Estimated Reading Time: 13 minutes
[Content Warning: This post contains information about racial disparities in maternal and infant mortality. There are also references to the mistreatment of Black people by doctors.]
“African Americans in particular face discrimination in the world of healthcare too. A 2012 study found that a majority of doctors have ‘unconscious racial biases’ when it comes to their black patients. Black Americans are far more likely than whites to lack access to emergency medical care. The hospitals they go to tend to be less well funded, and staffed by practitioners with less experience...And it seems that facing a lifetime of racism leaves African Americans vulnerable to developing stress-related health issues that can lead to chronic issues later in life.” [“7 Ways We Know Systemic Racism Is Real” on the Ben and Jerry’s site]
[Content Warning: This post contains information about racial disparities in maternal and infant mortality. There are also references to the mistreatment of Black people by doctors.]
“African Americans in particular face discrimination in the world of healthcare too. A 2012 study found that a majority of doctors have ‘unconscious racial biases’ when it comes to their black patients. Black Americans are far more likely than whites to lack access to emergency medical care. The hospitals they go to tend to be less well funded, and staffed by practitioners with less experience...And it seems that facing a lifetime of racism leaves African Americans vulnerable to developing stress-related health issues that can lead to chronic issues later in life.” [“7 Ways We Know Systemic Racism Is Real” on the Ben and Jerry’s site]
In addition, the Kirwan Institute for the Study of Race and Ethnicity reported in the “Implicit Bias Review,” “A 2012 study used identical case vignettes to examine how pediatricians’ implicit racial attitudes affect treatment recommendations for four common pediatric conditions. Results indicated that as pediatricians’ pro-[w]hite implicit biases increased, they were more likely to prescribe painkillers for vignette patients who were [w]hite as opposed to Black. This is just one example of how understanding implicit racial biases may help explain differential health care treatment, even for youths.”
I am continuing in the systemic racism series here on the Broadening the Narrative blog. To learn more about this series, you can read the first nine posts on the BtN blog. I am learning and sharing as a learner, not as a teacher or an expert. Today’s post addresses systemic racism in the healthcare system. I will include the data and history behind the current disparities, provide action steps, and link recommended resources for further exploration and education.
Data
Let’s look at healthcare data for maternal mortality, infant mortality, and COVID-19.
Maternal Mortality
According to the “Pregnancy Mortality Surveillance System” for the Centers for Disease Control and Prevention (CDC):
“Considerable racial/ethnic disparities in pregnancy-related mortality exist. During 2011–2016, the pregnancy-related mortality ratios were:
Maternal Mortality
According to the “Pregnancy Mortality Surveillance System” for the Centers for Disease Control and Prevention (CDC):
“Considerable racial/ethnic disparities in pregnancy-related mortality exist. During 2011–2016, the pregnancy-related mortality ratios were:
-42.4 deaths per 100,000 live births for [B]lack non-Hispanic women.
-30.4 deaths per 100,000 live births for American Indian/Alaskan Native non-Hispanic women.
-14.1 deaths per 100,000 live births for Asian/Pacific Islander non-Hispanic women.
-13.0 deaths per 100,000 live births for white non-Hispanic women.
-11.3 deaths per 100,000 live births for Hispanic women.”
Infant Mortality
The statistics available from 2018 from the Kids Count Data Center “Infant mortality by race in the United States” table show the following:
-7.5 deaths per 1,000 for American Indian infantsInfant Mortality
The statistics available from 2018 from the Kids Count Data Center “Infant mortality by race in the United States” table show the following:
-3.4 deaths per 1,000 for Asian/Pacific Islander infants
-10.7 deaths per 1,000 for Black or African American infants
-5.1 deaths per 1,000 for Hispanic or Latino infants
-4.6 deaths per 1,000 for white infants"
COVID-19
The CDC reported in “COVID-19 in Racial and Ethnic Minority Groups,” “As of June 12, 2020, age-adjusted hospitalization rates are highest among non-Hispanic American Indian or Alaska Native and non-Hispanic black persons, followed by Hispanic or Latino persons.
