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Health Equity: The Uneasy Truth

February 23, 2017

Sing a song full of the faith that the dark past has taught us,

Sing a song full of the hope that the present has brought us,

Facing the rising sun of our new day begun,

Let us march on till victory is won

-James Weldon Johnson

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CCP_2634.jpgWorking to ensure a society in which all people can live a healthy life regardless of race, geography or socioeconomic status is a task that requires the participation of everyone.  Racial and ethnic health disparities exist across multiple health indicators that plague communities, the healthcare system and the nation. According to the Centers for Disease Control and Prevention, the life expectancy for African Americans living in the District of Columbia is 71.6 years compared to 84.3 years for whites, representing an almost 13-year difference.  The infant mortality rate (deaths per 1,000 live births) is 14.2 for African American infants in Kansas while the rate for White infants is 5.5.  Nationally, the prevalence of childhood obesity is higher in Hispanic and Black children between the ages of 2-19 than non-Hispanic white children.

Acknowledging the differences across health outcomes based on race and understanding the role of social determinants in influencing health are important components in seeking health equity. Social determinants of health are the conditions in which people are born, live, learn, work and play that affect health.  These conditions are manifested through the social and physical environment that influences both health and quality of life, in effect perpetuating a cycle of poorer health, social and economic outcomes for communities of color.  According to the Pew Research Center, white households are about 13 times as wealthy as black households based on median net worth. Kids Count, a project of the Annie E. Casey Foundation that tracks the well-being of children in the U.S., reports that a higher percentage of Black (36%), American Indian (34%) and Hispanic or Latino (31%) children are in poverty than non-Hispanic white (12%) children. While these statistics represent economic outcomes, both are determinants that influence health.

Understanding the relationship between race and health is important to help inform the development of policies and programs to close the health equity gap.   This understanding must also include an acknowledgement of the structural and systemic inequities that negatively affects communities of color. For example, the criminalization of Black boys and men not only limits future employment opportunities as a result of their interaction with the criminal justice system, it may also lead to higher levels of prolonged stress that may lead to negative health outcomes such as high blood pressure. The work to close the health equity gap is directly connected with the work to close racial and ethnic disparities across social and economic indicators.

Eliminating the health equity gap also includes an emotional framing that acknowledges and views with importance the lived experiences of those communities that are disproportionately burdened with certain negative health outcomes.  As the nation celebrates Black History Month, an opportunity exists to reflect on the full experiences of Black Americans that has included the Middle Passage, slavery, Jim Crow and the struggle for civil rights. It also creates an important opportunity to examine how this history has influenced and continues to influence the health inequities experienced in Black communities.   Renowned African American sociologist and one of the founders of the National Association for the Advancement of Colored People (NAACP), W.E.B. Dubois described in his book The Souls of Black Folk, “for the problem of the Twentieth Century is the problem of the color line.” Dubois’ framing of the “color line” even today provides an opportunity for a much needed public discourse on race. The problem of the “color line” remains an uneasy truth that public health researchers, advocates, health care professionals and communities must continuously fight in order to close the health equity gap.

 

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Issue - Health Health Equity