“‘Lord, when did we see you…sick…and did not minister to you?’-Matthew 25:44
How healthy a person is, and how long they live, varies in America based partially on the color of a person’s skin. Racial disparities in health outcomes have been well documented across our country for decades. The infant mortality rate for African Americans is double that of the infant mortality rate for White Americans. Native Americans are nearly three times as likely to have diabetes than White Americans. Hispanic women are 20% more likely to die of cervical cancer than White women in the United States. Roughly 13% of African American children suffer from asthma, while the disease afflicts 8% of White American children. Statistics like these can go on for a depressingly long time. So, what is going on? How are people who are created equally, and beloved equally, by God experiencing such distressing differences in their physical (and mental) health?
Before we explore the “why” behind racial health inequities in our country it is important we pause and acknowledge what isn’t driving these disparate outcomes. What isn’t a contributing factor to poorer health in minority individuals is any sort of deficiency in people of color or specific ethnic cultures. We are quick to blame the victim. When we hear of the relatively high rates of terminal cervical cancer in Hispanic women, for example, maybe we imagine that Latinas are prone to making less responsible sexual health choices than White women. This line of thinking is wrong however. It ultimately reasons that because White Americans are the healthiest (and if health is a measure solely of genetics and good decision making) then White Americans must be genetically and/or morally superior to Americans of color. Clearly, we know that White people are not superior in any way to non-White people.
Black, Hispanic, and Native Americans are sicker than their White compatriots because of a harmful mix of environmental factors, difficulty accessing healthcare, and implicate bias in the medical system.
People of color are more likely to live in polluted and underserved neighborhoods and communities. Children in North Minneapolis, a neighborhood with a high proportion of Black residents, are six times more likely to suffer a life-threatening asthma attack than children elsewhere in the state. North Minneapolis is bisected by smog causing freeways and sits right next to a trash incinerator which belches out pollutants. When the lead-laced water of Flint Michigan poisoned the city’s youth it was largely people of color who were affected (roughly 60% of Flint’s residents are African Americans). While too much “bad stuff” often leads to health problems, not enough “good stuff” can also result in poor health. Black, Indigenous, and Hispanic Americans are more likely to live in areas where accessing healthy food is difficult. Without easy access to healthful foods chronic conditions such as diabetes and heart disease become harder to stave off. On some American Indian reservations access to clean water is severely limited; an estimated one in 10 Indigenous Americans lack access to safe tap water or basic sanitation. Clean water is essential to maintaining good health.
When we get sick, we all need access to the medical system. Access to our nation’s hospitals and clinics is not equally granted however. Black, Hispanic, and Native Americans are less likely to have health insurance than White Americans. People who are uninsured, or underinsured, are more likely to skip preventative care and seek care later than people who are appropriately insured. This delay in care often has sickening, and even deadly, consequences. Missing a cancer screening may mean the difference between catching a cancer when it easily treatable and when it is terminal. Heading to the ER after ignoring chest pain for hours could mean incurring preventable permanent cardiac damage.
Once within the doors of the hospital or clinic people of color may face another barrier to good care; implicit bias in their doctor or nurse. A systemic review of racism in medicine by National Institutes of Health concluded that “The attitudes and behaviors of health care providers have been identified as one of many factors that contribute to health disparities.…implicit bias was significantly related to patient–provider interactions, treatment decisions, treatment adherence, and patient health outcomes.”. Healthcare workers are people. They are just as likely to have prejudiced suppositions about the patients they care for as anyone else. When a doctor dismisses the complaints of a Black women in labor, he may be missing signs that would indicate a serious pregnancy complication. Implicate bias in physicians is thought to be one of the primary reasons African American and Native American women are two to three times more likely to die from pregnancy-related causes than white women. Racial bias in healthcare workers all to often leads to inadequate care and poor outcomes.
The reasons for our nation’s racial health inequities are vast and complicated. There are things we can do to address this unholy state of affairs however. Healthcare workers must examine their own biases and commit to addressing them. We can all pay attention to the way pollution affects our neighbors, and advocate for fairer and cleaner communities. Our Lady of Guadalupe Free Clinic in Worthington, MN and the Phillips Neighborhood Clinic in Minneapolis both serve people who are uninsured, many of whom are Hispanic and African American. Donate to them. We are all called to pray for an end to racism; in Medicine, our communities, our workplaces. Everywhere. Amen.