COVID-19
The CDC reported in “COVID-19 in Racial and Ethnic Minority Groups,” “As of June 12, 2020, age-adjusted hospitalization rates are highest among non-Hispanic American Indian or Alaska Native and non-Hispanic black persons, followed by Hispanic or Latino persons.
-Non-Hispanic American Indian or Alaska Native persons have a rate approximately 5 times that of non-Hispanic white persons,
-non-Hispanic [B]lack persons have a rate approximately 5 times that of non-Hispanic white persons,
-Hispanic or Latino persons have a rate approximately 4 times that of non-Hispanic white persons.” [I accessed this information on July 4, 2020. The page is now titled "Health Equity Considerations and Racial and Ethnic Minorities" as of August 3, 2020.]
In the American Council on Science and Health article “Coronavirus: COVID Deaths in U.S. By Age, Race,” Alex Berezow wrote, “The following chart depicts U.S. coronavirus deaths by race.
In the American Council on Science and Health article “Coronavirus: COVID Deaths in U.S. By Age, Race,” Alex Berezow wrote, “The following chart depicts U.S. coronavirus deaths by race.
The number that stands out here is the percentage of COVID deaths that occurred among Black Americans. Blacks constitute about 13% of the U.S. population but suffered 23% of all COVID deaths.”
Finally, in The New York Times article “The Fullest Look Yet at the Racial Inequity of Coronavirus,” Richard A. Oppel Jr., Robert Gebeloff, K.K. Rebecca Lai, Will Wright, and Mitch Smith reported, “Latino and African-American residents of the United States have been three times as likely to become infected as their white neighbors, according to the new data, which provides detailed characteristics of 640,000 infections detected in nearly 1,000 U.S. counties. And Black and Latino people have been nearly twice as likely to die from the virus as white people, the data shows...The data also showed several pockets of disparity involving Native American people. In much of Arizona and in several other counties, they were far more likely to become infected than white people. For people who are Asian, the disparities were generally not as large, though they were 1.3 times as likely as their white neighbors to become infected.”
History
In the Refinery 29 video “The Terrifying Threat to Pregnant Black Women and Their Babies,” Danielle Cadet, VP, Content Strategy and Development, and Managing Editor, spoke with Laura E. Riley, MD about the experiences of Black women giving birth. Cadet said, “Black women have said that they have told their doctors that they were in pain, that they were uncomfortable, that something was wrong, and that they weren’t listened to.” Riley explained, “I think that there’s a lot of unconscious bias that sort of sets up a situation where you hear what you think you hear. You know, ‘Oh, she’s always complaining of pain,’ or these preconceived notions that actually work against the patient.” In a voiceover, Cadet says, “It might be hard for some to imagine, but if we need proof of how racism has affected the perception of Black pain, we don’t have to look very far.” Cadet then met with Bill Pretzer, Senior Curator at the Smithsonian Institution for the National Museum of African American History and Culture.” Pretzer traced the origins of modern racial health disparities when he delineated, “There’s been a long tradition, going back at least as far as the United States was founded, of white physicians treating Black patients like they are subhuman, that they do not feel pain like white people. And particularly, the tradition that happens time and time again of a Black population being isolated and treated like lab animals. One of the most infamous instances of white physicians experimenting on enslaved women is Dr. Marion Sims, who began in the 1830s. Having access to enslaved women, he was very interested in a series of gynecological diseases and abnormalities that he then used surgery, without any anesthetic, to try to repair.” Cadet continued, “[Dr. Marion Sims] is known as the father of modern gynecology. He used Black women to learn. These were actually slaves who were being violated. Using the Black body as a source of experimentation isn’t limited to Dr. Sims. From the infamous Tuskegee study, a secret experiment on untreated syphilis in Black men, to what became known as the Mississippi Appendectomy, in which Black women were sterilized without consent. The Black American experience has too often been a painful one.”
