Racism, Health Disparities, and the State of Black Health in the US
"There is no American history without African American history,” said Sara Clarke Kaplan, executive director of AU's Antiracist Research & Policy Center (ARPC) and author of The Black Reproductive: Unfree Labor and Insurgent Motherhood in a recent interview with NPR. “The Black experience is embedded in everything we think of as American history."
The theme of this year’s Black History Month is Black Health and Wellness, and Kaplan’s comments are as true for the state of health and wellness in our nation as they are for American history. There is no way to examine health in the United States without examining the historic and systemic health inequities that that have put communities of color at higher risk for disease and death.
Black History Month’s Health and Wellness theme this year gives us an opportunity to examine the many reasons behind these health inequities, which have grown even more dire during the COVID-19 pandemic. We asked Assistant Professor of Health Studies Jessica Young and Public Health Scholars Director Martinique Free to provide some insights into the social determinants of health in our nation, and the inequities faced by in particular by Black women and children.
Health Inequities and Unjust Health Outcomes
Jessica Young, Assistant Professor, Department of Health Studies
The ongoing COVID-19 pandemic forces us to reckon with the ongoing inequities in the social determinants of health (SDOH). SDOH are social factors that influence our health, such as education, income, employment, transportation, food accessibility and quality, and housing, among others. Existing inequities in the SDOH prior to the pandemic have negatively impacted the health of Black Americans. These inequities have been documented for over a century, beginning with W.E.B. Du Bois’ The Health and Physique of the Negro American (1906). One of Du Bois’ findings that has stuck with me throughout my career is that the high infant mortality rate among Black infants is “an index of social condition…The matter of sickness is an indication of social and economic position.”
This quote also applies to the pandemic.
The racial inequities in the risk factors for not only contracting COVID-19, but also dying from it, are rooted in the SDOH. The social and economic positions of Black populations in the United States, from being more likely to be exposed to air pollution to attending public schools with lead pipes, no air conditioning, and inadequate ventilation, puts Black communities at higher risk for illness and death. Add the fact that Black communities are more likely to receive less and lower quality health care, the pandemic, combined with the SDOH, is a recipe for unjust health outcomes. For instance, while Black and white children have similar case rates of COVID-19, Black children are more likely to be hospitalized and more than twice as likely to die from COVID-19 than white children.
These issues have solutions. The pandemic has provided opportunities to improve the social and economic conditions of Black communities. The Economic Impact Payments (stimulus checks) showed that if we, as a society, decide to give people more money, they can use those funds to pay for resources that promote health, like rent, utilities, and more nutritious foods. Investing in high-quality and accessible health care in Black communities and addressing historical discrimination in health care is another way policy can be leveraged to address racial health inequities. Because health inequities are a social problem, we can use social solutions to create equal chances for good health for all.
Inequities Within and Beyond the Healthcare System
Martinique C.G. Free, Director, AU Public Health Scholars Program
Black women have a history of embarking on self-determination, mutual aid, and social support initiatives. These efforts were formalized with the establishment of the National Association of Colored Women in the 1880s, all while they were facing segregation and racism. Health and wellness for Black women has evolved since the 19th century, and advocacy organizations are encouraging us to embrace radical self-care by prioritizing our holistic well-being. This is especially important because of the inequities Black women still face within and beyond the healthcare system and how these inequities contribute to Black women having some of the highest morbidity and mortality rates of any group.
As economic security is tied to greater health outcomes, it’s also important to highlight advocacy around the wage disparity that Black women are paid 64 cents for every dollar paid to white, non-Hispanic men (U.S. Census Bureau, 2021) which puts us at a further disadvantage to provide for or equitably contribute to our households. In addition to wage disparity, advocacy organizations are creating resources to address stressors including the imposition of microaggressions, and structural racism experienced by Black women in the workplace. The Black Women’s Health Imperative, one of the largest organizations created by Black women to advance the health and wellness of Black women and girls, created an Anti-Racism Toolkit for wellness. The intention of the toolkit is to help Black women practice healing and self-care while navigating discrimination in the workplace.
Not often are advocacy organizations recognized for innovating programming and shifting policy to improve quality of life and health outcomes for Black women. As this Black History Month’s theme is centering Black Health and Wellness, it is important to acknowledge and celebrate the accomplishments Black women have made for better health and healing.