Racism and Health Disparities: A Public Health Crisis in America
By: Donna Shambley-Ebron, RN, PhD, Transcultural Scholar, Associate Professor Emerita, University of Cincinnati College of Nursing
“Of all the forms of inequality, injustice in health is the most shocking and inhuman.”
Dr. Martin Luther King, Jr., 1966
From the cradle to the grave, Black Americans continue to bear an excess burden of illness and death when compared to White Americans. Black Americans outpace White Americans in deaths from cancer, heart disease, hypertension, stroke, and end-stage renal disease. Alarmingly, Blacks who are under the age of 65 die more frequently from chronic conditions that are found in Whites at much older ages (CDC, 2017). Moreover, Black women are 4-6 times more likely to die during childbirth than White women, and likewise, infant mortality rates are twice as high among Black babies (Krisberg, 2019). Most recently in the first six months of the COVID19 pandemic, non-Hispanic Black Americans have been overrepresented among those who have died (CDC, 2020). The life expectancy of Black Americans continues to lag behind White Americans. These unacceptable health disparities have been the subject of health scientists for some time, and yet very slow progress has been made in closing this gap in sickness and death. However, in recent years, public health scientists and practitioners have begun to acknowledge the major role that systemic racism plays in poorer health experienced by Black Americans.
Health disparities are often directly attributed to the Social Determinants of Health (SDOH). According to Healthy People 2020, the SDOH are defined as “the conditions in the environment in which people are born, live, work, play, worship, and age that affect a wide range
of health and quality of life outcomes (Healthy People 2020, 2020)”. Some examples of social determinants are: 1.) neighborhood and built environment (available green space, neighborhood walkability, suitable housing, public safety); 2.) health care system (access, availability, quality, health literacy); 3.) Economic stability (poverty, food insecurity, housing); 4.) education (access
to quality schools and educational opportunities), and 5.) the social and community context (discrimination, incarceration, community engagement, social cohesion and support). Although this explanation for disparities is quite valid given the less than optimal conditions in which many Black Americans exist; it is clear that these determinants can only be viewed and understood appropriately within the overarching context of systemic racism which has created and shaped these determinants.
Systemic racism can be explained as the systems, structures, and institutions that serve to oppress and render powerless a group of people based on the socially constructed designation of race. It also includes practices that marginalize groups as “others” and restricts them from experiencing the full benefits of society’s institutions that are fully available to the majority group. Moreover, systemic racism includes daily experiences of discrimination that can create unhealthy coping mechanisms among those who are impacted. Both implicit and explicit bias in the health care system have been especially egregious in eroding the trust of Black Americans in the health care system.
The impact of the constant social environment of racism that ranges from major experiences to daily microagressions have even warranted diagnoses of post-traumatic stress disorder (PTSD) (Williams, 2019). This repetitive trauma is finally being recognized as a source of poorer health among Black Americans. In a 2018 article published in the American Journal of
Public Health, the writers call for “public health practitioners to acknowledge the centrality of racism--the entrenched discriminatory practices of institutions” as necessary to eliminate the tragic health disparities that exist between Black and White Americans (Bassett & Graves, 2018, p. 458).
With the murder at the hands of police of George Floyd played out on televisions screens across the nation, and the chants of “Black Lives Matter” in the streets; states, counties, and jurisdictions across the country have declared racism as a public health crisis. This year, the American Public Health Association declared that “racism is an ongoing public health crisis that needs our attention now” (APHA, 2020). The urgency for change has never been more evident since the 1960’s civil rights movement. It is now the time to translate these declarations into tangible, purposeful, and strategic actions to dismantle the systems of oppression that create health disparities and lead to excessive morbidity and mortality in Black Americans.
American Public Health Association (2020, May 29). Racism is an ongoing public health crisis that needs our attention now. [News Release]. https://www. apha.org
Bassett, M.T & Graves, J.D. (2018). Uprooting institutionalized racism as public health practice. American Journal of Public Health, 108 (4), 457-458.
Centers for Disease Control and Prevention (2020). Provisional death counts for Coronavirus disease 2019 (COVID19). https://www.cdc.gov
Centers for Disease Control and Prevention (May 2017). African American health. Vital Signs, https://www.cdc.gov
Healthy People 2020. (2019). Social determinants of health. https://www.healthypeople.gove/2020/topics-objectives/topic/social-determinants-of-health.
Krisberg, K. (2019). Programs work from within to prevent black maternal deaths: Workers targeting root cause-racism. The Nation’s Health, 49 (6) 1-17.
Williams, M. T., Metzger, I. W., Leins, C., & DeLapp, C. (2018). Assessing racial trauma within a DSM–5 framework: The UConn Racial/Ethnic Stress & Trauma Survey. Practice Innovations, 3(4), 242–260. http://dx.doi.org/10.1037/pri0000076