Why do health inequities persist?
There’s an old adage that “when white folks catch a cold,
Black folks get pneumonia.”
The COVID-19 epidemic has made it deadly clear. Throughout North America, wherever data is tracked, people of African heritage have higher coronavirus infection rates, higher death rates of COVID-19, and are carrying an inequitable burden of many other diseases to boot.
In 1984, the U.S. Department of Health and Human Services commissioned the Heckler Report, a landmark study of racial and ethnic minority health. Heckler declared the lack of progress on racial injustice and health care was an “affront to our ideals and to the genius of American medicine.” Since then, very little has changed.
For instance, research studies to this day still identify Black populations as having the highest mortality rate of any racial or ethnic group for all cancers combined and for most major individual malignancies.
North Americans of African ancestry are 60% more likely to suffer from Type 2 diabetes than white people and more than twice as likely to die from this disease. They undergo more lower limb amputations, too, one of the many terrible complications of diabetes. They’re 3.5 times more likely to die of endstage kidney disease, 40% more likely to have hypertension, and 20% more likely to die from heart disease.
How well do different racial groups start out in life? By comparison, some not well. Black infants born in the U.S. are almost four times more likely to die from complications due to low birth weight than non-Hispanic white infants.
What about the current pandemic? The Centers for
Disease Control and Prevention reports that through May 2020 Black Americans were three times more likely than white Americans to become infected with the coronavirus. The rate of hospitalization or death from COVID-19 was nearly four times that of whites. Rates among Native Americans, Hispanics, and Alaska Natives are also higher than white Americans.
These higher rates have triggered false information. For example, some have claimed racial groups are more genetically susceptible. But socioeconomic factors tell the real story.
Health outcomes, fundamentally, are determined not by race, but by place. Reports from across North America show that coronavirus testing sites are less likely to be located in the neighborhoods home to ethnic minorities. On average, people in these communities rely more on public transportation and living conditions tend to be more crowded, both factors increasing the chance of infection.
The list goes on and on. Many of these communities are “food deserts,” areas having limited access to affordable fresh fruits and vegetables, which results in people eating more junk food, which in turn causes obesity, Type 2 diabetes, and heart disease. Less access to green spaces and playgrounds is another health trap.
If this isn’t enough, another report shows that those who live in racial and ethnic minority communities are at greater risk of death from particle pollution. This is caused by dirt, smoke, and soot in the air, increasing the risk of chronic obstructive lung disease, asthma and lung cancer.
Will we ever get our act together to end these injustices? More reports will be published, surely as another streetcar will come down the track. The New England Journal of Medicine and the Journal of the American Medical Association have published support for making health care equitable.
But the real need is for lasting behavior changes. This means training everyone — medical professionals and everyone else — on unconscious bias, microaggressions, and how to advance anti-racist efforts. And it means addressing structural inequalities through better policies and investments.
Let’s hope that we do not leave this injustice to the next generation. It’s been aptly said that “The greatest amount of wasted time, is the time wasted by not getting started.”
Dr. Ken Walker (W. Gifford-Jones, M.D.) is a graduate of the University of Toronto and Harvard Medical School. He trained in general surgery at the Strong Memorial Hospital, University of Rochester, Montreal General Hospital, McGill University and in gynecology at Harvard. He has been a general practitioner, ship’s surgeon and hotel doctor. He is also the author of 10 books. Contact him at info@docgiff.com.