“There is no such thing as race. There's just the human race, scientifically. Racism is a construct, a social construct,” stated Toni Morrison (Appelo, 2019). The plague of racism remains one of our nation's most traumatic topics. The American Society of Human Genetics expresses that the very idea of race is a lie, and has no biological basis. “The science of genetics demonstrates that humans cannot be divided into biologically distinct subcategories therefore, race itself is a social construct” (Prontzos, 2019). The human genome project confirms that the genomes found around the globe are 99.9 percent identical in every person. Hence, the very idea of different “races” is nonsense.
Health disparities in the United States are the differences that exist among specific population groups in the attainment of full health potential that can be measured by differences in incidence, prevalence, mortality, the burden of disease, and other adverse health conditions (NCBI, 2017). The Centers for Disease Control and Prevention (CDC) identifies health disparities as, “preventable differences in the burden of disease, injury, violence, or opportunities to achieve optimal health that are experienced by socially disadvantaged populations.” (Nabi Ndugga, 2021). Disparities cut across dimensions such as race and ethnicity, gender, sexual orientation and gender identity, disability status, socioeconomic status, age, and geographic location.
Racial and ethnic disparities
Health disparities - that stem from unequal access to safety, to healthy and affordable food, housing, medical care, and transportation - in the racial and ethnic demographics are arguably the most obstinate iniquities in health throughout the history of our country. Health disparities among black and brown populations of America take many forms such as increased rates of chronic disease and premature death compared to the rates among whites. Conditions in the places where people live, learn, work, play, and worship affect a wide range of health risks and outcomes. The National Center for Health Statistics (NCHS) reports that among the five racial and ethnic groups measured in the National Vital Statistics Survey (NVSS) in 2014, African American women had the highest percentage of preterm singleton births at 11.1 percent, while Asian or Pacific Islander women had the lowest at 6.8 percent (NCHS, 2016). For indigenous populations, infant mortality rates are staggering. Native Americans and Alaska Natives have an infant mortality rate that is 60 percent higher than the rate for their white counterparts (HHS, 2014).
Obesity also affects racial and ethnic populations disproportionately; From 2011 to 2014, Latinx children and adolescents ages 2 to 19 had the highest prevalence of obesity in the United States (21.9%), and Asians had the lowest (8.6%) (NCHS, 2016). The U.S. Centers for Disease Control and Prevention (CDC) reports that nearly 44 percent of African American men and 48 percent of African American women have some form of cardiovascular disease and African American and American Indian/Alaska Native females have higher rates of stroke-related death than Latinx and white women (Blackwell DL, 2014).
Mortality rates for Native Americans are almost 50% higher than that of their white counterparts with an infant mortality rate that is 1.5 times higher than for whites (Mathews TJ, 2015). The rate of diabetes as an underlying cause of death and a multiple cause of death has remained 2.5 to 3.5 times higher for Native Americans than for whites of all ages 20 and older.
Gender disparities in health are not based on biological mechanisms, rather on socioeconomic conditions that can shape gender differences in health outcomes such as mortality rates, alcohol, and substance abuse, mental health disorders, and violence victimization (NCBI, 2017). Within health care systems, unconscious gender biases –based on gender stereotypes and sexism affect patient care.
In 2014 life expectancy at birth was 81.2 years for women and 76.4 years for men, and from 2004 to 2014, the gap in life expectancy between men and women decreased from 5.1 years to 4.8 years (NCHS, 2015). The narrowing of the age gap between men and women might be mistaken for a positive event; while in fact, it is troubling because it stems from a rise in mortality rates among women.
The gender pay gap, men earning more than women, has serious implications on health iniquities because income is closely tied to health. The number of men not insured in the country is higher than that of women because historically, men have not qualified for Medicaid.
Living in low-income neighborhoods is linked to an increased risk of gender-based violence for African American and white women. Women are at a higher risk of sustaining injuries compared to men, and the effects of the violence continue having lasting effects on the health of women. The women who experience violence are at a higher risk of arthritis, asthma, heart disease, gynecological problems, and risk factors for HIV or sexually transmitted diseases (STDs) than those who do not experience violence (Campbell JC, 2000). For men, community violence is likely to affect their health, and this is particularly true for men of color, who experience disproportionate amounts of violence. Men also have higher suicide rates than women regardless of age, race, or ethnicity, with overall rates at almost four times those of women.
