Institutional declarations of support for Black lives were ubiquitous in the aftermath of the murder of George Floyd. The radical, transformative change demanded by hundreds of thousands of protestors across the country, however, has not been realized.
Health systems can and must help move the country in that direction. Addressing immediate social needs, such as food insecurity, housing, or access to health care, as some health systems are now doing, is important. But to truly value Black lives, they must also be willing to tackle one of the most upstream drivers of racial health disparities: the racial wealth gap.
At its most basic, wealth is the value of one’s assets minus the total amount of their debt. The racial wealth gap is large, exists within every income level, and has not changed in more than a century. The median net worth of a White family in the United States in 2019 was $188,200, compared to just $24,100 for a Black family.
The reasons for this gap are myriad and complex. But many of them can be traced back to a common denominator of structural racism: the end of slavery, when Black families were released into “freedom” with little to no assets; the effects of historical redlining and present-day home-valuation disparities on intergenerational wealth building through homeownership; subtle tax code differences that disproportionately affect how much Black families receive on their returns; and more.
In an essay we wrote for the New England Journal of Medicine, we described the opportunities health systems have to reconceptualize their roles in building Black wealth. Wealth matters for health, which should make it a natural focus for health systems seeking to prevent and treat illness. Greater wealth is associated with a reduced likelihood of early death, lower rates of chronic diseases such as high blood pressure and diabetes, and better overall functional status over the life course. Given the racial wealth chasm that exists, it’s no surprise that it can be hard to move the needle on health disparities without addressing this upstream determinant.
Consistent with an anti-poverty medicine model, we describe three key approaches — reducing expenses, maximizing income, and decreasing debt/increasing savings — to doing this work and offer examples of how each one might be implemented. This work is readily accomplished through medical-financial partnerships. These cross-sector collaborations between health and community-based financial organizations can improve the financial, physical, and mental well-being of those they serve.
To reduce expenses, for example, health systems can connect staff and patients with public benefits to which they are eligible, better allowing families to cover basic needs. To maximize income, health systems can provide employees with a living wage or offer free tax preparation services for employees and patients to avail themselves of potentially thousands of dollars in tax credits. To decrease debt and increase savings, health systems can connect Black staff and patients to long-term investment products such as Child Development Accounts and educational 529 plans, or make matching 401K contributions to all employees.
Health systems can intentionally source goods, services, and food with Black-owned businesses, which provides more opportunities for wealth building. Health systems can also limit business practices that may contribute to wealth gaps, such as health system consolidation, which may lower prevailing wages by increasing health care costs, and pursuing aggressive bill collection practices.
We know that some in the health care industry will protest: Is this really the job of health systems? Don’t health systems have enough to focus on delivering health care? Shouldn’t health systems stay in their lane and resist this scope creep?
We believe that if health systems are in the business of promoting health, a focus on the racial wealth gap is critical. We acknowledge that many health systems are now struggling with increased labor and supply expenses, but posit that this work complements their primary role of health care delivery.
Health systems are, in fact, uniquely positioned to address the racial wealth gap because they are often economic engines in their communities with both job opportunities and purchasing power. Further, the health care sector is the largest employer of Black Americans, although Black staff are often the lowest-paid and have the worst health outcomes. Health systems have internal expertise, including human resources and business administration professionals, and can take an asset-based community partnership approach to bring in external experts to help staff and patients address wealth.
Change is not always easy, but it is necessary if Black lives are to truly matter. And concrete steps like these are needed to make greater strides in addressing the effects of racism that caused national protests on an unprecedented scale just two years ago.
The U.S. is still at a crossroads, with an opportunity to fundamentally rethink and redefine the impact that health systems can have on erasing the ravages of structural racism on Black lives. By focusing on closing the racial wealth gap, health systems have the chance to truly live up to the title of anchor institutions. In this way, the medical profession, in humble partnership with the communities it serves, can unironically state that it not only values Black lives, but adds value to those lives as well.
George Dalembert is a pediatrician in the Children’s Hospital of Philadelphia (CHOP) Care Network and Medical Director of CHOP’s Medical Financial Partnership. Atheendar Venkataramani is an assistant professor of medical ethics and health policy and director of the Opportunity for Health Lab at Penn Medicine. Eugenia C. South is an assistant professor of emergency medicine in the Perelman School of Medicine at the University of Pennsylvania and faculty director of Penn Medicine’s Urban Health Lab.
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