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Racism Creates Health Disparities: Debunking Common Myths

1. Myth: Animals are also racist, so blame racism on evolution.

Let’s start off with the most ridiculous myth right off the bat, so we can get into the nitty-gritty later. Very intelligent and accomplished anthropologists have stood behind this myth, and basically argued that life isn’t fair because we are biologically designed to create systems of imbalance. Regardless of your stance on the legitimacy of evolution theory, I hope you can understand that this is a massive dodge in attempts to promote what were the leading theories at the time, not to mention the anthropocentric and speciesist narratives that it promotes.

Increased sociality and developed cognitive patterns associated with social interaction that compose the human experience make racism a uniquely human problem.

Although animals do observe and actively favor specific physical or behavioral traits in mating and reproductive decisions, these animals often live within the same population with a limited geographical niche, so the majority of them do not have significant differences in their appearance, except for how natural selection has affected traits designated as reproductively favored. Globalization and the technology of travel among humans has blurred the lines of a geographical niche for humans in terms of population biology, favoring the clinal nature of human variation over delineated races. The increased focus that humans have placed on epidermal melanin concentration across populations by using it as a determinant of cultural worth, with unmeasurable or inaccurate proxies like intelligence, criminality, poverty, and wealth. Despite Eurocentric narratives that aimed to convince otherwise with the eugenics movement, epidermal melanin is not correlated with cultural worth by any of these “proxies”, but the societal systems which still operate under this farce create an increased burden for people of color to this day.

2. Myth: Some races are biologically inclined to having specific health problems

If you’ve ever seen your lab results from a basic metabolic panel that your doctor has ordered, you may notice that the category for glomerular filtration rate (GFR) is split into African American and Non-African American categories-- at least that’s what mine says.

Is it discriminatory to use a metric that is based on a scientifically derived equation based on observations to make assumptions about kidney function based on race? Can science be racist? (In case you were wondering, the short answer is yes. Although scientific fact doesn’t lie, the context is important and science is performed by people, who always carry biases and context with them throughout research and discovery. Try typing “eugenics” or “tuskegee syphilis study” or even “Henrietta Lacks” into Google and start to educate yourself.)

Many medical studies attempt to use race as a variable to consider within studies because it’s undeniably easier to evaluate and analyze humans when they are put into separate, neat little boxes. Unfortunately for them, that is not how human variation has developed. As mentioned previously, human variation is clinal, and this couldn’t be clearer than the results shown in Table 1. The dilution of African American and Latinx DNA by “European” sources shows how genome-wide distribution of various genetic data by ancestry differs from people as they self-identify, largely due to the involuntary and forced assimilation of Black and Indigenous women into European society. This delineation affirms race as categorically a social construct, and medical institutions that seek to preserve it remind me of our odd and random fascination with how much Neanderthal DNA has survived in modern humans. Many anthropologists have attempted to use cranial measurements, body shape relative to climate, and “cultural complexity” to distinguish humanity or create hierarchies of favorable traits for the sake of establishing an evolutionary timeline, but they have found that these characteristics vary across a single population, and both “good” and “bad” traits can be found in one “race” or social group. The point is that ancestry and genetics can be taken into consideration, but this quality is ultimately rendered baseless due to globalization, so studies need to find another proxy.

Although the incidence of many diseases is unequivocally higher in some racial groups than others, the phenomenon of “John Henryism” and allostatic load can explain this consequence. The intersection of many different institutions, each with their own detrimental effects, generates a more pronounced stress response from individuals of color, low socioeconomic status (SES), or other factors. Even apart from the explicit social determinants and their corresponding effects on limiting healthcare access or quality of care, there exists a convalescence of chronic stress from the intersection of many facets of structural racism leads to increased cardiovascular diseases, decreased life expectancy, and what would generally be considered unusual outcomes among individuals of color. This phenomenon of chronic stress debunks the common myth that socioeconomic “success”, in the form of respectable education, strong support networks, steady employment, and generational wealth, precludes individuals of color from the effects of systemic racism.