Sexual orientation(Lesbian, Gay, Bisexual, and Transgender, Intersex, Asexual) health disparities
The acronym LGBTIA is an umbrella term for Lesbian, Gay, Bisexual, and Transgender, Intersex, Asexual even though there exist within this population more forms of sexual and gender expression. The LGBTQIA population has been the subject of hate crimes and were excluded from many of the rights and social advantages of our society. Despite there being laws that protect the rights of the LGBTQIA community, they still face disturbing rates of healthcare discrimination from humiliation, harassment, and outright being turned away by medical practitioners and hospitals.
Center of American Progress, CAP, survey data shows that 8% of LGBTQIA were denied access to a health practitioner because of their actual or perceived sexual orientation, 6% said that the doctor refused to give them healthcare related to their actual or perceived sexual orientation, 9% said that a doctor used harsh or harmful language and 7% said that they experienced unwanted physical touch such as fondling and even rape from the care providers (CAP, 2018).
In a case, a transgender teenager who was admitted to a hospital for suicidal ideation and self-inflicted injuries was repeatedly misgendered and then discharged early by hospital staff. Unfortunately, he ended up committing suicide. Infants have been turned away from pediatricians for having same-sex parents.
Discrimination, or even the potential of discrimination, has the potential of keeping the LGBTQIA community away from hospitals.
Geographical location disparities
Rural counties have always had the highest premature death rates in the country. In comparison to urban areas, they have increased rates of preventable conditions such as obesity, diabetes, cancer, and injury. Rural areas have historically been affected by poverty and lack of opportunities for achieving optimal health, including factors such as employment, education, housing, and access to transportation. Limited or no access to a health care provider, poor management of chronic disease, and limited subspecialty availability are very real concerns for rural communities (Wong ST, 2009).
In urban areas, violence, and the resulting injuries and trauma, put them at higher risks of health complications than any other area. Approximately two-thirds of all U.S. firearm homicides occur in large urban areas, with inner cities as the most affected by firearm homicide (Prevention Institute, 2011). Youth violence is also higher in cities than in rural areas.
Urban communities have been characterized by a high burden of asthma, especially for children living in crowded and polluted areas.
United States citizens within lower-income or otherwise socially disadvantaged groups are confronted with a multilevel web of challenges that negatively impact their health and wellbeing. Discrimination exists in systems meant to protect the well-being or health of its people. Individuals who have experienced discrimination in the past may be more reluctant to seek health care, as they may perceive it as a setting of increased risk for discrimination. These disparities need to be addressed and a long-term solution reached to ensure equity in the healthcare system.
Appelo, T. (2019, August 6). Impact of celebrated author's work reverberates in nation's conscience. From AARP: https://www.aarp.org/entertainment/books/info-2019/toni-morrison-national-treasure.html
Blackwell DL, L. J. (2014). Summary health statistics for U.S. adults: National Health Interview Survey, 2012. National Center for Health Statistics; Vital and Health Statistics. PubMed. Retrieved February 10, 2014
Campbell JC, B. D. (2000). Violence against women: Synthesis of research for health care professionals. Washington, DC: National Institute of Justice.
CAP. (2018, January 18). Discrimination Prevents LGBTQ People From Accessing Health Care. From CAP: https://www.americanprogress.org/article/discrimination-prevents-lgbtq-people-accessing-health-care/
HHS. (2014). Infant mortality disparities fact sheets. Retrieved October 21, 2016 from http://minorityhealth.hhs.gov/omh/content.aspx?ID=6907&lvl=3&lvlID=8
Mathews TJ, M. M. (2015). Infant mortality statistics from the 2013 period linked birth/infant death data set. Hyattsville, MD: National Center for Health Statistics; National Vital Statistics Reports.
Nabi Ndugga, S. A. (2021, May 11). Disparities in Health and Health Care: 5 Key Questions and Answers. From KFF: https://www.kff.org/racial-equity-and-health-policy/issue-brief/disparities-in-health-and-health-care-5-key-question-and-answers/
NCBI. (2017). The state of health disparities in the United States. Bethesda MD: National Academy of Sciences.
