Racial Disparities in Healthcare
“Our lives begin to end the day we become silent about things that matter.”
Key Takeaways
Racial disparities in healthcare is defined as “racial or ethnic differences in the quality of healthcare that are not due to access-related factors or clinical needs, preferences, and appropriateness of intervention.”
Black people are more likely to suffer from chronic illness, such as high blood pressure and metabolic disease, and experience premature death compared to other populations in the U.S.
Change requires that we talk about health disparities in the context of the social and political history of race in the United States.
To elicit change, we must first:
Understand the issue
Increase awareness
Recognize and reduce your implicit bias
Racial disparities in healthcare won’t be remedied without an unyielding commitment to change.
Full Story
Imagine that everyone whose name started with a “J” was automatically subject to poor health outcomes. Everyone from John to Julie to James would experience higher rates of chronic disease and premature death compared to others, just because society developed in such a way that put them at a severe disadvantage. Would you sit idly by while your friend Jill, Uncle Jimmy, and Jennifer Aniston suffered due to no fault of their own? Or would you see the injustice for it was and demand a change?
For the entire history of healthcare, there have been severe racial disparities in health outcomes. Put another way, skin color and ethnicity have been and continue to be a major determining factor of the quality of healthcare one receives. Both very troubling and complex, this is an issue that I’m learning more about every day, and I do not have all the answers. But here are three 30,000 foot view points that may better shape your understanding - being informed is the first step to implementing change.
1. What is it?
Health disparities are “racial or ethnic differences in the quality of healthcare that are not due to access-related factors or clinical needs, preferences, and appropriateness of intervention'” (1, 2). Racial disparities are just one of many inequities that exist in the U.S. healthcare system, as disparities also exist across various aspects such as gender, sexual orientation, age, disability status, socioeconomic status, and geographic location (3-8).
2. What is the Severity?
Without a doubt, black people are more likely to suffer from chronic illness and experience premature death compared to other populations in the U.S. This study found that Black people were 30% more likely to die prematurely from heart disease and twice as likely to die prematurely from stroke compared to white people (9). Additionally, black people are more likely to suffer from high blood pressure, obesity, and develop certain kinds of cancer and dementia (10, 11, 12). As a more recent example, the research indicates that black people are more likely than other racial groups to die from COVID-19. 34% of deaths in people from this study were among non-Hispanic Black people, despite the fact that they only make up 12% of the population (13).
In addition to improving population health and preventing early death, reducing racial disparities in healthcare would result in profound downstream economic benefits. Racial disparities in healthcare are extremely costly. Some estimates show that health disparities account for $93 billion in medical care costs and $42 billion lost in productivity as a result of early deaths (14). As one example, this 2019 paper suggests that the economic benefit of reducing racial disparities in healthcare across Minnesota would generate an additional $1.2 - $2.9 billion per year in economic savings (15).
Finally, this issue will only compound as the country continues to become more diverse and the income gap expands. People of color will soon make up the majority of the population, as they are expected to account for 52% of the population by 2050 (16). Additionally, the richer are becoming richer and the poorer are becoming poorer. As of 2018, the richest 20% of households had an average yearly income of $234,000, about 17 times that of the average income of the bottom 20% (17, 18). If disparities in healthcare are not reduced, this economic gap will further subject people of lower income levels to poorer quality of treatment and worse outcomes, increasing the magnitude of the problem. Considering the reverberating ethical and socioeconomic repercussions, it becomes clear that racial disparities in healthcare deserves to be a top priority of healthcare advocates and government officials.
(18)
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3. What Can You Do About It?
Though significant progress has been made in support of health equity across the country, the disparities remain (19). Change requires that we talk about health disparities in the context of the social and political history of race in the United States. These are some daunting concepts, but the key word is TALK. To elicit change, we must first:
Understand the issue - take advantage of free information from reputable sources.
Increase awareness - discuss the issues with your friends and colleagues, repost informative messages on social media, attend peaceful protests and rallies, sign petitions, contact your legislators, etc.
Recognize and reduce your implicit bias - we all have bias. Through self reflection, we can better understand it.
Just as racial disparities in health care didn’t develop over night, they won’t be remedied without an unyielding commitment to change. Through more awareness, discussion, and compassion, we can take steps every day in the right direction (20, 21, 22).
Wrap Up
This Martin Luther King Jr. Day, my first instinct was to learn more about his diet and workout routine and share it with you all. Turns out, he was too busy making legendary civil rights strides to worry too much about his fitness. Addressing the important and very much understated issue of racial disparities in healthcare, I believe, turned out to be much more productive and purposeful use of my time. As a student of physical therapy at Duke University, I am lucky to have been able to learn about the injustices that exist in the healthcare space. Racial disparities in healthcare is just one of the many issues that plague our healthcare system and it is up to all of us, health provider or otherwise, to seek and fight for positive change.
Sources:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1924616/#:~:text=The%20Institute%20of%20Medicine%20
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1449502/?rendertype=abstract
https://jamanetwork.com/journals/jamaneurology/article-abstract/2763600
https://minorityhealth.hhs.gov/omh/browse.aspx?lvl=4&lvlid=25
http://click.alerts.jamanetwork.com/click/axac-12wapd-jms1qa-bah70xo1/
https://www.census.gov/content/dam/Census/library/publications/2019/demo/p60-266.pdf