Sherman James characterizes racism as a public health crisis, stating on the Social Distance podcast1 that the “wear and tear” that results from the overrepresentation of African-Americans in low-wage, physically demanding jobs with inadequate levels of economic security is a major contributing factor to the epidemic of cardiometabolic diseases in the African American population. Although the racial differences in the incidence of cardiovascular disease and hypertension were noted in the medical community, particularly among Southern Blacks, the cause was initially assumed among the biomedical community to be mostly genetic with little environmental input to health outcomes. James dubs the actual phenomenon “John Henryism,” which describes the chronic physiological and psychological stress that comes from dealing with the personal impacts of structural racism. The “John Henry” phenomenon is echoed in the Geronimus “weathering” hypothesis2, which explains the unusual early health deterioration in Black Americans, as compared to white individuals, using indicators such as pregnancy outcomes, excess mortality or disability, and other physiological markers of chronic stress to illustrate the consequences of constant socioeconomic or political tribulations. These racial differences persisted across the poverty line, though the allostatic load (AL) score increased with poverty, gender, and race, with non-poor, white males having the lowest AL score, and poor and non-poor Black females having the highest and second-highest scores, respectively2. It is also of note that gender difference among whites was not a significant predictor of AL score, whereas Black women consistently had significantly higher scores than Black men2, emphasizing the exponential impact that intersecting systems of racist and sexist oppression have on the individual. Chronic stress from health disparities due to racism harms not only the individual, but has debilitating effects on the society they are a part of and their reproductive or social contributions to that society.

Implicit bias in healthcare, due to a lack of resources or unstandardized care for disadvantaged communities, leads to evident health disparities in indigenous communities across the globe. In the U.S., American Indians and Alaska Natives have a life expectancy that is 5 and a half years less than that of all other races, dying at much higher rates than other Americans from cirrhosis, diabetes, suicide, and chronic lower respiratory diseases3. Indigenous women face additional prejudices; they are two to three more times likely to die from pregnancy-related causes than white women, even when living in urban areas with access to healthcare3. Historically redlined districts, such as Englewood, Chicago, have much higher rates of asthma and cardiovascular diseases and shorter life expectancies than even surrounding neighborhoods, showing the systemic impact of postwar housing policy on the current inhabitants of those neighborhoods almost 70 years later. The economic burdens of health inequities cause a 30.6% increase in medical expenditures for families of color who have to suffer the ramifications of increased incidence of heart disease, diabetes, hypertension, acute coronary syndrome and congestive heart failure4.

Inequality and segregation of access on the basis of race in social determinants of health have been well proven to contribute to health disparities. While other social determinants of health and institutionalized racist policies , it is important to still emphasize that hospitals must be part of the solution, since “some of these health systems disparities persist after controlling for both socioeconomic and clinical variables”4. Physicians, who have mostly been educated in a Eurocentric lens, are “unlikely to recognize disparities in their own hospital setting or within their own practices… [and] are more likely to attribute disparity to patient-level… deficiencies”4. This myth of non-compliance is propagated among even physicians of color, who struggle to connect to and encourage their patients of other ethnicities but are not fully aware of the historic consequences that medicine and other racially tainted industries have in the United States on people of color, either due to their immigrant status or lack of education. The biomedical framework of dealing with health issues among different races is flawed, and the medical community needs to broaden its perspective and relinquish its obsession with race as a proxy for disease to find and help solve the real systemic issues that hinder the preventative care model across populations.

3. Myth: Race doesn’t matter for health outcomes; socioeconomic status is the true indicator.

In the Advancing Health Justice podcast5, Dayna Bowen Matthew explained that 40% of health outcomes are determined not by genetics or even healthcare access, but by social or environmental factors such as housing, education, food security, wages and employment, and local law enforcement. The 2003 Unequal Treatment Report reinforced this, remarking that when controlling for quality access to healthcare, “race and ethnicity remain significant predictors of the quality of health care received”, emphasizing the necessity for healthcare professionals to build partnerships across disciplines to close the pervasive disparity gap.

