“There has never been any period in American history where the health of blacks was equal to that of whites,” Evelynn Hammonds, a historian of science at Harvard University, says. “Disparity is built into the system.”
The New York Times “Why doesn’t the United States have universal health care? The answer has everything to do with race.
Jeneen Interlandi AUG. 14, 2019
“Racism” and “Racist” are heated words in this culture and in this time. So be it, no way around it. A racist is defined by Ibram Kendi, in his 2019 book, How to be an Antiracist, as “one who is supporting a racist policy through their actions, inactions or expressing a racist idea”, and a racist policy is “any measure that produces or sustains racial inequity between racial groups”. While such definitions of racism can and will be debated, the question of whether our health care system is racist, needs to be faced. Can there be any doubt that the American Health Care system produces and sustains racial inequity?
Health outcomes by almost every measure are worse for people of color. For example, black women have a lower incidence of breast cancer than white women (124.3 vs 128.1 per 100,000) but the five-year survival of black women with breast cancer is 80%, the five-year survival for white women is 91%. A black woman is 22% more likely to die from heart disease than a white woman, 71% more likely to perish from cervical cancer and 243% more likely to die from pregnancy or childbirth-related causes.
In 2020, we have found that blacks and hispanics are 2-3 times more likely to die from Covid-19 than whites.[1][2]
The multiple, complex reasons for this are often referred to as the social determinant of health (SDH). They include; economic stability, physical environment, education, nutrition, community/social context and the health care system. Debating the importance of one determinant above another is a fool’s errand. They are all important. But it is clear that health care coverage, and the availability and cultural competency of providers and hospitals and the quality of care are critical.
Health insurance that is tied to employment has resulted in higher rates of un-insurance for black and Hispanic Americans. Even the current “safety net” of medicare and Medicaid have not contributed to equal coverage for all races.
In the US 2018 the uninsured rate was 7.5% for whites, 11.5% for blacks and 19.0% for non-white Hispanics. While these rates have gone down since the passage of the Affordable Care Act, they remain a true disparity. Blacks are 1.5 times more likely to be uninsured than whites and the Hispanic uninsured rate is over 2.5 times higher than for whites.
Blacks and Hispanics are more likely to delay or omit care than whites. We don’t have to imagine the reasons; bus schedules are unreliable, child care is unreliable, low paying jobs and no time off from work make the process of getting care difficult. Difficult, but not impossible.
High co-pays and no coverage make getting care impossible. People with lower incomes report poorer health, higher risk of disease, and shorter lives, at every level.[3] A system that produces and sustain these results is a racist system. A system that reduces racial inequality is anti-racist.
How could a universal health care system be anti-racist. It could
[1] https://www.commonwealthfund.org/publications/podcast/2020/jun/why-are-more-black-americans-dying-covid-19
[2] https://www.nytimes.com/interactive/2020/07/05/us/coronavirus-latinos-african-americans-cdc-data.html
[3] How are income and wealth linked to health and longevity, The Urban Institute https://www.urban.org/sites/default/files/publication/49116/2000178-How-are-Income-and-Wealth-Linked-to-Health-and-Longevity.pdf