The disparities have long been documented. Black people are more likely than white people to die from cancer. They are more likely to suffer from chronic pain, diabetes, and depression. Black children report higher levels of stress. Black mothers are more likely to die in childbirth.

Those findings are part of a mountain of research cataloguing the complex and widespread effects that racism has on the health — and the medical care — of Black people in the U.S. Those effects stretch back centuries and take different forms, from discriminatory diagnostics to institutional barriers to care, all of which affect a person’s health.

But while the problem has been studied for decades and improvements have been made, many disparities persist unchecked.

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The demonstrations sparked by the killing of George Floyd in Minneapolis have prompted a reckoning over racism and police brutality. But, among those in the medical communities, there have also been calls for urgent action to address the role that systemic racism plays in health disparities among Black people.

“Health disparities still exist because nothing has truly changed,” said Ashley McMullen, an assistant professor of internal medicine at University of California, San Francisco.

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The Covid-19 pandemic has only made those disparities — and the structural discrimination they are rooted in — all the more apparent. Black Americans have been dying at about 2.4 times the rate of white Americans. As medical anthropologist Clarence Gravlee put it in Scientific American: “If Black people were dying at the same rate as white Americans, at least 13,000 mothers, fathers, daughters, sons and other loved ones would still be alive.”

“People of color right now are more likely to be infected, and we’re more likely to die. What we’re seeing here is the direct result of racism,” said Camara Phyllis Jones, an epidemiologist who recently served as president of the American Public Health Association. “That’s the thing that is slapping us in the face. Actually, it’s lashing us like whips.”

The systemic discrimination that has impacted Black health so inordinately dates back to the first ships carrying enslaved Africans that crossed the Atlantic. The colonial narrative of hierarchy and supremacy exists to this day, Jones said, and has translated, centuries later, into gaping health disparities.

Today, Black people in the U.S. are more likely than white people to live in food deserts, with limited access to fresh fruit or vegetables. They are less likely to be able to access green spaces, and more likely to live in areas without clean water or air. Black children are more likely to grow up in high-poverty areas. Black adults are more frequently exposed to greater occupational hazards, often working in frontline jobs across many fields.

The list goes on. All of these factors shape health, and all are shaped by structural racism.

“The air you breathe, the food you eat, the visual representations of what your future could look like — all are distorted by structural racism.”

Jessica Isom, psychiatrist and researcher

“The air you breathe, the food you eat, the visual representations of what your future could look like — all are distorted by structural racism,” said Jessica Isom, a community psychiatrist in Boston who studies health disparities in the Black community. “Other kids have internalized ideas of white supremacy — and that will have deep effects on a Black child’s psyche and body.”

And Black individuals often face baked-in barriers to accessing the resources that could help offset, even in part, the impacts of those effects, such as high-quality health care.

“The fact that the Black body experiences so much more harm, in so many ways, compared to other bodies — it really explains how racism continues to hurt people,” said Roberto Montenegro, a psychiatrist at Seattle Children’s Hospital who studies how perceived discrimination affects mental health.

Studies have shown that long-term discrimination can lead to a disruption in the stress hormone cortisol, leaving people with less biological energy and more fatigue, said Elizabeth Brondolo, a psychologist at St. John’s University who researches the issue. That type of chronic, sustained stress contributes to health conditions like diabetes, obesity, and depression. It can also take a significant toll on mental health.

“Everyone feels stress, but we forget how many more resources some people have to mitigate stress when they’re not a member of a discriminated group,” Brondolo said.

And structural social and economic disadvantages don’t account completely for health disparities, Montenegro said. One study compared childbirth outcomes of wealthy, educated Black women against white women with less income and education and found Black women have worse outcomes than white women with fewer resources.

“This is clear evidence that racism, and its biological and social impact, transcend a lot of the things we say we should work on — like education and income and poverty,” Montenegro said. “Black women experience racism; white women do not.”

The American Academy of Pediatrics last year published a policy statement on how racism is a core cause of health problems in children and adolescents. What wasn’t? Race itself. The paper drove home a crucial point: Racism, not race, affects health, and race shouldn’t be used to explain away disparities caused by racism.

“People think of race as a biological factor in health outcomes, when it is not,” said Jacqueline Dougé, medical director of the Howard County Health Department in Maryland and a co-author of that statement.

But that fact is not always carried over to medical education. In her coursework for medical school, Isom, the psychiatrist and health disparities researcher in Boston, said she was taught about disease risk factors grouped by age, sex, and race. Students weren’t, however, taught about racism itself. It’s a gap in the curriculum that other researchers and students have pointed out before.

“There’s an explicit lack of mentioning that it’s racism, as opposed to race, that is the root cause of vulnerability to disease,” Isom said.