NCHS. (2015). Health, United States, 2015: With special feature on racial and ethnic health disparities. Hyattsville, MD: National Center for Health Statistics. Retrieved 2016 from https://www.ncbi.nlm.nih.gov/books/NBK425844/#
NCHS. (2016). Health, United States, 2015: With special feature on racial and ethnic health disparities. Hyattsville, MD: National Center for Health Statistics. Hyattsville, MD:: PubMed.
NCHS. (2016). Health, United States, 2015: With special feature on racial and ethnic health disparities. Hyattsville, MD: National Center for Health Statistics.
Prevention Institute. (2011). Fact sheet: Links between violence and health equity. Oakland, CA: Prevention Institute. Retrieved October 12, 2016 from https://www.preventioninstitute.org/sites/default/files/publications/Fact%20Sheet--Links%20Between%20Violence%20and%20Health%20Equity.pdf.
Prontzos, P. G. (2019, May 14). The Concept of “Race” Is a Lie. From SCIENTIFIC AMERICAN: https://blogs.scientificamerican.com/observations/the-concept-of-race-is-a-lie/
Wong ST, R. S. (2009). Patient perspectives on primary health care in rural communities: Effects of geography on access, continuity and efficiency. Rural and Remote Health.
February! Here comes Black History Month!
Black history month is an annual month-long observance that honors the contributions of African Americans to the history of the United States. This annual event has received official recognition from the United States government and Canada and most recently has received recognition from Ireland and the United Kingdom. Black History Month celebrates the rich cultural heritage, triumphs, and adversities that are an indelible part of our country's history. The month offers us a chance to look into the history of African Americans beyond the usual narrative of racism and slavery to straight-up black excellence.
The theme was the brainchild of Carter G. Woodson who came up with the idea of Negro History Week in 1926. Carter G. Woodson and Jesse E. Moorland founded the Association for the Study of Negro Life and History (ASNLH) to research and promote the achievements of Black Americans and other people of Black descent. The history month began to be officially celebrated in the United States in 1976. President Gerald Ford called upon the general public to honor the too-often overlooked accomplishments of Black Americans in the history of America.
The theme for 2022 is Black Health and Wellness. It seeks to explore "the legacy of not only Black scholars and medical practitioners in Western medicine, but also other ways of knowing (e.g., birth workers, doulas, midwives, naturopaths, herbalists, etc.) throughout the African Diaspora. The 2022 theme considers activities, rituals, and initiatives that Black communities have done to be well (History, 2022). "
The healthcare system is plagued with disparities that often see African Americans discriminated against. Black folks are now embarking on self-determination, mutual aid, and social support initiatives to build hospitals, medical and nursing schools. These institutions are set to counter the economic and health disparities and discrimination found in mainstream institutions. By educating more black folk, there will be diversity in the medical field, and the African American community will have representation from people who are like them, who understand them.
The Black Health and Wellness theme also strongly focuses on the emotional and mental health of the African American community. Social media and podcasts, such as The Read, hosted by Crissle and Kid Fury have normalized talking about mental health issues and going to therapy as well as initiatives such as Therapy for Black Girls (ASALH, 2022). There is also more talk on holding down, supporting, and fiercely fighting for the rights of the LGBTQIA+ community of African Americans.
In this age and century, especially the Black Millenials, this month-long celebration offers them a chance to imagine the endless possibilities that lie ahead for them and the community in general. They come from greatness, and they can give rise to even more Black Excellence.
As Lonnie G. Bunch III said (Tedeneke, 2022), “There is no more powerful force than a people steeped in their history. And there is no higher cause than honoring our struggle and ancestors by remembering".
ASALH. (2022). BLACK HISTORY THEMES. Retrieved from Association for the Study of African American Life and History (ASALH®): https://asalh.org/black-history-themes/
History. (2022, January 31). Black History Month. Retrieved from History: https://www.history.com/topics/black-history/black-history-month
Tedeneke, A. (2022, January 27). Black History Month: What is it and why do we need it? Retrieved from World Economic Forum: https://www.weforum.org/agenda/2022/01/black-history-month-what-is-it-and-why-do-we-need-it/
In 1903, W. E. B. Du Bois prophetically stated: “The problem of the twentieth century is the problem of the color line (Jung, 2019).” We are well into the 21st century and we are still experiencing the problem of racial segregation in America. The lines of racial segregation in America were drawn in big bold lines. In St. Louis, racial segregation was institutionalized by intent, accident, or benign neglect throughout its history, affecting the nature of race relations in the city today (Louis, 2020).
