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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.”

    • After major medical issues I lived in my car for over six months and i can assure you a white person has no white privilege living in a car. I will say because of our system I was able to overcome major issues and now live well.

  • Meghana:

    Maybe you should join CNN, MSNBC, etc. Perhaps StatNews.com, is now supported by Bill Gates and others who are agitators and the real racists. The Riots are not organic and the recently joined community of race riots and medical staff taking a knee is nothing more than a psyop. It’s called agitation warfare and the left is doing a poor job of it as we speak. If the medical community was truly willing to change the culture wars and the racist remarks your article implies why not develop green houses at Black Churches as I have began to create in my own city. We define who receives the food based on the help of the churchs. How about ending Planned Parenthood in the Hood? Why not end PayDay loan providers in poor communities which steal the persons money with high interest rates. Why not end destructive regulations in left leaning regions which elevate the people? Why not expose the secret medical experiments waged against both blacks and whites while enlisted in the Amy and/or other branches of Government. No, you chose to stoke the flames for more race baiting. Are you having dinner with Al Sharpton tonight so he can pat you on the back? Will you take a knee and bow before Alicia Garza? Statnews.com has demoted itself to garbage and any thinking person can understand the truth. There are racists in every race and i personally choose to love and be kind to all persons and I believe most of Americans hold similar views.

  • Let’s view this from another perspective:

    a. Do all poor people with limited knowledge/access to education regards of skin color exhibit the same (or close to the same) problems?
    I suspect the answer would be yes. The fix would be to address the root cause – poverty, education, opportunity, etc.

    b. Are there genetic pre-dispositions based on your individual family genes and/or race?
    I suspect the answer is yes. See item a above and address the education component and support it with health coverage to address the genetic pre-disposition

    c. Have these trends worsened or improved over the years?
    I do not know. If they have worsened, shame on us all. We are all equal parts of this society and if we did not pay attention to these, we are all equally culpable. Regardless of whether one agrees with ACA, Universal Healthcare, Single Payer, etc., the problems impacts us all directly/indirectly. We also have a moral and ethical obligation.

  • What a wonderful job you did in your report of, indeed, “calling a spade, a spade”. I know that comment is horrifically racist as is the history of how institutions, including hospitals, have played into the institutional racism in the United States that has created the inexcusable disparities in health and life expectancy between whites and blacks in this country.

    Thank you for bringing this to light!

    • Your virtue signal is loud and clear. We could take the money from Planned Parenthood within communities and use the local churches as a distribution network in black communities to promote endless nature cures for all persons both black and white. The natural cures are proven to improve health, longevity and special cures are proven to cure cancer for all races. In many Black Communities a church is within walking distance and essential vitamins are lacking with people of poor health of every race. The CDC defines essential vitamins (I’m no fan of he CDC) I find those who participate is flaming the flames of negativity seldom offer positive and simple solutions. Essential vitamins improves all lives. Additional ideas can solve most of mans problems in accordance with Life, Liberty and Freedom and any subversion restricts humanity

  • what a pile of crap -seems to be the most erudite comment to the above pile of unprovable accusations. No good research shows “racism” effecting anything but a growing Grievance Industry. Please read Heather MacDonald book- The Diversity Delusion for further clarity

  • I am tired of accusations of racism every time something happens. Its white priveledge, its institutional racism, its this, its that. Give me a break! I someone wasn’t a racist before they sure are now, and justifiably!

    • So true. This latest dialogue is sowing more racial division. I cannot stand the term “white privilege.” There are advantaged and disadvantaged people of all races, and just being white doesn’t give you special privileges across the board. There are a lot of black people with privileges. For example, my company only hires summer interns through a minority recruitment program. Should a minority student who went to Sidwell Friends and then Ivy League schools get more help then a white kid who went to community college and state other state schools?

