Black lives and the US healthcare system

At a point where the American people and the world have stepped up to challenge discrimination and unchecked brutality in the US police force, it’s an important time to recognise and examine other prominent instances of institutionalised racial bias at play, namely the discrepancies between the impacts of the US healthcare system on African Americans and the rest of the population. 

According to Whitt-Glover’s paper ‘Diversifying the Healthcare Workforce Can Mitigate Health Disparities’, national data “consistently show[s] higher rates of morbidity and mortality from racial/ethnic subgroups compared to Whites.” McFayden’s article ‘Key Factors Influencing Health Disparities Among African Americans’  shows statistics that African American’s die at significantly higher rates from heart disease than white Americans, 20% more from strokes, and had higher death rates in every specific form of cancer reviewed by the National Cancer Institute in 2008. 

The average age of death among black men and women was 62.1 and 69.7 respectively in 2017, while the average for white men (72.0) and women (78.1) in the same year was just under 10 years different in both cases.

In 2019, maternal deaths among black women were more than triple their white counterparts, while the ‘Non-hispanic Black’ infant mortality rate was double the national average. At 56.1%, black women are the leading demographic for US obesity rates. Black citizens in the US are 80% more likely to be diagnosed with diabetes, 20% more likely to report psychological distress and 50% less likely to receive counselling or mental health treatment. The average age of death among black men and women was 62.1 and 69.7 respectively in 2017, while the average for white men (72.0) and women (78.1) in the same year was just under 10 years different in both cases.

This oppression isn’t as overt as the shocking videos of police brutality we’ve seen. American doctors aren’t kneeling on black patients’ necks. There’s no money shot, but as we can see from the mortality and diagnosis rates, Black people are losing their lives younger or enduring unequal levels of suffering. The US healthcare system and the societal structures that feed into public health are failing the black population of America.

One of the simplest answers for inequality within the US healthcare system is cost. Due to structural barriers, black Americans are much likelier to live in poverty than white Americans. Black people make up 40% of America’s homeless and according to Taylor’s ‘Racism, Inequality, and Health Care for African Americans’ paper,  whereas white families hold ten times the wealth of African American families on average. 

With a disproportionate amount of low-income black American households, a situation exacerbated by wage gaps between black and white workers, many are priced out of paying healthcare insurance premiums or out-of-pocket medical costs and must accrue significant debt to do so, thus perpetuating the class divide. The Affordable Care Act, or “Obamacare”, has done a lot to reduce these inequalities, significantly dropping the uninsured rate for U.S. working age adults from 20.4% in 2013 to 12.4% in 2018, and closing the coverage gap between black and white citizens down to 5.8%. It has also been hugely beneficial for the Hispanic community, who remain the least insured demographic at 24.9%. Since 2016, however, progress in expanding health coverage has slowed and even gone backwards. 

Several of the states yet to expand Medicaid, e.g. Texas, Florida, Georgia, are those with some of the largest black American populations in the US, meaning that these decisions and delaying tactics made here disproportionately affect people of colour.

Under the Trump administration, the rate of un-insurance has risen again to approximately 14%. Fourteen states, mostly situated in the South, have yet to adopt the ACA expansion of Medicaid. There is no deadline for states to expand, several of these have passed the expansion into legislation but have failed to implement the policies or are proposing state Medicaid waiver proposals that limit the ACA’s scope and structure. In Oklahoma, the expansion is to be decided by public vote this month on June 30th. Several of the states yet to expand Medicaid, e.g. Texas, Florida, Georgia, are those with some of the largest black American populations in the US, meaning that these decisions and delaying tactics made here disproportionately affect people of colour.

This disparity has been attributed to a bias among doctors: a reluctance to prescribe painkillers to minorities, fearing that they may attempt to sell them or easily become addicted.

Many researchers also suggest the presence of latent racism within the culture of the US medical sector. Taylor outlines racial bias at play in the health algorithms which guide public health decision-making and influence cost-benefit analyses, meaning that even the methodologies employed by hospitals or drugs produced by pharmaceutical companies are very possibly designed to benefit white citizens more. The opioid crisis disproportionately impacted the white population, due to the fact that medical professionals consistently prescribed lower levels of pain medication to people of colour. This disparity has been attributed to a bias among doctors: a reluctance to prescribe painkillers to minorities, fearing that they may attempt to sell them or easily become addicted. It is a shocking demonstration of how different racial stereotypes can influence practitioners to disproportionately medicate patients. 

The Harvard Business Review also points out that many practices try to limit the number of patients using Medicare, Medicaid or other public programmes, viewing them to be ‘unprofitable.’

Even when insured, many black Americans find themselves under-serviced by health providers. There is significantly uneven distribution of healthcare services across rural and impoverished areas. African American and Hispanic neighbourhoods are often forced to overly rely on underfunded community-based providers. The Harvard Business Review also points out that many practices try to limit the number of patients using Medicare, Medicaid or other public programmes, viewing them to be “unprofitable.” Even when playing the game, minority groups still frequently face obstacles preventing them from receiving the care they need.

Black Americans are underrepresented within the healthcare workforce. Those that do enter the health sector are often overrepresented at the lower-skill levels, dropping off significantly in more specific professions, e.g. dentists, chiropractors, pharmacists, and psychologists. Whitt-Glover suggests that a drive to establish a more diverse workforce is key to establishing more culturally competent practices.

The environment that many lower-income black families live in also contributes to health complications, e.g. higher levels of stress due to housing insecurity, smaller living spaces, everyday experiences of racism or local crime. Lack of expenditure also means that households have to cut corners on basics like food. Black American children are twice as likely to go hungry as white children, and the poor nutritional value of low-cost foods available in US supermarkets and restaurants are direct causes of the higher diabetes, obesity and high blood pressure rates among African Americans.

The US healthcare system is structured to maximise profit not public good, and that is shown very clearly in the suffering of the disadvantaged members of society.

The US healthcare system is structured to maximise profit not public good, and that is shown very clearly in the suffering of the disadvantaged members of society. Not only is this an insurance and pricing issue, there are several social determinants, e.g. food security, housing and environment which also perpetuate a disproportionate level of poor health among people of colour in America.

Not only does the privatised system need to change to better accommodate minorities, the workforce and surrounding economy also need to evolve to a point where there is no inequality in America’s treatment of its sick and injured. Black Lives Matter and should be protected in the streets and in hospital beds alike.

It is important to flag that racial bias in public health isn’t a specifically American issue. There’s just more data on it. The HSE itself has a page acknowledging the low health status and lack of access to health services for the Irish travelling community, but more research needs to be done into the root causes.

Within direct provision centres, asylum seekers are five times more likely to develop mental health issues and psychiatric conditions. First-hand accounts from people who have lived or are living within these centres also raise issues with the food provided. Restrictions on self-catering in many centres has left asylum seekers dependent on Aramark catering, which has been flagged as inadequate in both quantity and quality e.g. greasy meals of low-nutritional value that do not properly cater to dietary requirements, like vegetarianism. Systemic racism and health inequality are easier to spot in the US right now, but they are still present here in Ireland, and must be acknowledged.

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