It’s no longer news that, for most Americans, your zip code has more to do with your health than your genetic code—that where you live, work, learn and play has more impact on your health than regular doctor visits. This fact is particularly stark for low-income people, a disproportionate percentage of whom are Black or Latino.
There is now a mountain of evidence that the mere fact of being Black or Latino can have adverse affects on one’s health, due, in part, to structural racism in this country. The piece below, co-authored by Robert Wood Johnson Foundation President Risa Lavizzo-Mourey and Harvard Professor David Williams makes this point.
Read original op-ed at U.S. News & World Report here.
We must acknowledge the link between race and poor health before we can meet our nation’s daunting health equity challenge.
April 14, 2016, at 8:00 a.m.
When we talk about seeking health equity in this country, the goal is to ensure that all people have the access and means to live a healthy life. But the often unspoken truth underlying this challenge is that being a person of color in America – whatever your economic status – is bad for your health.
Researchers have coined a term – “excess deaths” – to explain the sad fact that if blacks and whites had the same mortality rate, nearly 100,000 fewer black people would die each year in the United States. Even educated African-Americans are sicker and die younger than their educated white peers. A black person will live on average about three fewer years than a white person with the same income, according to Paula Braveman, a leading researcher on health inequalities at the University of California, San Francisco.
To see this tragic reality playing out in our nation’s largest cities, look at the maps of two metropolitan areas surrounding Miami and Philadelphia that were just published by researchers at Virginia Commonwealth University. They show that where you live can have more to do with how long you live than your DNA, medical history, insurance status or experience with the health care system. When it comes to good health, our ZIP code can be more important than our genetic code.
A few years ago, the first of these maps made clear that living in the affluent white neighborhood of Bethesda, Maryland, is associated on average with an additional 10 years of life compared to people who are born in primarily poor, black Southeast Washington, D.C., only 10 miles away. Where we live can determine opportunities to access high-quality education, employment, housing, fresh foods or outdoor space – all contributors to our health.
The health disparities between blacks and whites run deep, no matter the age or ailment. Adult obesity rates for African-Americans are higher than those for whites in nearly every state. They have higher rates of diabetes, hypertension and heart disease than other groups. Black children have a 500 percent higher death rate from asthma compared to white children. And African-American adults with cancer are much less likely to survive prostate, breast and lung cancer than white adults.
In fact, merely being black in America triggers exposure to stressors linked to premature biological aging. Research indicates that blacks get sick at younger ages, have more severe illnesses and are aging, biologically, more rapidly than whites. Scientists call this the “weathering effect,” or the result of cumulative stress.
Racial bias is partly to blame for these inequities, according to an October 2015 report in JAMA Internal Medicine, published by the American Medical Association. On average, white Americans spent 80 minutes waiting for or receiving care, while black Americans spent 99 minutes and Latinos 105 minutes waiting for that same care. Alexander Green, an assistant professor at Harvard and director of the Disparities Solution Center at Massachusetts General Hospital, has studied racial and ethnic disparities in health. He and other researchers have documented “unconscious bias” in physician behavior, to the point of recommending more aggressive treatments for chest pain for a white patient compared to one who is black.
This is not just a health care problem, though. A study of the 171 largest U.S. cities found that whites living in the worst conditions in urban areas – in terms of poverty rates and single-parent households – are nonetheless residing in circumstances much better than those of the average black person.\
The reality we’ve laid out here may not be news in cities with significant minority populations. Indeed, some of these communities recognize these disparities and are finding ways to lift all people of color, making their communities healthier for all. Their work, and progress, may be instructive for the rest of the nation.
In the largely black East Lake district in Atlanta, Purpose Built Communities is breaking the cycle of poverty by addressing housing, education, crime, jobs and other factors that impact health simultaneously. Since 1995, investments in the community have driven high school graduation rates from 30 percent to 78 percent, while the employment rate of low-income adults increased from 13 percent to 70 percent.
In Philadelphia, childhood obesity rates have declined by 6.3 percent in seven years, with the biggest declines among black and Asian children. These declines are happening as the city is prioritizing physical activity in schools, improving access to fresh foods and adopting rigorous nutrition standards across city agencies. Researchers called these results unique among communities reporting reductions in the prevalence of childhood obesity.
In Spartanburg, South Carolina, the community put a plan in place to reduce teen pregnancy rates. The community effort engaged unique partners, such as churches, barber shops and the city recreation department, to coach parents and young people to talk honestly about love, sex and relationships. It’s paying off, with teen pregnancy down 55 percent among African-Americans (and 53 percent overall) in only a few years.
There is no single solution for the confluence of societal racism, poverty and other factors that lead to poor health. However, we now know enough to improve the situation. Health builds from where we live, learn, work and play – and only secondarily in the doctor’s office. Data conclusively show that early childhood education matters greatly, as does the nutritional value of the food we put in our bodies and our access to safe outdoor spaces. We need to work on all those and other social and economic fronts in underserved communities.
But we also need to acknowledge the connection between racism and poor health and actively work to close that gap so that everyone has the best opportunity for good health. As Martin Luther King Jr. is often attributed as saying, “Of all the forms of inequality, injustice in health is the most shocking and inhumane.”
Communities that understand these challenges are moving the country to a better place. By accepting hard truths and offering solutions to seemingly intractable problems, we can rectify this injustice and give millions of minority Americans a real chance at a better life.