    • Really, you’re a racist now? Let me tell you: you’re just coming out as a racist to yourself. This is a fact-based article. You don’t like what it says because you know that you get easier, better health care than most people of color AND the facts don’t let you get away from the fact that your easier, better health care is as a result of the health care industry profiling you as white and affluent enough (not rich) to either pay your bills through your own cash or your insurance. Remember: your life doesn’t matter until all black other non-white lives matter. Now, go burn a cross on a lawn and feel better for doing it.

  • to say that a wealthy, educated black woman has a worse outcome during child birth than a lower middle class white woman is pure myth. what school of medicine teaches, “the black body is flawed?” equity, disparity, systemic are words that have been shoved out into mainstream media and repeated like robots by people in our communitites

    • Don’t say it’s a myth. Ask where the study came from and read the findings for yourself!

  • Yet another leftist political article. I see the claim the much higher black death rates from Covid are due to some kind of social inequality -but no clear mechanisms by whch the inequality directly increases the death rates. \

    A fair response to CoV2 would have been to allow workers with high risk factors to get unemployment until the epidemic passed.

    So, if you are 65 with serious diabetes and overweight – you get to stay home, your chance of dying if you get infected is too high. If more black people are in high risk categories, more black people are staying home, collecting unemployment.

    The difference in rates of risk factors may be only part of the difference in death rates – anecdotally, black people are not using face masks as much as whites and asians – I do not know, but it seems very plausible.

    If I hear someone claim structural or some other form or racism, to explain something which ultimately is in black people’s own control – diabetes appears to be, obesity appears to be – my feeling is, what do you want me to do about it? Get better at talking black people into taking better care of themselves. Someone will say a lot of black people can not afford good food – but anyone can afford to eat less carbohydrates and not be obese.

    For black workers, or anyone, who was forced to go to work despite high risk factors – I believe that is very wrong and ought to have been stopped- but I never heard of ANY state, red of bluest blue, which too ANY action to prevent that – it’s a legitimate complaint for sure, but should be brought to state government officials – SHOULD STILL BE NOW – and get them to act – but vague complaints of endemic structural racism will not get such legislation, we need DOCTORS to explain the public health importance of it and make it very concrete. Political ranting and dithering is not a plan.

    • I’m sorry but your statement is flawed and blatantly shows your ignorance and intolerance. 1. People who live in impoverished communities don’t get the education required to know what that carbs, big quantities of read meat, lack of vitamins aren’t healthy. They may know the simple eat your vegetables but that’s about it. 2. They can not afford health insurance for doctors to make them aware of this fact. Can’t even afford to go to a clinic and get a physical check-up because it either costs too much or it takes out of there busy schedule working 3 jobs just to make ends meet. 3. In impoverished communities fast food chains / corporate America feed off the poor providing cheap food at the risk of their health. Research shows there are an abundance of fast food chains in town centers where impoverished communities have easy access too rather than your city where you have family owned restaurants. Now I explained this only on the aspect of you bigoted statement on diabetes. If I had to go further I may get an aneurysm. So please explain to me how they go around this hmmm? Calling people leftist when they point out social injustices is pathetic and outdated. Get out of that old mindset and look at their lives and take the time to actually care.

    • Well, you have a lot less than i do for the intelligence of “people who live in impoverished communities” – I think they can generally READ – and, even if they can not READ – or not read in English – they can understand spoken words. Like, when their doctor says “You have to lose weight, you are going to become diabetic and diabetes can be really bad” – I think they understand those words. And, I might add here – you don’t seem to be up to the minute on diet advice- red meat is not “bad”.

      One can and should blame the US government, the Federal government, for giving out bad diet advice for decades and decades – I should say terrible advice – the “food pyramid” and, though not advice, the partially hydrogenated oil debacle- hundreds of thousand of fatal heart attacks from direct Federal government action, where, if they had done NOTHING – NOTHING AT ALL – then likely those people would not have died when they did, some would still be around.
      And, in my view, we can and should blame every public school district for not giving out good diet advice – it will only matter to a very few kids in the short term, but knowing what to do when they start to get overweight and prediabetic -which for many will not be long after high school – has greater value to them than most of their classes, IMO.
      But, getting back to your claim, you did not give evidence for the ignorance or stupidity of people who live in poor areas – can you do that?

