Systemic racism has a huge impact on the health of Black Americans, and not just in the doctor’s office. In a Facebook Live event, Side Effects Public Media reporter Darian Benson spoke with three experts on topics ranging from generational mistrust to the impact of COVID-19.
Guests were Breanca Merritt, policy researcher with Indiana University-Purdue University Indianapolis; Tony Gillespie, vice president of public policy and engagement at the Indiana Minority Health Coalition; and Shardé Smith, assistant professor of Human Development and Family Studies at the University of Illinois at Urbana-Champaign. Here's a recap of that conversation:
First off: What is a health disparity? What is systemic racism?
When one group of people has measurably different health outcomes than other groups, that’s a “disparity.”
“We’re really talking about differences in health outcomes that are closely linked with social, economic and environmental disadvantages,” said Smith.
For example, Black women are three to four times more likely to die in childbirth than white women. Black people in the U.S. also are more likely to have chronic health conditions like diabetes or hypertension, and more likely to die from them.
Systemic racism describes systems that have been purposefully designed to disadvantage specific groups of people — in this case, Black Americans.
“Really what this is talking about is disadvantaging Black communities and other communities of color,” Smith said.
So how does systemic racism lead to health disparities?
Systemic racism makes it much harder for Black people to reach the same health outcomes as white people.
Take the practice of redlining. For years, federal officials mapped out urban areas that were less desirable for investment, a practice that helped to create rundown neighborhoods and limited financial support of black residents. The effects are still felt today, said Merritt.
“If you live in a neighborhood where your home is undervalued, that means you’re not going to get the same tax breaks," she said. "Grocery stores aren’t going to build there because they’re afraid they’re not going to get the return on their investment.
“There are lots of things that, as we talk about how you get food access or how to get to a good school, if you already have a place that’s been there for 70-plus years that was intended to be disadvantaged, it’s really difficult for you to navigate out of that and have all these great outcomes.”
Additionally, she said, neighborhoods subject to redlining have negative qualities like proximity to a source of pollution, or lead contamination in the soil. And those factors have direct impacts on residents' health.
How have these factors played out during the COVID-19 pandemic?
When reports of new coronavirus cases first began appearing, Smith wondered why race wasn’t immediately part of the conversation. Within days, reports emerged showing that Black Americans were contracting, and dying of, the virus in higher numbers than white Americans. In Marion County, early data showed Black residents were almost twice as likely to be hospitalized or die from the virus compared to white residents, but it took some time for that data to be released.
Why wasn’t racial data available from the start?
“It was never a part of the plan, so I guess in that sense it would be an afterthought,” Gillespie said.
Black people are more likely to have a chronic condition, like diabetes or hypertension, that puts them at greater risk of complications if they were to contract the virus. Additionally, they are more likely to have jobs that put them in contact with lots of people, or to live near others with these jobs, increasing their odds of catching the disease. In some ways, the data showing a heavier disease burden on the Black community wasn’t surprising.
And that needs to be part of the equation during the next public health crisis, Smith said. “So when pandemics or other things like this happen, we’re ahead of it, and not waiting for data to come out when we know there are communities that are more likely to be susceptible.”
Black people are often underrepresented in data collection and clinical trials as well.
Gillespie pointed to the HIV/AIDS crisis as an example. When the disease was thought to affect primarily gay white men, public health officials came together to create support systems to address the problem, he said. But when research showed that the disease disproportionately affected gay men of color, those supports dried up.
That can’t be the case going forward, he said. Funding for vaccines and treatments should follow the “disease burden” — the population that bears most of the brunt of a public health issue. People in decision-making capacities have to factor in disparities when developing equitable solutions.
“There are people who ask, ‘Do we have to talk about race?’” he said. “Well, yeah. We have to talk about race.”
So what can people do to address some of these issues?
First, Smith said, people need to acknowledge that systemic racism is a public health concern.
“This is not new. Obviously the pandemic is new, but the issues have been around,” she said. Black Americans also need seats at the table in decision-making roles.
Gillespie encouraged young medical students to contact their federal, state and local legislators and offer themselves as a resource when healthcare legislation comes up. He also suggested that they do some work in a community health center or hospital in a minority community.
But the reality is that it’s the system, Gillespie said. And medical schools need to make sure their curriculum explains racial inequities, and includes cultural competency training.
That training must go beyond the doctor’s office, too. Medical and public health curricula often miss the systemic issues in education, housing and criminal justice — to name a few examples — that cause many health problems, Merritt said.
She said those factors go “beyond how you individually act with a patient or a client, and inform why their situation might be the way it is and they’re presenting to you in a certain way." Understanding broad systems and policies can help medical providers get to the heart of why a patient might develop issues in the first place.
“Really, all policies are local,” Merritt said. She encouraged people to learn about their local and state candidates. “Who’s actually doing the work to getting some of these systemic issues on the table?”