In the American Bar Association article “The Impact of Structural Racism in Employment and Wages on Minority Women’s Health,” Ruqaiijah Yearby wrote, “During the Jim Crow era, structural racism sponsored by the federal and state governments explicitly created advantages for Caucasians and disadvantages for African Americans. Structural racism still exists after the Jim Crow era, which significantly disadvantages minority women and limits their access to health care...As a result of structural racism in employment and wages, minority women tend to live in poverty and have limited access to health care even after the implementation of the Affordable Care Act because they do not have health insurance from their jobs or they cannot afford to pay for health care. As discussed above, women are segregated to low-paying jobs that do not provide health insurance. Consequently, 1 in 10 women remained uninsured in 2017. Wage gaps also lessen the amount of income women have to spend on health care services; thus, it is not surprising that 1 in 4 women have reported delaying or forgoing health care in the past year due to costs.”
Nina Lakhani wrote in The Guardian article “'Heat Islands': Racist Housing Policies in US Linked to Deadly Heatwave Exposure,” “Heatwaves have been occurring more frequently since the mid-20th century, and are expected to become more common, more severe and longer-lasting due to the climate crisis. However, exposure to extreme heat is unequal: temperatures in different neighborhoods within the same city can vary by 20F. It is mostly lower-income households and communities of color who live in these urban ‘heat islands’ which have historically had fewer green spaces and tree canopy, and more concrete and pavements and thus are less equipped to cope with the mounting effects of global heating...This new study examined the link between historic ‘redlining’ and current heat islands.”
In the New York Times article “Climate Change Tied to Pregnancy Risks, Affecting Black Mothers Most,” Christopher Flavelle expounded on this by writing, “Pregnant women exposed to high temperatures or air pollution are more likely to have children who are premature, underweight or stillborn, and African-American mothers and babies are harmed at a much higher rate than the population at large, according to sweeping new research examining more than 32 million births in the United States. The research adds to a growing body of evidence that minorities bear a disproportionate share of the danger from pollution and global warming. Not only are minority communities in the United States far more likely to be hotter than the surrounding areas, a phenomenon known as the ‘heat island’ effect, but they are also more likely to be located near polluting industries...Compounding the added risks from warming and pollution, Dr. Basu said, research has shown that minority communities tend to have less access to medical help and that minority patients tend not to receive equal levels of treatment.”
With all of the history in mind as well as the current living and working conditions of Black Americans, Nikole Hannah-Jones shared why it makes sense that Black Americans are being disproportionately impacted by COVID-19 in the MSNBC video “Nikole Hannah-Jones: ‘It’s Not Surprising that Black Americans are Bearing the Brunt of Coronavirus.’” Hannah-Jones elucidated this point by saying, “Black Americans remain the most segregated group of people in this country, the most likely to live in areas with lots of pollutants and toxins in the environment, [and] live in areas that don’t have access to level one trauma centers. They’re the most likely to be working in the service sector public-facing jobs, least likely to own cars, most likely to take public-transit, so all the ways that this virus was spread. And at the top of that, living in conditions without access to quality health care. Black Americans were more likely to get the virus and then of course have been more likely to die from it.”
