In May of 2020, The Center for American Progress (CAP) reported that 10.6% of Black Americans and 16.1% of Hispanic Americans were uninsured (compared to 5.9% of white Americans without health insurance). CAP also noted that, in the U.S.:
- Nearly one out of every four adults of Hispanic heritage are managing high blood pressure.
- 12.6% of Black children have asthma (compared to 7.7% of white children).
- Hispanic women are 40% more likely to have cervical cancer than non-Hispanic white women.
- 42% of Black adults over the age of 20 struggle with hypertension (compared to 28.7% of white adults).
These statistics are startling, and they speak to the latent systemic racism in American culture, as well as within the health care system.
It is clear that these health disparities align with historical patterns of poverty in America. Centuries of structural racism in every system that shapes our lives – from health care to housing, schools, and employment – have created the extreme disparities that persist today. As a result, the average white family has eight times the wealth of the average Black family, and five times the wealth of the average Hispanic family.
Many of the health-related imbalances noted above can be explained when you consider the intersection of other systems with health. For example, the Federal Housing Association’s practice of “redlining” caused widespread racial segregation and little to no business investment (except for polluting industries like manufacturing, meat-packing, and transportation) in non-white neighborhoods. As a result, racially diverse areas offered few grocery stores or other amenities. The food deserts that still exist to this day are a direct result: 23.5 million people in the U.S. live in low-income areas that are farther than 1 mile to the nearest large grocery store. Other common health indicators like asthma and infant mortality rate also have direct ties to this historically unfair housing practice. Redlining is just one example of the many racist policies that succeed in perpetuating racism today.
Racism is a public health crisis
In April 2021, the CDC identified racism as a “serious threat” to public health. They affirmed their commitment to studying the social determinants of health and launched a portal on their website dedicated to addressing the structural racism that has led to the health disparities we see today.
The New York Times Magazine recently called attention to a 2016 survey of white medical students and residents wherein half of them endorsed at least one myth about physiological differences between black people and white people. One such myth is that nerve endings are less sensitive in Black bodies than white bodies. According to the article, “When asked to imagine how much pain white or black patients experienced in hypothetical situations, the medical students and residents insisted that black people felt less pain.” It is of the utmost importance that we dispel bigoted ideas such as this one, which stem from the centuries-old physiological justifications for slavery.
Breaking down structural racism at CommunityHealth
CommunityHealth has long prided ourselves on the high-quality care demonstrated in our health indicators. For example, our cancer screening rates far exceed the average of federally qualified health centers (primarily serving Medicaid patients) in Illinois. At the request of a new Board member in 2020, we began breaking down our quality measures by race and ethnicity. When we did, we quickly discovered that, for the small number of Black patients seen at CommunityHealth (less than 2% of patient population), quality measures fell far below that of other demographic groups. Further investigation revealed that almost all of the Black patients seen at CommunityHealth were transitional patients – those who qualify for Medicaid but are experiencing a lapse in coverage of just a few months.
Once the disparity was identified, the CommunityHealth team immediately took action to rectify the situation. Emphasis was placed on making sure that all Medicaid-eligible patients receive immediate referrals for routine screenings for cancer, HIV, and other transmissible diseases – as well as labs to review blood pressure and diabetes control. This resulted in critical diagnoses and expedited treatment plans designed to identify and address issues quickly, during the short time that these patients are in our care.
Within the larger ethnic groups we serve, our efforts at equity are also apparent. The majority of individuals served by CommunityHealth identify as Latinx. Though only about 64% of the Latinx population in Chicago is fully vaccinated against COVID-19, 75% of CommunityHealth’s Latinx patients are vaccinated. This is the result of extensive health promotion and education efforts to dispel fears hesitation about the vaccine throughout 2021. It also happened because we made a huge effort to meet patients where they were: CommunityHealth hosted Chicago’s first community vaccination pop-up event in the Belmont Cragin neighborhood in February 2020. We continue to ensure that testing and vaccinations are available every day to the vulnerable populations we serve.
Dismantling structural oppression is an immense challenge, but it is imperative that we acknowledge the existing disparities and tackle them with urgency. As health care providers, we often witness these disparities first-hand, and we are tasked with providing care. However, until we acknowledge and address how those disparities came to be, we’re treating the symptoms (our patients’ health issues) without curing the disease (structural racism). We need to confront racism from all sides: auditing clinic policies, updating medical school curricula, reviewing clinical algorithms, retraining health care leaders, creating wellness spaces designed by and for people of color, elevating BIPOC in the health care industry, establishing frameworks for accountability, and confronting racism on every level. This work is long overdue. Let’s work together to find and implement solutions.