News to some, a well-known reality for people of color
It’s been said that when white people catch a cold, black people catch pneumonia. This adage painfully illustrates the striking contrast between the health and well-being of whites compared to that of African Americans. When black people get sick, they don’t just get sick but have more serious symptoms and a greater risk of dying from illness. Recent health statistics substantiate this saying.
In 2017, the average life expectancy for whites was 78.5 years compared to 74.9 years for African Americans. Infant mortality refers to the death of an infant before his or her first birthday. The infant mortality rate is the number of infant deaths for every 1,000 live births. According to the Centers for Disease Control and Prevention (CDC), the infant mortality rate is a key indicator for the health of a society. In the United States in 2016, the infant mortality rate for white infants was 4.9 deaths while the rate for African American infants was 11.4 deaths. The 2018 US maternal mortality rate is equally startling – 14.7 deaths per 100,000 live for white women and 37.1 deaths per 100,000 live births for black women. If you were unaware of these facts, I imagine that your jaw has hit the floor. This is the reality in 2020 for African Americans living in the US.
Media outlets all over the country are now telling a similar story for African Americans diagnosed with the coronavirus. According to an article on NPR, 1 in 3 people who end up hospitalized with COVID-19 are African American though blacks compromise only 13% of the US population. Additionally, a disproportionate number of COVID-19 deaths occur among African Americans. This is NOT a coincidence or by happenstance.
So, why? Why do African Americans get sicker and die sooner than other populations? The answer is complicated; but, it’s not just about genetics, gender, and bad choices. The full truth lies within the causes of the causes.
Health, health disparities, & health equity
It’s an interesting phrase, the causes of the causes. What does it mean? First, let’s discuss a few terms. Health, as defined by the World Health Organization (WHO), is “a state of complete physical, mental, and social well-being and not merely the absence of disease.” In the preamble, the WHO further states, “The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition … Governments have a responsibility for the health of their peoples which can be fulfilled only by the provision of adequate health and social measures.”
Healthy People 2020, an initiative of the federal government, outlines several goals designed to improve the health of our society including attaining health equity, eliminating health disparities, and improving the health of all populations irrespective of race, gender, socioeconomic status, etc. Healthy People 2020 defines a health disparity as “a particular type of health difference that is closely linked with social, economic, and/or environmental disadvantage. Health disparities adversely affect groups of people who have systematically experienced greater obstacles to health based on their racial or ethnic group; religion; socioeconomic status; gender; age; mental health; cognitive, sensory, or physical disability; sexual orientation; geographic location; or other characteristics historically linked to discrimination or exclusion.” It is important to note that these disparities are avoidable through policies and practices that extend beyond the health care sector.
Health equity requires fairness such that ALL people have opportunity to pursue the greatest level of health with equal access and distribution of societal power, wealth, resources, and opportunities, i.e. social justice.
The causes of the causes
It’s an interesting phrase, the causes of the causes. What does it mean? Sir Michael Marmot, Professor of Epidemiology and Public Health at University College London, has researched health inequalities extensively for three decades. He says, “The causes of the causes are the social determinants of health and they influence not only lifestyle, but stress at work and at home, the environment, housing and transport.”
The social determinants of health, according to the WHO, are the conditions within which people are born, grow, live, work, and age that impact health; factors like discrimination and social exclusion, an unjust legal system, lack of living wages, housing instability, poor access to quality health care, transportation limitations, food insecurity, income inequality, the built environment, and poor education. Individuals have little control over these factors, many of which bear the regrettable stain of structural racism. Consider redlining, the practice where lenders refused to provide mortgages or offered exorbitant rates to people living in certain neighborhoods. There were also racially restrictive covenants that essentially made it impossible for homeowners to sell their homes to people of certain racial backgrounds. Although no longer legal, the impact of these and other divisive practices continue to plague black people.
You may be wondering how the social determinants of health lead to more severe COVID-19 symptoms and higher mortality rates for blacks? African Americans have higher rates of underlying chronic health problems like hypertension, cardiovascular disease, and diabetes. African Americans are less likely to receive a high school diploma which means they work at low-wage jobs earning minimum wage which is not a living wage. Communities where they live are impoverished which means fast food is plentiful but fresh produce is rare; neighborhoods aren’t safe to walk and there are no gyms; and health care choices are limited. Such jobs typically do not provide benefits like health insurance or sick leave but are considered essential like hospital custodial staff, gas station attendants, or in public transportation where the risk of exposure to the coronavirus is high. Without savings and no other source of stable income, not working is simply not an option. African Americans already at high risk because of pre-existing illness that’s poorly managed must work in high risk environments where disease exposure is at an all-time high and social distancing and personal protective equipment is largely non-existent.
Change is long overdue; but, unfortunately, the political will for such change at the local, state, and national levels has been inconsistent at best and absent at worst. Dr. Fauci was bold enough to bring it to light amid the global pandemic, but this reality has been present for far too long in the United States. We must continue the goals established by Healthy People 2020, provide access to quality health care for all people irrespective of their zip code which has become a significant predictor of health, and implement a “health in all policies” approach that underscores the dialogue spelled out in the post. From education reform to housing initiatives to overhauling the criminal justice system, all can positively benefit the health of individuals and communities.
If it is true that a chain is only as strong as its weakest link, isn’t it also true a society is only as healthy as its sickest citizen and only as wealthy as its most deprived?– Maya Angelou