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Battle health inequity during Black History Month and beyond
Let’s keep the social factors that influence our health in view year-round
This year’s Black History Month theme has been black health and wellness – an important issue that impacts the future and prosperity of the entire nation, and strikes an even more salient chord as we continue to battle our way through the Covid-19 pandemic. But while I am thankful for and welcome any opportunity to highlight health, wellness and disease prevention, we also must focus on these issues year-round and take the opportunity to redefine how we think about improving our health.
In the United States, our health is closely tied to the conditions in which we live, like our neighborhood, access to green space for physical activity, whether we live in a “food desert” or have access to healthy food, exposure to environmental toxins, the ability to access health care, and the quality of the care available to us. Collectively, these types of health-influencing agents are known as social determinants of health, and they are often stratified by race.
Take, for example, these sobering statistics: Black/African American people comprise about 13 percent of the U.S. population, but have accounted for 39 percent of homeless individuals and approximately half of homeless families with children. In 2020, 1 in every 5 Black/African American individuals was living below the poverty line. One in every 5 Black/African American households was food insecure – meaning they had inadequate food for household members to lead active, healthy lives. As a population, Black/African Americans also are exposed to a lower quality of education, have higher unemployment and have higher uninsured rates than white Americans.
The World Health Organization defines social determinants of health as “the conditions in which people are born, grow, live, work and age, stating that “these circumstances are shaped by the distribution of money, power and resources at global, national and local levels, which are themselves influenced by policy choices.”
Indeed, these modifiable factors are systematic, facilitated through policy, and result in unequal opportunities and living conditions for many in our communities. They also are primarily responsible for the health inequities experienced by communities that have historically faced discrimination or marginalization. To that end, racism has increasingly been acknowledged in the US as a root cause of health inequities and has been declared a public health crisis.
During the pandemic, several social determinants offer explanations for why many people of color have been more at risk of getting Covid-19 or more likely to be hospitalized and die from it. For example, factors like whether you work a job that requires high contact with the public and coworkers (e.g. public transit workers, servers, factory or plant workers) or have a job that allows you to work from home affect your risk of exposure to Covid-19, as does whether you own a car or are dependent on public transportation, the number of people and rooms in your household, and whether there is space to isolate and quarantine after exposure. Similarly, whether your neighborhood has access to urgent care and high-quality health care can impact the type of medical treatment you receive after contracting Covid-19.
Social determinants are also directly associated with conditions like obesity and diabetes that occur disproportionately among people of color and are tied to increased COVID-19 risks. In fact, given that our country’s history of institutional racism and bias has influenced nearly all facets of life, including health, it’s no surprise that Black people in the U.S. have experienced long-standing and pervasive patterns of disparity across a multitude of health conditions, such as:
- maternal and infant mortality
- asthma
- cancer
- HIV/AIDS
- hypertension
- stroke
- heart disease
But that doesn’t have to be the case: While much attention has been placed on medical solutions, we need to tackle the social determinants of health and their root causes head-on to address these types of health and wellness issues properly. The public needs to be aware of the social conditions that drive disparities in health and the fact that they are systemic, requiring solutions that go beyond health care. We need to educate our communities and our legislators that every policy decision impacts health, whether in the short or long term. Addressing these issues can help us achieve the ultimate health goal of prevention across the range of diseases in which health disparities exist.
Diabetes offers a perfect model for tackling a major killer within the Black population and demonstrating the role of social determinants of health. More than 37 million Americans (about one in 10) have diabetes, and more than 90 million American adults are prediabetic. In 2018, Black/African American adults were 60 percent more likely to be diagnosed with diabetes than whites. Meanwhile, Type 2 diabetes – the most common form of the disease – has been associated with factors such as income level, whether a person has access to green space, early life nutrition and the retail food environment.
Most recently, as diabetes deaths in the U.S. have surged, the National Clinical Care Commission sent a report to Congress on using federal programs to prevent and control the diabetes crisis.
The report’s executive summary states that “the Commission approached its charge through the lens of a socioecological and an expanded chronic care model. It was clear that diabetes in the U.S. cannot simply be viewed as a medical or health care problem, but also must be addressed as a societal problem that cuts across many sectors, including food, housing, commerce, transportation, and the environment.” Recommendations from the commission include solutions tied to social determinants of health, such as enhancing and improving nutrition assistance programs, increasing breastfeeding rates and expanding housing opportunities.
There are ways to address the social determinants of health by changing our social, economic and political systems and dynamics. But we cannot solve problems we refuse to face and understand. To tackle these crucial factors, facing up to racism and classism — and their intended and unintended long-term impacts on health — is necessary, no matter how uncomfortable it makes us feel. This is easier said than done, but by working with leaders and decision-makers from all sectors — not just the medical community, but also those in housing, education, criminal justice, finance and more — it is possible to formulate actionable plans and achieve obtainable goals to chip away at systemic burdens one year at a time.
As we celebrate Black History Month this February, let us not lose sight of the work to be done. We have another 11 months of the year and generations to work together to move toward becoming a healthier and more equitable nation in which every American has an opportunity to achieve optimal health.
Felicia Hill-Briggs, Ph.D., is vice president of prevention at Northwell Health and associate director of the Institute of Health System Science at the Feinstein Institutes for Medical Research.
This op-ed originally appeared in US News & World Report.
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