“We were taught that to be Black was a risk factor for these diseases, without any context — because they think the Black body is flawed,” she added.

McMullen, the UCSF internal medicine professor, said her medical education focused on the most well-known examples of racism and mistreatment in medicine — such as the Tuskegee syphilis experiments on Black men or the story of Henrietta Lacks’ cell line — but did not involve a deeper exploration of why such stark health disparities persist today.

The remnants of racist ideology, too, can be found in certain medical devices. Take the spirometer, a tool that measures lung capacity. There’s often a button on it that “corrects” for race. Black people are measured on a different rubric than white people, based on rationale that dates back to when physicians on plantations used the tool to unjustly rationalize why slaves were fit only for field labor. The same settings are still in use today.

“That button came from medical racism,” Isom said. It’s one of a number of medical tools — from algorithms used in hospital care to tests for kidney function — that have been inaccurately shaped by racism against Black people and that can harm their health.

“Racist practices of medicine lead to worse outcomes.”

Roberto Montenegro, psychiatrist and researcher, Seattle Children's Hospital

“Racist practices of medicine lead to worse outcomes,” Montenegro said.

For that to change, the entire health care field — from medical schools and professional societies to hospitals and medical device manufacturers — needs to work to unravel and address racism within the system.

“I think health care is protected from this broader discourse because the narrative is that we’re all heroes,” said McMullen, who is working on an audio documentary about the issue. “We don’t actually address that the structure being perpetuated in health care is the same dynamic that’s playing out in the criminal justice system.”

While the effect of racism on health is well-established, progress will take time — and has to occur on a societal level, Dougé said. That has to involve a wide range of actions, including improving wages and closing pay gaps, improving access to health insurance, and ensuring more diversity in the health care system so that practitioners can provide culturally competent care.

“There has to be a systemic change,” Dougé said, “because racism — not race — has a profound impact on our health outcomes.”

  • Facts will help inform this conversation and the debate regarding the Political Movement of BLM. “Police shootings are not the reason that blacks die of homicide at 8 times the rate of whites and Hispanics combined: criminal violence is”-Heather MacDonald. Police fatally shot 9 unarmed blacks in 2019 and 19 unarmed whites. A police officer is 18 1/2 times more likely to be killed by a black male than an unarmed black male is to be killed by a police officer.

  • I was thinking using the exact same parallel regarding how the corona-virus displays systemic racism on a global scale.
    Multiple myeloma, a rare malignancy of plasma cells, was first described in 1950 as an abnormal production of immunoglobulins. (1) It accounts for approximately 10 to 15% of all hematologic malignancies, 1% of all malignant neoplasms in whites and 2% in blacks, and 2% of deaths from all malignancies. (1-3).
    The medication to remain alive after a successful stem cell transplant cost $20,000 for 21 pills per month and is called Revlimid a drug created in the 60’s and protected by a flotilla of lawyers to keep out generics.
    Thanks for the great article and letting me vent.

  • This is an informative eye-opening article. Many will deny this truth: there is systemic racism and it means much more illness and death in our Black community. We must not be silent.

  • The author has discover that this is an incredibly sophisticated virus, it can actually detect the race of each person in the USA and tailor its attack as a result! Quite a feat to accomplish in the USA, as most people are actually mixed race, so the virus must determine which category a person identifies with out of their various ancestors and then act accordingly.

    Y’know, a virus ain’t alive so it must be a machine. But this one is intelligent (according to the author), and is thus the first instance of viral AI. Quick, issue this woman her Nobel Prize!

    • Sarcastic, yes, but not completely ignorant. Doubtless racism is a factor in the issues the author correctly states in the first paragraph. And what about cultural factors (the same outcomes are not seen to the same degree in, say, Asian communities)? Obesity? Smoking? Diet? Value placed on education? Prevalence of fatherless black families? Just because something “can” be attributed to racism does not mean it “must” be so attributed. But when confirmation bias meets a predetermined narrative… The reality is complex.

