New Haven Register (New Haven, CT)
Health crisis for Black, Hispanic people
Lower life expectancy among the issues spotlighted by pandemic
Public health professionals and scholars have written for decades about systemic racism being a major cause of Americans who are Black, Hispanic or Native American having poorer health and life expectancy than white people.
The intense focus on race relations after George Floyd’s killing and the disproportionate impact of the COVID-19 pandemic on people of color have brought the issue even more into the forefront, with a growing number of cities and states declaring racism a public health crisis.
Tekisha Dwan Everette, an assistant clinical
professor in social and behavioral sciences at the Yale School of Public Health, has been leading the call in Connecticut to recognize racism’s role in overall health as executive director of Health Equity Solutions in Hartford. “To me it becomes clear that there is a problem here, and first we have to name the problem. And once we name the problem, we can fix it,” she said.
“All the research shows that when you’re a person of color that you are more than likely experiencing stress in your daily life related to covert and overt racism,” she said. It comes from being followed in a store or “when you see a police car and don’t know what the outcome is going to be from people who are supposed to protect the public,” she said.
In August 2019, the American Academy of Pediatrics declared, “Racism is a social determinant of health that has a profound impact on the health status of children, adolescents, emerging adults, and their families.”
According to the Robert Wood Johnson Foundation, “Health varies markedly by income within every racial group, and racial or ethnic differences can be seen at each level of income. These patterns are seen across a wide range of health conditions. At the same time, findings from studies in the U.S. and other countries have found that perceived racial/ethnic bias—and the resulting toxic stress — makes an additional contribution to racial or ethnic disparities in health.”
While overtly racist words and actions increase the stress and trauma people of color experience, it is the institutionalized racism in society that is most to blame, Everette said.
“It’s not about the people. It’s about the policies, environment and systems that are creating the environment
in which people are living and working and causing some of the conditions we are seeing,” she said.
Historic redlining of neighborhoods, cementing segregation in cities, is one root cause. Schools, which in Connecticut are financed by property taxes, are unevenly supported, leading to lower education levels, poorer chances at good jobs and a lack of affordable health insurance, she said.
The impact on health is huge, and the COVID pandemic has put a spotlight on how social inequities affect health. According to the Centers for Disease Control and Prevention, Native Americans have the highest age-adjusted rate of the disease, 5.5 times that of whites. Blacks follow at 4.4 times the rate and Hispanics at four times.
Black women die of pregnancy-related causes at almost 3.2 times the rate of white women, and the problem is not solely a factor of income. Such deaths “for black and [American Indian/Alaskan Native] women with at least some college education were higher than those for all other racial/ethnic groups with less than a high school diploma,” the CDC has stated.
White people can expect to live three years longer than Black people, though Hispanics’ life expectancy is three years more than whites’, according to the CDC. And Blacks are twice as likely to be killed by police as whites, despite comprising 13 percent of the population, according to a Washington Post study . Hispanics are almost twice as likely as whites to be victims of police killings.
More than 20 cities and counties and at least three states, Michigan, Ohio and Wisconsin, have declared racism a public health crisis, according to the Pew Charitable Trusts. Windsor, Hartford, Bloomfield and West Hartford have done so, and others are considering taking such action, according to the
Connecticut Mirror.
The New Haven Board of Alders will take up resolutions at its meeting Monday to declare racism a public health crisis and to form “a working group to recommend appropriate actions regarding racism as a public health issue in New Haven.”
“We think there needs to be a statewide commitment,” Everette said. “The naming part is important, but the action part is even more important.” Police reform is “a really good first step,” she said. Then, “I think we should be looking at our budgeting process to see how we privilege some communities over others. … I do think we need to make better investments and different investments in health care and education.”
The goal, Everette said is that “people of color are welcomed, uplifted and wanted just like everyone in our state.”
Danya Keene, an associate professor in the Yale School of Public Health, said there’s no doubt the differences in health outcomes between cultures is based on systemic racism, beginning with slavery. “Everything can be linked back. There’s no other explanation,” she said.
Keene focuses on housing policy, which she said “is very important to people’s health. We know having a safe, affordable place to live is important.” But the United States has “a long history of racist housing policy,” from redlining and other barriers to home ownership to demolition of Black neighborhoods through redevelopment.
“There’s zoning practices that make it hard to build affordable housing in certain places. … There’s huge wealth differences. Where does that come from?” she said.