Racism corrupts the fabric of morality of the US healthcare system. Centuries of racism have a direct impact on the black community as these discriminatory practices barred black students from enrolling and studying medicine, nursing, pharmacy, and dentistry. The effects of this discrimination have bred mistrust in the black community as they are always on the receiving end of mediocre and substandard treatment.
The infant mortality rate in the United States varies widely by state and county and on average is
higher than in the rest of the world’s first world countries. The survival of infants is used as a benchmark for societal overall health because they are very vulnerable. Despite the government spending more money than any other country in the world on healthcare, more than 23,000 infants die before celebrating their first birthday (Carpenter, 2017). Across the country, black infants die at a rate that’s twice that of white infants.
Black women, even those highly educated and in well-paying jobs are twice as likely to lose their infants than white women who haven’t even graduated high school (Flourish, 2020). More than 6,200 babies born in Missouri between 2002 and 2012 lost their lives before their first birthday. One-third of those deaths occurred in the Bootheel and St. Louis alone (Foundation, 2020).
In St. Louis, black infants are three times likely to die as compared to white children. Pregnant black women have a 243% chance of succumbing to pregnancy-related issues in comparison to white women. According to Peristats, the infant mortality rate in St Louis city declined by more than 17% between 2008 and 2018. The leading causes of death are birth defects, sudden infant death syndrome, maternal complications of pregnancy, and respiratory distress syndrome.
The high infant mortality rate in the Black community begs the question, what is killing America's Black children?
For many years, researchers attributed the following as what black mothers were doing wrong; smoking or drinking during pregnancy, obesity, diabetes, lack of prenatal care, poor eating, underage pregnancies, and smothering newborns in their sleep (Carpenter, 2017). As a result of highlighting these problems, more women took better care of themselves and got better care but still, there was little improvement in birth outcomes. Black women who received prenatal care starting in their first trimester were still losing their infants at higher rates than white women who did not get antenatal treatment during their pregnancies.
Another school of thought proposed that black women were genetically predisposed to poor birth outcomes, and began to hunt for “preterm birth genes.” Well, we know that the genetic variation in humans is too minuscule to be attributed to infant mortality in the black community. Others suggested that high poverty levels and lack of education in black women were the cause of the deaths. But, educated women in well-paying jobs were still losing their children more than uneducated white women, so where does the problem lie?
Racial discrimination rather than race itself plays a major role in why black infants are dying in such big numbers. Black women complain of physicians being dismissive, impatient, and condescending when dealing with them. This systemic racism puts them in three times more chances of losing their children as compared to white mothers. Many black women express their desire to be attended to by a black medic, but that is not entirely possible. We need to reduce systemic racism for all patients to be comfortable getting treated by the doctors available.
The golden rule says do unto others as you would have them do unto you so that the heart of a doctor needs to be that kind of heart where you are taking care of folks the way you would want to be treated or want your family treated (Zaragovia, 2021).
Carpenter, Z. (2017, March 6). What’s Killing America’s Black Infants? Retrieved from The Nation: https://www.thenation.com/article/archive/whats-killing-americas-black-infants/
Flourish. (2020). Racial Disparity in Health. Retrieved from Flourish: https://www.flourishstlouis.org/problem/equity/
Foundation. (2020). Reducing Infant Mortality. Retrieved from Missouri Foundation of Health: https://mffh.org/our-focus/infant-mortality/
Jung, S. (2019). The Endurance of the Color Line. Retrieved from Othering and Belonging: https://www.otheringandbelonging.org/endurance-color-line/
Louis, S. (2020). A Preservation Plan for St. Louis. Retrieved from St Louis-MO Government: https://www.stlouis-mo.gov/government/departments/planning/cultural-resources/preservation-plan/part-i-african-american-experience.cfm
Zaragovia, V. (2021, May 28). Trying To Avoid Racist Health Care, Black Women Seek Out Black Obstetricians. Retrieved from NPR: https://www.npr.org/sections/health-shots/2021/05/28/996603360/trying-to-avoid-racist-health-care-black-women-seek-out-black-obstetricians
Sarah Hobson, Ph.D. specializes in supporting teams, departments and schools, businesses, and government agencies in building inclusive innovative change-making communities who understand how to connect well with and join diverse populations in providing needed sustainable resources for all youth and families.