    • Nice another racist. Never said they were stupid because in actuality, these people are the most hardworking. A majority have to work multiple jobs but I explained everything before since you can’t read all I will say is God will judge your heart. Type in social injustice in health in google scholar you will find you answer there. Otherwise I’m not playing into your pathetic temper tantrum. You have the right to be wrong and I respect that. Bye.

    • Nice another racist. Never said they were stupid because in actuality, these people are the most hardworking but I explained everything before and since you have proven can’t read all I will say is God will judge your heart. Type in social injustice in health in google scholar you will find you answer there. Otherwise I’m not playing into your pathetic temper tantrum. You have the right to be wrong and I respect that. Bye.

    • I do not like rants because they are not discourse, by please reexamine all your statements – it will look like a rant when I point them out but please reexamine them:
      1. You claim people who live around poor people do not have very basic health knowledge.
      First, I really do not accept very many people have not been told that being overweight is not good for their health. Some people very actively deny it, there are even support groups for that claim -‘ I think “Healthy at any size”??? but even people in that group know the medical establishment does not view it that way. Pretty much everyone does know that. You seem to assume also people who live around poor people do not get access to the Internet, which is full of advice about losing weight and why it is beneficial. I do not accept that, because I see practically everyone has smart phones nowadays, in the US.
      You got a smart phone – even one with no carrier – and get on the Wifi, and look all this stuff up. Maybe absolutely dirt poor people, or those who live in remote rural areas, would be isolated that way, almost everyone else is not.
      As for the claim some people can not afford to go to a doctor – I actually agree with that – but I think they get basic dietary advice anyway – maybe not repeated – as I say, the schools should do more – and teach the kids about how the parents could better take care of themselves, which my kid’s school actually do.
      As for corporate america putting fast food restaurants in poor areas – they are businesses and try to maximize their profits-but, since you did not know this – they actually sell totally OK food for diabetics – hamburgers. Or fried chicken. By no means health food, but not causing high blood glucose. Avoid the sodas, ice cream, and fries and you are OK.
      Poor people, just like everyone else – like black people for example- because new research indicates the entire difference between blacks and whites in diabetes can all be accounted for by the different obesity rates – and do not bet me wrong, there are a hell of a lot of overweight white people, I am one of them – but getting back to point – poor people, just live all other people, need to go easy on the fries, cakes, ice cream, and above all else, sodas – but if they do not, they are not being victimized by the big bad junk food companies, – it is easier to avoid temptation if it is across town, I grant you that but this is highly exxagerated, people make choices = white people make choices based on avoid practially all possible risk- I do not totally approve of it – black people do more risky stuff, in my observation – not all a bad thing, of course the nanny staters disapprove – and, in fairness, if your job is offering health advice, you can not endorse risky stuff – but let’s keep some perspective here – people are making choices – as a group, some people make more dangerous choices – no one has a gun to their heads, nor are they acting out of ignorance as you accuse me of doing -they simply think differently.

    • steve i couldn’t agree with you more. there is a disagreement between people in the black community about health, wealth and crime depending on who is doing the talking. why do some blacks put their own people down as if all blacks are uninformed and live behind some wall that prevents them from accessing food, information, healthcare,etc. can things be better for many people of all races? of course it can. we don’t get to choose our parents. money thrown at projects that enable society to clothe, feed, teach kids worthy values is wasted because families are broken and your next door neighbor doesn’t have time or resources to bail you out. terrible that now the jobs that were sought after, nurses, city workers, bus drivers, etc are now oppresive to some people. can’t win for losing!

  • Your article contains nothing from sources who may counter the view that systematic racism is behind healthcare outcomes, ‘whipping black people’. You’ve built the story you wanted, congrats, it has no value because you didn’t do the work to explore any counter arguments to your uniformly racism blaming set of sources. There are plenty of qualified black/white/whatever sources who would happy refute statements in this article. Not sure why I went off here, just seems like everything I read these days is self serving and political. Best to you – Marty

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