans were less likely than whites to receive cardiac diagnostic and revascularization procedures to remove blockage which are essential to save lives even when patients presented with similar symptoms.
Actions need to be taken at each level to mitigate the disparities by race. To address the differences in exposure and life opportunity by race, we all need to continue to raise awareness of these existing disparities. Researchers, journalists, public health officials, and policymakers need to take essential steps to discuss and address racial inequalities, especially in the public sphere. In order to target the differences in access to health care, we need to explore a better system of universal health care coverage, institute training of a more racially diverse health workforce at all levels and more importantly have a mechanism for assuring that there is an appropriate distribution of physicians geographically. To tackle the differential care received within the healthcare system, there should be a process for monitoring physician practices and seeing if they are adhering to treatment protocols. Besides, all health providers should have training on “ cultural competency” or anti-racism. Finally, as one draws attention to COVID racial disparities, we need to collect data on socioeconomic status (SES). The Harvard Public Health Disparities Geocoding Project uses publicly available Census data on poverty, level of household crowding, racial composition, and segregation to analyze COVID-19 data along multiple axes of inequality, down to the level of the ZIP Code tabulation area. Complementary SES information will clarify how racial and class forces are intertwined in the case of COVID-19 By highlighting connections between racial disparities and upstream effects such as economic inequality, which carry widespread societal consequences, we can tackle the problem of racism affecting health outcomes.
In summary, the ways we can solve the problems on these three levels are by monitoring physician practice and adherence to protocol, have universal health care coverage and training of a more racially and linguistically more diverse health workforce, and lead national campaigns to raise awareness on this facet of racism.
Written by Akash Raman
Jones, Camara Phyllis. (2002). Confronting Institutionalized Racism. Phylon, 50(1/2), 7-22.
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