The pandemic has illuminated long-standing inequities in the American health care system, and it will take a nation to fix them
Structural racism in the U.S. seeps into many aspects of Black Americans’ lives. As we’re witnessing with the coronavirus pandemic, health is no exception. Evidence has emerged showing Black people in the U.S. have an increased likelihood of being diagnosed with COVID-19, and they are twice as likely to die from the disease, according to data from the Centers for Disease Control and Prevention.
Part of the reason Black people are disproportionately affected, according to the CDC, is due to living conditions racial and ethnic minority groups experience in the United States. These conditions contribute to underlying health issues, and research has linked these underlying health issues to adverse health outcomes that put them at greater risk for hospitalization should they contract COVID-19.
Diseases continue to disproportionately affect certain populations due to the vast disparities in economic and social conditions, said Rachel R. Hardeman, an associate professor at University of Minnesota’s School of Public Health, who studied race, gender and health since 2007.
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Today, her research is focused on structural racism and its effects within the health care system — and the health care inequalities the pandemic has revealed do not surprise her. For generations, social limitations within our society have continued to widen disparities and have further compromised the health of marginalized populations, she explained.
In a paper published in the New England Journal of Medicine, Hardeman and her colleagues provided a comprehensive explanation of the terms race and racism: Race is the social classification of an individual based on physical features, and racism is a system of structuring opportunity and assigning value based on race that unfairly disadvantages some and advantages others. The researchers explicitly stated that in order to address this topic within our health care system, researchers, clinicians and public health professionals must first recognize and understand both terms.
Most health care policies perpetuate vast inequalities among groups, Hardman said. The majority of U.S. health care workers are white; therefore, the approach and development of policies within the system does not broadly reflect the historical context of racism, which has disproportionately affected Black Americans.
“Without acknowledging and understanding that history, we cannot move forward to tackle racism,” Hardeman states.
The COVID-19 pandemic has revealed the health care system is broken, said Terence Keel, an expert on the interconnectedness of science and racism in his role as an associate professor at University of California Los Angeles.
The virus has shown how racism, capitalism and inequality all play off one another, he added. Many without jobs and those who are affected most by the pandemic are now protesting to dismantle a system in which racism persists.
“Until now, one of our challenges was to convince people that structural racism exists. Nowadays, it is inspirational to see young people protesting and fighting to challenge this system,” Keel enthusiastically said. “I believe we are turning a new corner.”
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Keel said not only do Black Americans want less policing and more accountability; they also want equal job opportunities and longer, healthier lives. For that to be possible, the health care and economic system must change. For that to happen, we need changes in health care policies, and we also need to see changes in economic laws that favor wealthy and advantaged communities.
He teaches a course on critical issues in public health, which focuses on understanding the risk factors of structural racism. The class further explores racial inequalities to better understand why and how COVID-19 disproportionately affects certain populations.
Keel’s research has linked harmful environmental pollutants to diseases, and his studies have shown such pollutants exist largely in low-income neighborhoods where working-class, Black communities reside. Due to the long-term effects of the pollutants, those communities are at higher risk of being diagnosed with cancer and other chronic conditions.
These conclusions are in line with recent research at the Harvard T. H. Chan School of Public Health on the impact of COVID-19 and its linkage to air pollution, which found that elevated levels of fine particulate matter are associated with an increase in COVID-19 deaths.
“Racism is a public health crisis,” said Jaime Slaughter-Acey, assistant professor at University of Minnesota’s School of Public Health. Her research has focused on the adverse effects of maternal and child health in marginalized communities, showing Black women are at greater risk of death during pregnancy, childbirth and postpartum than their white counterparts.
Slaughter-Acey believes grassroots engagement can help close the gap.
“Organizations like Black Mamas Matter Alliance, whose primary mission is to advocate, drive research, build power and shift culture for Black maternal health, rights and justice are exactly what is needed. The organization has already done a lot of groundwork that allows us to have conversations about racial disparities that are evident during the pandemic,” Slaughter-Acey said. “Every incident is intertwined. Therefore, it is important to make the connections between racism and public health now.”
Following the enactment of the Civil Rights Acts in 1964 and 1968 and the Voting Rights Act in 1965, people assumed that equality had been achieved, Slaughter-Acey pointed out.
“We have made huge strides since then,” she said, “in terms of gaining important and necessary rights for Black Americans and people of color. However, we lost the momentum and acknowledgment that so much more work needs to be done. The country moved on and shifted their focus on other things. Now, due to incidents such as the death of George Floyd, we are back on the path of achieving equality, in a true sense.”
Hardeman, Keel and Slaughter-Acey all hold positions at the Center for the Study of Racism, Social Justice & Health, which, since its inception in 2017, has consisted of scholars and experts in the field studying and promoting health equity through research, teaching and community engagement.
In response to the pandemic, the center developed a Task Force on Racism and Equity in March. One of its goals is to address the collateral consequences expected in communities of color and socially disadvantaged communities.
While Hardeman, Keel and Slaughter-Acey continue to conduct research on inequalities in health care systems due to structural racism, organizations that are at the intersection of the academic world and the local community, such as the Othering and Belonging Institute, are taking a holistic approach to address marginality.
During the pandemic, the institute has developed a vulnerability map showing which groups are most marginalized by COVID-19 in the state of California. Such maps allow the group to better understand the socioeconomic disparities within the communities that are most affected.
Additionally, the institute is focused on generating awareness of the Kerner Report.
Much like today, in the 1960s, the U.S. saw uprisings in more than 100 cities across the nation in response to violent police encounters. To investigate the underlying conditions of racial segregation and discrimination that gave way to them, President Lyndon B. Johnson established the National Advisory Commission on Civil Disorders. The resulting report was signed by the political commission at that time and listed approximately 100 recommendations related not only to policing, but also to unemployment, housing, education and welfare to address the issues at hand.
Since that time, very few of the recommendations have been implemented. The Othering and Belonging Institute hosted conferences in the past to bring like-minded people together to assess the progress of the recommendations and to determine how to support and improve the implementation process.
The institute’s director of research, Stephen Menendian, said the core cause of racism is structured within a system that increases over generations. Therefore, such systems are not about individuals’ views. Rather, they are about societal views.
“To change the systems, we have to develop the political will to act,” Menendian said. He is hopeful about changes for the future, as there is currently momentum in the country among professionals, activists and leaders at all levels.
Based on the ongoing work in the face of the pandemic, as well as the discussions surrounding racial justice, I believe there is potential to make an impact. While public health professionals continue to do the work on achieving racial justice in the health care field, it is just as important for everyone else in the community to do their part, whether it is in the form of advocating to dismantle oppressive laws or training future activists to bring awareness to these issues.
Everyone has a role to play, and if we address this together, we can collectively tackle structural racism.
Rupal Ramesh Shah examines the intersection of public health and social justice in this periodic column she writes for Street Roots. Shah has bachelor's degrees in biology and chemistry from Southern Wesleyan University, a master’s degree in microbiology from Clemson University and a master’s degree in public health from Boston University. She has extensive experiences in the field of infectious diseases through her prior work at Harvard University’s School of Public Health in the Department of Immunology and Infectious Diseases and Partners in Health. Currently she serves as the executive director of Konbit Sante, an organization that supports the development of health systems in Haiti.
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