Finally, in The New York Times article “The Fullest Look Yet at the Racial Inequity of Coronavirus,” Richard A. Oppel Jr., Robert Gebeloff, K.K. Rebecca Lai, Will Wright, and Mitch Smith reported, “Experts point to circumstances that have made Black and Latino people more likely than white people to be exposed to the virus: Many of them have front-line jobs that keep them from working at home; rely on public transportation; or live in cramped apartments or multigenerational homes...The risks are borne out by demographic data. Across the country, 43 percent of Black and Latino workers are employed in service or production jobs that for the most part cannot be done remotely, census data from 2018 shows. Only about one in four white workers held such jobs. Also, Latino people are twice as likely to reside in a crowded dwelling — less than 500 square feet per person — as white people, according to the American Housing Survey...The higher rate in deaths from the virus among Black and Latino people has been explained, in part, by a higher prevalence of underlying health problems, including diabetes and obesity. But the new C.D.C. data reveals a significant imbalance in the number of virus cases, not just deaths — a fact that scientists say underscores inequities unrelated to other health issues...Dr. Bassett, a former New York City health commissioner, said there is no question that underlying health problems — often caused by factors that people cannot control, such as lack of access to healthy food options and health care — play a major role in Covid-19 deaths. But she also said a big determinant of who dies is who gets sick in the first place, and that infections have been far more prevalent among people who can’t work from home.”
The centuries old belief that Black people do not feel pain like white people continues to affect Black people today. Khiara M. Bridges reported in “Implicit Bias and Racial Disparities in Health Care” for the American Bar Association, “One study showed that physicians whose IAT tests revealed them to harbor pro-white implicit biases were more likely to prescribe pain medications to white patients than to black patients. Another study administered an IAT test to physicians and then asked them whether they would prescribe thrombolysis—an aggressive, yet effective treatment for coronary artery disease—to patients presenting symptoms for coronary artery disease. The experiment revealed that physicians whom the IAT tests revealed harbor anti-black implicit biases were less likely to prescribe thrombolysis to [B]lack patients and more likely to prescribe the treatment to white patients.” Bridges concluded, “Proposing that implicit biases are responsible for racial disparities in health might seem dangerous if one believes that individual and structural factors can never operate simultaneously. But this is not the case. United States’ policies make public health insurance unavailable to undocumented immigrants as well as documented immigrants who have been in the country for less than five years. Our residential neighborhoods remain dramatically segregated. We have a two-tiered health care system that provides wonderful care to those with private insurance and mediocre care to those without. The list of structural factors that make people of color sicker than their white counterparts is long. If providers’ implicit racial biases contribute to excess morbidity and mortality among people of color, we must recognize that individuals with implicit biases practice medicine within and alongside structures that compromise the health of people of color.”
Action Steps
Complete additional research on the topic of systemic racism in the healthcare system. I will link additional resources at the end of the post.
Have action that follows your research and reflection.
-Support policies at every level of government that will bring reform to the healthcare system.
Finally, in The New York Times article “The Fullest Look Yet at the Racial Inequity of Coronavirus,” Richard A. Oppel Jr., Robert Gebeloff, K.K. Rebecca Lai, Will Wright, and Mitch Smith reported, “Latino and African-American residents of the United States have been three times as likely to become infected as their white neighbors, according to the new data, which provides detailed characteristics of 640,000 infections detected in nearly 1,000 U.S. counties. And Black and Latino people have been nearly twice as likely to die from the virus as white people, the data shows...The data also showed several pockets of disparity involving Native American people. In much of Arizona and in several other counties, they were far more likely to become infected than white people. For people who are Asian, the disparities were generally not as large, though they were 1.3 times as likely as their white neighbors to become infected.”