How does the argument that race doesn’t matter explain the story of Shalon Irving? Shalon’s multiple master’s degrees and Ph.D., strong family support network, and secure employment and wages as a CDC epidemiologist, and top-tier health insurance, still led her to succumb to the unconscious biases of the healthcare system and a statistic of black maternal mortality6. She is just one of many black women who are defeated by increased mortality rates among women of color, even across the poverty line. Given the overlap of multiple systems of oppression, it’s difficult to say which determinants of health matter more or less, but that isn’t the right question. The goal is to equilibrate the field in terms of every way that we humans attempt to categorize ourselves, and denying that race is one of those categories when it comes to health disparities is detrimental to this goal.

The contribution of racism to health disparities is ultimately negative for human health outcomes and affects all constituencies of color, as well as the white population by increasing their ignorance and attempting to blame other individuals for systemic failures. Other white people still may be subject to chronic stress-- certainly less than that experienced by people of color, but nevertheless-- regarding how to manage irrational fears of other races and feeling alienated by other races, even if some of them are detrimentally affected by other systems, like socioeconomic inequality, which can worsen their health outcomes. This missed opportunity for solidarity can make challenging systemic racism more difficult, and in the future, more disadvantaged white people must be enveloped into reform movements to ensure its complete success. Families of color must manage multigenerational trauma from institutionalized racism, additional economic burdens due to rising health costs, and political strife while advocating for their rights.

So racism creates health disparities… now what?

Since racial health disparities have come to the forefront during the COVID-19 pandemic and the social uprisings in response to the racially-motivated murders of George Floyd, Breonna Taylor, Ahmaud Arbery, and many other Black Americans, the future of eliminating health disparities appears optimistic. Interdisciplinary attempts at urban social policy, like those mentioned by Matthew in Charlottesville, are being implemented to eliminate other sources of chronic stress with increased focus on social determinants of health, such as law enforcement, housing, food insecurity, as well as quality of care. Medical schools are emphasizing under-represented minorities among their matriculants and training people of color who are more likely to bring care back to their own underserved communities. Matthew highlighted the fact that just as physician advocacy for equality on behalf of their patients was at the forefront of the push in the 1960s to pass Title VI of the Civil Rights Act by the Medical Committee for Civil Rights, physicians are currently stepping up to call for “the right to the opportunity to live a healthy life” and holding their respective institutions accountable for spaces that create unequal outcomes5. In creating this interdisciplinary approach that Matthew calls for, more evidence-based legal remedies are being mixed with the anti-implicit bias perspectives that hospitals had previously incorporated to create a systemic approach in replacing the context of discriminatory healthcare practices.

The racist mindset that extends to immigrants and their healthcare status is slowly eroding, with some states granting non-citizen immigrants eligibility for state-funded health insurance coverage, similar to Medicaid. In indigenous reproductive justice, recent surges in indigenous midwifery has been shown to decrease maternal death by 83% in indigenous populations, greatly alleviating the cost of giving birth, such as language barriers and lack of cultural competency, to indigenous women in the Western biomedical paradigm. The apparent solutions within the medical community appear to be obvious: increases in cultural competency and POC representation at various levels in healthcare can improve patient satisfaction, compliance, and decrease the burden of systemic racism that contributes to health disparities stemming from quality of care. Collective challenging of the system, such as the desegregation of Southern hospitals in the 1970s to allow for better access to healthcare, truly does lower mortality rates, improve health outcomes, and change the metrics of disease as they present within communities of color within a relatively short period of time1. Obviously, racism as an ideology is much more burdensome to address, but attacking the institutional ways in which it manifests can potentially lead to better life outcomes for people of color and allies.