If you are a Black woman in America, you are 2.5 times more likely to die during or after childbirth than a white woman, and 40 percent more likely to die from breast cancer. You have higher rates of diabetes, hypertension and heart disease. If you are diagnosed with COVID-19, these preexisting health conditions make you more likely to be hospitalized and die from the virus. Similar disparities exist for other groups, especially the Latinx community.
Genetics plays a role in health, but there are larger and more insidious forces at work for Black Americans. Our nation lacks culturally competent, quality health care. Implicit bias among health care providers often prevents Black patients from accessing the best care or even obtaining appropriate treatments. Studies show that Black patients are less likely to be referred to a specialist for signs of heart problems than white patients with the same symptoms. And they are less likely to receive pain medication compared with white patients.
There are environmental and social drivers of health that also impact Black Americans. Our ZIP codes have a profound impact on how well and how long we live. In Baltimore, life expectancy can vary up to 20 years between wealthy, predominantly white neighborhoods and poverty-level, majority-Black neighborhoods.
That’s because economic and environmental inequality is pervasive. Residents in low-income neighborhoods often lack access to the basics: healthy and nutritious foods, clean water, health care, job opportunities and safe and affordable housing. Consequently, they have higher rates of obesity, asthma and other chronic conditions that are heavily influenced by community environments.
Whether intentionally or implicitly, racial bias and systemic racism in our society have created a public health crisis that commands our attention – and our immediate action.
To start, we must understand and acknowledge the vastly different experiences that Black people have in America and how these experiences undermine health. The poverty rate among Black Americans is more than double the rate among whites– largely caused by inequality in education and economic opportunity.
Black males are three times more likely to be killed during a police encounter compared with white males. George Floyd. Freddie Gray. Eric Garner. Rayshard Brooks. Their deaths, and many others like them, highlight racial inequities in law enforcement.
Living with racism is linked to elevated levels of stress and anxiety, which exacerbate chronic conditions such as high blood pressure, diabetes and asthma. Research suggests that the stress also impacts the professional success of Black Americans. A NEJM Catalyst study found that Black employees pay an “emotional tax” at work due to feelings that they must be “on guard” and protect against bias. This “tax” prevents Black employees from thriving in and outside of work.
Steps we can take
So how do we move from protests to action? How do we ensure sweeping changes to address systemic racism in our nation?
I believe there are five important steps that we in the medical community can take to support change and improve public health:
- Look in the mirror. We must identify biases in our patient care. This involves reviewing health outcomes data to understand what disparities exist and why. Use the data to educate and develop solutions.
- Train our staff. We must train our clinical teams – physicians, nurses and other staff – to deliver more culturally competent, patient-centered care. In a 2019 survey, 97% of respondents said their medical providers should ask about social needs, which are predictors of physical and mental health.
- Support health outside of the doctor’s office. Invest in community solutions to address socio-economic conditions. Support minority-owned businesses. Recently, the Local Initiatives Support Corporation (LISC) and Kaiser Permanente announced $60 million in business loans for Black and minority-led businesses. The health system will also invest $15 million in grants to help businesses overcome systemic economic disadvantage. More efforts are needed to support these businesses.
- Help shift policy. Use our knowledge, resources and influence to replace or change policies that harm. We must advocate for policies that are just and that drive equity and inclusion.
- Learn. Respond. As caregivers, we have an important role in listening to learn what prevents people from achieving health. We must have these conversations and then use this information to help address barriers, both in health care and throughout our communities.
This is long-term work. As we look to drive real and lasting change, we must be bold and committed to rebuilding a “new normal” that re-frames race in this country and addresses racism as a public health crisis.
Ruth Williams-Brinkley, RN, is regional president of Kaiser Permanente.