History
In the Refinery 29 video “The Terrifying Threat to Pregnant Black Women and Their Babies,” Danielle Cadet, VP, Content Strategy and Development, and Managing Editor, spoke with Laura E. Riley, MD about the experiences of Black women giving birth. Cadet said, “Black women have said that they have told their doctors that they were in pain, that they were uncomfortable, that something was wrong, and that they weren’t listened to.” Riley explained, “I think that there’s a lot of unconscious bias that sort of sets up a situation where you hear what you think you hear. You know, ‘Oh, she’s always complaining of pain,’ or these preconceived notions that actually work against the patient.” In a voiceover, Cadet says, “It might be hard for some to imagine, but if we need proof of how racism has affected the perception of Black pain, we don’t have to look very far.” Cadet then met with Bill Pretzer, Senior Curator at the Smithsonian Institution for the National Museum of African American History and Culture.” Pretzer traced the origins of modern racial health disparities when he delineated, “There’s been a long tradition, going back at least as far as the United States was founded, of white physicians treating Black patients like they are subhuman, that they do not feel pain like white people. And particularly, the tradition that happens time and time again of a Black population being isolated and treated like lab animals. One of the most infamous instances of white physicians experimenting on enslaved women is Dr. Marion Sims, who began in the 1830s. Having access to enslaved women, he was very interested in a series of gynecological diseases and abnormalities that he then used surgery, without any anesthetic, to try to repair.” Cadet continued, “[Dr. Marion Sims] is known as the father of modern gynecology. He used Black women to learn. These were actually slaves who were being violated. Using the Black body as a source of experimentation isn’t limited to Dr. Sims. From the infamous Tuskegee study, a secret experiment on untreated syphilis in Black men, to what became known as the Mississippi Appendectomy, in which Black women were sterilized without consent. The Black American experience has too often been a painful one.”
In the American Bar Association article “The Impact of Structural Racism in Employment and Wages on Minority Women’s Health,” Ruqaiijah Yearby wrote, “During the Jim Crow era, structural racism sponsored by the federal and state governments explicitly created advantages for Caucasians and disadvantages for African Americans. Structural racism still exists after the Jim Crow era, which significantly disadvantages minority women and limits their access to health care...As a result of structural racism in employment and wages, minority women tend to live in poverty and have limited access to health care even after the implementation of the Affordable Care Act because they do not have health insurance from their jobs or they cannot afford to pay for health care. As discussed above, women are segregated to low-paying jobs that do not provide health insurance. Consequently, 1 in 10 women remained uninsured in 2017. Wage gaps also lessen the amount of income women have to spend on health care services; thus, it is not surprising that 1 in 4 women have reported delaying or forgoing health care in the past year due to costs.”
Nina Lakhani wrote in The Guardian article “'Heat Islands': Racist Housing Policies in US Linked to Deadly Heatwave Exposure,” “Heatwaves have been occurring more frequently since the mid-20th century, and are expected to become more common, more severe and longer-lasting due to the climate crisis. However, exposure to extreme heat is unequal: temperatures in different neighborhoods within the same city can vary by 20F. It is mostly lower-income households and communities of color who live in these urban ‘heat islands’ which have historically had fewer green spaces and tree canopy, and more concrete and pavements and thus are less equipped to cope with the mounting effects of global heating...This new study examined the link between historic ‘redlining’ and current heat islands.”
In the New York Times article “Climate Change Tied to Pregnancy Risks, Affecting Black Mothers Most,” Christopher Flavelle expounded on this by writing, “Pregnant women exposed to high temperatures or air pollution are more likely to have children who are premature, underweight or stillborn, and African-American mothers and babies are harmed at a much higher rate than the population at large, according to sweeping new research examining more than 32 million births in the United States. The research adds to a growing body of evidence that minorities bear a disproportionate share of the danger from pollution and global warming. Not only are minority communities in the United States far more likely to be hotter than the surrounding areas, a phenomenon known as the ‘heat island’ effect, but they are also more likely to be located near polluting industries...Compounding the added risks from warming and pollution, Dr. Basu said, research has shown that minority communities tend to have less access to medical help and that minority patients tend not to receive equal levels of treatment.”
With all of the history in mind as well as the current living and working conditions of Black Americans, Nikole Hannah-Jones shared why it makes sense that Black Americans are being disproportionately impacted by COVID-19 in the MSNBC video “Nikole Hannah-Jones: ‘It’s Not Surprising that Black Americans are Bearing the Brunt of Coronavirus.’” Hannah-Jones elucidated this point by saying, “Black Americans remain the most segregated group of people in this country, the most likely to live in areas with lots of pollutants and toxins in the environment, [and] live in areas that don’t have access to level one trauma centers. They’re the most likely to be working in the service sector public-facing jobs, least likely to own cars, most likely to take public-transit, so all the ways that this virus was spread. And at the top of that, living in conditions without access to quality health care. Black Americans were more likely to get the virus and then of course have been more likely to die from it.”