Even though redlining — excluding people of color from certain neighborhoods — was made illegal by the Fair Housing Act of 1968, “that has implications for African Americans’ housing today,” Keene said.
“Grocery stores have very tight margins and tend not to be located in low-income neighborhoods.”
“When we think about health, we think it’s food, it’s exercise,” but it’s also affected by stressors,
“these constant threats to well-being,” such as learning of another Black person killed by police, she said.
Other examples are the mass incarceration of primarily Black men for lesser crimes than white criminals commit. “We also know that when you have a criminal record, it’s more difficult to get housing, and when you don’t have … a safe place to live, you’re more likely to be arrested,” she said.
“Research has shown that exposure to racism in all these different forms … creates kind of a toxic stress that chips away at the body,” Keene said. In what Arline Geronimus of the University of Michigan has called “weathering,” “your cells are actually aging more rapidly,” Keene said. From high blood pressure to diabetes,
“Black Americans experience these comorbidities at younger ages due to this toxic stress,” she said.
Also, she said, “these health disparities by race … exist between Black and white Americans even at the highest income levels.” They also have not gotten smaller over time. Comparing infant mortality, “the disparity is greater between Blacks and whites than it was in 1850,” Keene said.
She said racism also manifests itself in a pandemic, because it “leads to disproportionate exposure to the virus, it makes people more vulnerable to the effects of the virus when they’re exposed, and it also shapes the kind of health care they receive.”
The Rev. Kelcy Steele, pastor of Varick Memorial AME Zion Church in New Haven’s largely Black Dixwell neighborhood, has called for the city to declare racism a public health crisis “because, first of all,
we have to account for the added stress mentally and physically because of the trauma.”
That includes “the fear of being stopped by a police officer, the trauma that a parent feels when their young child goes out the door. … No matter how we look at it, racism is directly correlated with our health, mental health.”
He also pointed to past policies. “When you look back in the historical records, those areas that experienced redlining are the ones that are struggling now,” he said.
He said white people need to work to dismantle racism as allies, “working on the unconscious biases and really seeing what they can do to contribute to the well-being of Blacks and begin to work toward some type of reparation.”
Another way to bridge the gap, Steele said, is to “encourage Black people and white people to support Black-owned businesses and Black-owned enterprises and really begin to look at this inequity. The Black dollar and the white dollar is circulating everywhere except in Black and urban neighborhoods.”
Gregg Gonsalves, an assistant professor in the School of Public Health, calls the racial gap in health outcomes “death by public policy. You can go back pretty far into history and see … that public policies go hand in hand with race,” he said.
In order to reverse the problem, more resources need to be put into helping people of color improve their health, Gonsalves said. “Let’s hire people not just to do contact tracing but to build health from the ground up. Do you have enough food to eat? You might get evicted. … You haven’t been tested for diabetes.”
He said despite the gains of Medicare, Medicaid, the Clean Water Act and other public policies, since the era of President Ronald Reagan “we’ve had this stunted notion of what we can do for each other.”
Dr. Vikas Saini is president of the Lown Institute, a think tank in Brookline, Mass., that focuses on health care. “We made a fateful decision at the end of World War II to opt for employer-based health coverage,” he said.
Based on private insurance vs. Medicare and Medicaid, “hospitals are put in the position where they are revenue-seeking organizations,” Saini said. “The way we’ve structured our health care system, there are more financial incentives and financial rewards … if you focus on elective procedures, people that are relatively healthier.” He said some large health systems discourage caring for Medicare and Medicaid patients.
The financial losses hospital-based systems suffered because of the COVID pandemic were “a shock to the system,” Saini said. “They need to rethink their business models. They need to partner with their communities in making the case that reimbursements ought to be changed. … COVID-19 shows that hospitals really are essential partners in every community.”
Vincent Petrini, vice president for public affairs for the Yale New Haven Health System, said Medicare reimburses the hospitals at 88 percent of its costs, and Medicaid “in the 40s.” But he added, “It doesn’t impact the way we provide care. Two-thirds of our patients are insured by either Medicaid or Medicare. That’s across all services we provide.”
Petrini said serving all populations is part of Yale New Haven’s mission as “a safety net hospital.” He said some of the losses brought by the pandemic were because the hospitals decreased the number of patients from more than 100 percent capacity to 60 percent, in order to reduce the risk of exposure. “That led to financial distress as well,” he said.