  • Other races have been enslaved throughout history. I’d like to see a diverse study that gives your theory some substance. Furthermore all see in this article IS a theory and at that a weak theory. There’s no scientific link. No data just the issue that black individuals are more prone to certain disease. The hardest thing in the scientific community or any circumstance to prove is CAUSE… if you can actually prove cause your on you’re way to be a billionaire. Social workers with child development and parental influence can’t intersect cause. Social environment vs. Individual growth and choice making. Can’t intersect cause. Some influence maybe I’ll yield that. But directly linking “white supremacy” (which don’t exist today) to a race being more susceptible to some disease is ludicrous. You’re preying on the black race with the knowledge they are the most emotional race. They have lived as “victims”since the 60s. And you and your false platform keep them there. From 1920 through the 50s the black community was flourishing. Welfare…… housing…….DEMOCRATS. The marriage of the black race to the Democratic party. Every form of “White supremacy”that ever was a problem was and still is Democrat, false information, victim mentality, the nuclear family, quality education, crime, God. Keeping blacks mentally on the plantation is a crime of humanity. The view that they”built this country” is also spin. What percentage of the south owned slaves? I’m an advocate of equal rights and police reform. I’m also an advocate of truth. Did you know the first declaration to the king of England to abolish slavery was in 1688? Then in 1777 ? Then i believe 1787…? I can send you quotes from 4 or 5 founding fathers who before the constitution had difficulty establishing this country while enslaving men. The original draft of the constitution had a no slave clause but as a democracy it didn’t make the cut. Our founders in many papers and books disclose that the constitution set the path to allow the abolishment of slavery. If they would have demanded slavery be abolished this country would never have been born. So they set the stage for things to happen. People defend founding fathers of having slaves for being “men of their time” but in reality they were the first to realize the importance of “all men are created equally.” They just didn’t have the majority. Every nation in the world practiced slavery of one form or another at that time. Including Africa who enslaved and sold thier own.

  • I can’t believe that you quote divisive and frankly trite opinions of McMullen and co without pushing back. Giving a platform to those grinding an axe, with zero common sense — where will it end? It’s like paying the Danegeld — it will come back to haunt you. These perpetually angry race-baiting intersectionalists are NEVER satisfied. They live to be offended. Push back now!

    • Karl Weinrich – I am not sure if you are being sarcastic or not, but Athol Stann was right on the money I think with “These perpetually angry race-baiting intersectionalists are NEVER satisfied. They live to be offended”
      Perhaps you are not living in the US, but they have more of them in Europe as best I can tell from here. StatNews let some black grievance mongers from Yale put in an opinion piece – they were really dishonest, claiming there is no evidence of a difference between white crime rate and black crime rate – I guess if you have never lived in black areas you can believe anything your ideology tells you to believe – there is a HUGE difference – like the black rates for many crimes is ten times the white rate – my point with all this is, many of the people complaining are very dishonest about the reasons blacks are treated differently by the police – huge difference in crime rate, and, quite likely huge difference in defiance of the police. Now, with all the publicity, of course it goes on all the times to some extent, but recently we have a bunch of flat out murders of police – which the US media, the left wing media -unfortunately we only have leftwing and rightwing now – will not publicize, but there seem to be several per day.

    • Sorry, my last comment was really more about another article in Stat. I stand by the Comment but I apologize for being slightly off topic.
      The risk factors for severe Wuhan coronavirus – I know the disease is supposed be called “Covid19” and the virus is SARS CoV2 – but throughout human history diseases have been named for the places they are first identified – Wuhan would be that place – and also throughout history, no one made up names to distinguish the illness caused by an infection from the infection. You go to the doctor and ask what’s wrong, she tells you, “I think you have the flu” not “Looks like you have Influ 19” “What the heck is that Doctor?” – “Oh that is the illness caused by Influenza virus” – “So, you mean I’ve got the flu?” – “Yes, that is what we used to call it before a country which give billions of dollars to the WHO demanded they change the name to one which did not reference their country”
      “Why did they care so much about their country being identified as the place the virus was first found in humans? ” = “Well, they lied and covered up and set the world up for the biggest pandemic in a hundred years, and they want everyone to forget about that” “So, Doctor, if is it all a dirty scheme to cover up wrongdoing by a totatlitarian dictatorship, why is all the medical establishment going along with it? ” – “We are afraid we will be called racist if we don’t, plus China might cut a couple billion in donations to WHO and the UN” ”

      So, if you think I was digressing with that rant – NO, I was not at all – the same principle applies – EVERY possible grievance group = except on primarily consisting of white men- in the US, is supposed to have some god given right to silence anyone who disputes them – China is using this to cover up their wrongdoing vis a vis Wuhan virus – do not assume I think the US govt. did not screw up very badly – but still, China did the worst of any entity in this – black grievance groups get to silence realisitc criticisms, such as – black risk factors are higher – diabetes and obesity being two huge ones – due to black people being more overweight and eating high glycemic food more – it has nothing to do with disparities in health care – there are more black people working in blue collar public contact jobs – it I was king, i would not let them be at risk – if you are 50 years old and diabetic – you get unemployment so you don’t die of Wuhan – but that is not what is wanted – a reasonable plan to protect people from social conditions which will make some people suffer much more from this – you do not hear the anyone say “OK, we need essential services, but we don’t need every 60 year old obese man going to work where he is going to get infected – like that poor bus driver who knew he was at high risk, then got it and died – but it’s never sensible stuff like that, always some Marxist theory abstract never ending complaint.

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