Finally, in The New York Times article “The Fullest Look Yet at the Racial Inequity of Coronavirus,” Richard A. Oppel Jr., Robert Gebeloff, K.K. Rebecca Lai, Will Wright, and Mitch Smith reported, “Experts point to circumstances that have made Black and Latino people more likely than white people to be exposed to the virus: Many of them have front-line jobs that keep them from working at home; rely on public transportation; or live in cramped apartments or multigenerational homes...The risks are borne out by demographic data. Across the country, 43 percent of Black and Latino workers are employed in service or production jobs that for the most part cannot be done remotely, census data from 2018 shows. Only about one in four white workers held such jobs. Also, Latino people are twice as likely to reside in a crowded dwelling — less than 500 square feet per person — as white people, according to the American Housing Survey...The higher rate in deaths from the virus among Black and Latino people has been explained, in part, by a higher prevalence of underlying health problems, including diabetes and obesity. But the new C.D.C. data reveals a significant imbalance in the number of virus cases, not just deaths — a fact that scientists say underscores inequities unrelated to other health issues...Dr. Bassett, a former New York City health commissioner, said there is no question that underlying health problems — often caused by factors that people cannot control, such as lack of access to healthy food options and health care — play a major role in Covid-19 deaths. But she also said a big determinant of who dies is who gets sick in the first place, and that infections have been far more prevalent among people who can’t work from home.”
The centuries old belief that Black people do not feel pain like white people continues to affect Black people today. Khiara M. Bridges reported in “Implicit Bias and Racial Disparities in Health Care” for the American Bar Association, “One study showed that physicians whose IAT tests revealed them to harbor pro-white implicit biases were more likely to prescribe pain medications to white patients than to black patients. Another study administered an IAT test to physicians and then asked them whether they would prescribe thrombolysis—an aggressive, yet effective treatment for coronary artery disease—to patients presenting symptoms for coronary artery disease. The experiment revealed that physicians whom the IAT tests revealed harbor anti-black implicit biases were less likely to prescribe thrombolysis to [B]lack patients and more likely to prescribe the treatment to white patients.” Bridges concluded, “Proposing that implicit biases are responsible for racial disparities in health might seem dangerous if one believes that individual and structural factors can never operate simultaneously. But this is not the case. United States’ policies make public health insurance unavailable to undocumented immigrants as well as documented immigrants who have been in the country for less than five years. Our residential neighborhoods remain dramatically segregated. We have a two-tiered health care system that provides wonderful care to those with private insurance and mediocre care to those without. The list of structural factors that make people of color sicker than their white counterparts is long. If providers’ implicit racial biases contribute to excess morbidity and mortality among people of color, we must recognize that individuals with implicit biases practice medicine within and alongside structures that compromise the health of people of color.”
Action Steps
Complete additional research on the topic of systemic racism in the healthcare system. I will link additional resources at the end of the post.
Have action that follows your research and reflection.
-Support policies at every level of government that will bring reform to the healthcare system.
In the American Bar Association article “The Impact of Structural Racism in Employment and Wages on Minority Women’s Health,” Ruqaiijah Yearby reported, “Companies also should be required to provide health insurance for low-wage and minority women workers. Finally, companies should be required to provide additional health care resources to minority women to cope with experiencing structural racism.”
