Getting to the Root of Racial Disparities in Healthcare
How does our country’s racist history drive health disparities across medicine? Whether overt or covert, race-based prejudice and discrimination lie at the root of the widely divergent health outcomes for Black and white people. Covid has both exacerbated and illuminated these divisions. How do we as a society reckon with systemic racism?
A Reckoning with Racist History
“The past 2 years have brought a renewed call to reckon with our racist history,” Damon S. Tweedy, M.D. said in a recent commentary in the New England Journal of Medicine. The author of “Black Man in a White Coat,” Tweedy described his own experience going to medical school in the 1990’s.
”Twenty-five years ago, H. Jack Geiger — physician, civil rights activist, founder of community health centers — implied in an influential editorial that racism within the medical profession was contributing to health inequities between Black and White Americans.1 He recommended that medical educators teach trainees about the dilemmas associated with race and health. A month earlier, I had started medical school, and though my working-class Black family faced premature chronic disease and death, I knew little of the health literature Geiger referenced. In my classes, it seemed that whenever we learned about a new disease, the lecturers noted that it was more common among Black people, had worse outcomes among Black people, or both. Full stop. They never mentioned social drivers of health, such as insurance coverage or residential segregation, nor that health care practices themselves might be problematic, as Geiger suggested. Rather, they obliquely blamed genetic differences or an insalubrious Black culture.”
Twenty-five years later, Tweedy lays out just how little progress society has made in addressing these systemic problems. To change that, we need to “change our language regarding race and health,” he said, and “cultivate and sustain a workforce of thriving Black clinicians.”
Medical education, of course, is only one sliver of the problem.
Connecting the Dots in Black History
An article in Stat by Meghana Keshavan connects the dots between systemic racism and race-based health disparities. The Covid-19 pandemic, she wrote, “has only made those disparities— and the structural discrimination they are rooted in — all the more apparent.”
“People of color right now are more likely to be infected, and we’re more likely to die. What we’re seeing here is the direct result of racism,” said Camara Phyllis Jones, an epidemiologist who recently served as president of the American Public Health Association. “That’s the thing that is slapping us in the face. Actually, it’s lashing us like whips.” The systemic discrimination that has impacted Black health so inordinately dates back to the first ships carrying enslaved Africans that crossed the Atlantic. The colonial narrative of hierarchy and supremacy exists to this day, Jones said, and has translated, centuries later, into gaping health disparities. Today, Black people in the U.S. are more likely than white people to live in food deserts, with limited access to fresh fruit or vegetables. They are less likely to be able to access green spaces, and more likely to live in areas without clean water or air. Black children are more likely to grow up in high-poverty areas. Black adults are more frequently exposed to greater occupational hazards, often working in frontline jobs across many fields.”
The complex interplay of how racism impacts health directly and indirectly is a subject of increasing interest. This was true even before Covid shone a light on the glaring inequities that have been there all along.
Learn More and Find Resources
About Health Disparities:
For an analysis of the racism-health connection, read Meghana Keshavan’s article in Stat: ‘The direct result of racism’: Covid-19 lays bare how discrimination drives health disparities among Black people.
Read Damon S. Tweedy’s editorial in the New England Journal of Medicine: Race and Health — A Persistent American Dilemma.
Learn how the Covid-19 pandemic has disproportionately affected Blacks in Vermont, in our blog: Covid Reveals Health Equity Shortcomings, Exacerbates Health Disparities.
Visit the Vermont Department of Health website page on Health Equity for information and further resources.
About Black History Month in Vermont
Vermont’s African American Heritage Trail traces Black history in the Green Mountains. For more information, including tools for educators (downloadable lesson plans, live programs and more) and a geocaching experience visit www.vtafricanamericanheritage.net
Learn about the origins of Black History Month from the Association for the Study of African American Life and History.
Need to Talk?
Call 2-1-1 (in Vermont) for assistance.
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Find resources and tools for coping with stress at www.COVIDSupportVT.org.
Find your local community mental health center by visiting Vermont Care Partners.
COVID Support VT is funded by the Substance Abuse and Mental Health Services Administration and Federal Emergency Management Agency, managed by Vermont’s Department of Mental Health, and administered by Vermont Care Partners, a statewide network of 16 non-profit community-based agencies providing mental health, substance use, and intellectual and developmental disability services and supports.