In the section “Part II: Policies to increase the Native American employment rate” of the Economic Policy Institute briefing paper “Native Americans and Jobs: The Challenge and the Promise,” by Algernon Austin, the interconnectedness of systems is highlighted. Austin wrote, “Improve maternal and child health: There are lessons for Native Americans from research on African Americans. While black students perform worse than white students on standardized tests, black test scores have improved over time, and the black–white test score gap narrowed considerably over the 1980s. Recent research suggests that this narrowing was due to improved neonatal health outcomes for black children following the desegregation of hospitals in the 1960s. The researchers conclude that ‘investments in health through increased access at very early ages have large, long-term effects on [educational] achievement’ (Chay, Guryan, and Mazumder 2009).A larger proportion of Native Americans than whites are uninsured, and they fare poorly on health access measures. Native Americans who have health coverage through the federally funded Indian Health Service have low rates of contact with health professionals (James, Schwartz, and Berndt 2009). The post-neonatal mortality rate of Native Americans is about twice that of whites (National Center for Health Statistics 2013). Improvement of the maternal and child health of Native Americans is likely to improve the educational performance of Native American children.”
In the section “Part II: Policies to increase the Native American employment rate” of the Economic Policy Institute briefing paper “Native Americans and Jobs: The Challenge and the Promise,” by Algernon Austin, the interconnectedness of systems is highlighted. Austin wrote, “Improve maternal and child health: There are lessons for Native Americans from research on African Americans. While black students perform worse than white students on standardized tests, black test scores have improved over time, and the black–white test score gap narrowed considerably over the 1980s. Recent research suggests that this narrowing was due to improved neonatal health outcomes for black children following the desegregation of hospitals in the 1960s. The researchers conclude that ‘investments in health through increased access at very early ages have large, long-term effects on [educational] achievement’ (Chay, Guryan, and Mazumder 2009).A larger proportion of Native Americans than whites are uninsured, and they fare poorly on health access measures. Native Americans who have health coverage through the federally funded Indian Health Service have low rates of contact with health professionals (James, Schwartz, and Berndt 2009). The post-neonatal mortality rate of Native Americans is about twice that of whites (National Center for Health Statistics 2013). Improvement of the maternal and child health of Native Americans is likely to improve the educational performance of Native American children.”
-Write, email, call, and tag representatives and others in local, state, and federal political positions. Demand that they “understand [and] address historical and contemporary structural racism in laws and policies affecting the social determinants of health that cause poverty and lead to racial health disparities” as explained in the excerpt by Ruqaiijah Yearby below.
In the American Bar Association article “The Impact of Structural Racism in Employment and Wages on Minority Women’s Health,” Ruqaiijah Yearby explained, “In 2010, at the end of the great recession that disproportionately harmed racial minorities and women, the federal government recognized that health disparities are caused by the social determinants of health (SDOH) (Figure 1), which are outside an individual’s control. In fact, research shows that SDOH account for 80 to 90 percent of health factors that contribute to health outcomes. One of the five SDOH is economic stability (employment and wages), which accounts for 40 percent of the health factors that contribute to health outcomes. To address the SDOH and health disparities, state and local governments adopted the health-in-all-policies (HiAP) approach to integrate policy responses across sectors and used health impact assessments (HIAs) to ensure decisions regarding laws and policies consider the health impacts. Unfortunately, recent research has shown that the application of HiAP and use of HIAs has not resulted in broad changes or actual reductions in the SDOH or health disparities. This is because neither the HiAP nor the HIAs require government officials or policymakers to understand or address historical and contemporary structural racism in laws and policies affecting the SDOH that cause poverty and lead to racial health disparities.”
-Donate to organizations like Black Women Birthing Justice and Birthing Beautiful Communities that are addressing racial disparities in the healthcare system.
Vote, show up, and engage in meaningful ways to dismantle systems of oppression. Do all of this under the leadership of Black, Brown, Indigenous, Asian, and Pacific Islander People of Color.
What to Expect in Future Posts
Vote, show up, and engage in meaningful ways to dismantle systems of oppression. Do all of this under the leadership of Black, Brown, Indigenous, Asian, and Pacific Islander People of Color.
What to Expect in Future Posts
At this time, I plan to address systemic racism as seen in the environment, the media, the military, politics, and the Christian church in future posts. I will give action steps for myself and readers and provide additional resources.
As I look at the Equal Justice Initiative calendar and read it to my kids, I see that every single day conveys at least one injustice, usually based on race. These are past and present injustices, spanning hundreds of years, demonstrating that racism in this country is not simply an individual problem. Rather, racism is a systemic problem, infecting institutions and structures. Further, this problem centers around justice, therefore it's a problem Godde is concerned about, which means I must be concerned. In my opinion, systemic racism is not solely a political issue but also a spiritual issue. I am called to love my neighbor, and one way I can do this is by joining the fight to dismantle systems of oppression so that all people can flourish.
(Resources are linked below.)
National Black Doulas Association
BLACK FEMINIST PERSPECTIVES ON COVID-19: A READING LIST
National Black Doulas Association
BLACK FEMINIST PERSPECTIVES ON COVID-19: A READING LIST
Videos to View
Race Forward “What is Systemic Racism? - Infant Mortality”
Podcasts (for your listening pleasure and discomfort)
The Stakes “Giving Birth While Black”
Recommended Reading
Articles
“American Indian and Alaska Native Maternal and Infant Mortality: Challenges and Opportunities” by Lucy Truschel and Cristina Novoa
“Birthing While Black: An Experience I’ll Never Forget” by Denene Millner
“Eliminating Racial Disparities in Maternal and Infant Mortality” by Jamila Taylor, Cristina Novoa, Katie Hamm, and Shilpa Phadke
“Implicit Racial/Ethnic Bias Among Health Care Professionals and Its Influence on Health Care Outcomes: A Systematic Review” by William J. Hall, PhD, Mimi V. Chapman, PhD, Kent M. Lee, MS, Yesenia M. Merino, MPH, Tainayah W. Thomas, MPH, B. Keith Payne, PhD, Eugenia Eng, DrPH, Steven H. Day, MCP, and Tamera Coyne-Beasley, MD
“Mass Incarceration, Stress, and Black Infant Mortality” by Connor Maxwell and Danyelle Solomon
“Study of Nearly 41,000 Women Who Almost Died Giving Birth Shows Who’s Most at Risk” by Lindsay Admon, M.D., M.Sc. and Vanessa Dalton, M.D., M.P.H.
"The Sex Education Expert Speaking Up About Medical Racism" by Ananya Garg (added October 13, 2020)
"Why America's Black Mothers and Babies Are in a Life-or-Death Crisis" by Linda Villarosa (added October 23, 2020)
Books
Battling Battling Over Birth: Black Women & The Maternal Health Care Crisis in California by Chinyere Oparah, Linda Jones, Dantia Hudson, Talita Oseguera and Helen Arega
Medical Apartheid: The Dark History of Medical Experimentation on Black Americans from Colonial Times to the Present by Harriet A. Washington
Thick: and Other Essays by Tressie McMillan Cottom
Music (that may make you uncomfortable)
“Long Live the Champion” by KB feat. Yariel and GabrielRodriguezEMC
“Fan Mail” by Micah Bournes feat. Propaganda
“A Time Like This” by Micah Bournes
“Too Much?” by Micah Bournes
“Land of the Free” by Joey Bada$$
“Cynical” by Propaganda feat. Aaron Marsh and Sho Baraka
#systemicracism #racismissystemic #racism #prejudicepluspower #dismantlewhitesupremacy #endracism #endracismnow #antiracism #antiracist #becomingantiracist #beingantiracist #healthcare #health #care #politics #policies #justice #loveyourneighbor #seekjustice #restorativejustice #transformativejustice #facethepast #healthefuture #equality #vote #showup #blog #blogger #challengethenarrative #broadeningthenarrative
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