Being Black in America’s Healthcare System
Race serves as one of the driving forces of social determents of health in America amongst other factors such as education, economic status and employment. Social determents of health are primary factors in health inequality for blacks and whites. Racism is obviously an unacceptable and very detrimental but it becomes even more of an issue when racism shows up in America’s healthcare systems. This doesn’t just happen on an individual level but an institutional and policy level as well which makes the issue even more difficult to control. In order to effectively address the racial disparities and inequalities in our health care systems we have to appropriately train medical professionals, improve data systems and recruit healthcare providers from all backgrounds. Tragic events such as police brutality and various hate crimes serve as, often overlooked, severe public health issues.
National Data has discovered that over the past 50 years the health of black and white people has improves in the United States of America. Black people still have increased rates of morbidity and mortality of illnesses. Hispanics and American Indians also have increased rates of mortality with some illnesses. Black men live on an average 6 years less than their white counterparts, while black women live 4 years less on average than white women. Infant mortality rates are almost doubled for Black Americans. While there is so much data on infant mortality rates for African American, there is virtually no data on exactly why black babies are dying more than white babies. I believe that the answer isn’t a simple one but is multifaceted, stemming from racial inequalities.
Throughout history, African Americans have been discriminated against and treated unfairly in America’s healthcare systems which led for them to become distrustful. The infamous Tuskegee Syphilis study contributed to the distrust of healthcare systems in the African American community. The Tuskegee Syphilis study was designed exclusively for African American men. The study was facilitated by the United States Public Health Services from the years 1932-1972. Researchers withheld treatment from the 400 participants in order to see how the disease progressed. This case has served as a staple in one of the reasons why African Americans have a distrust for the health care systems.
Although many different races are effected by racism in our health care systems, African Americans have experienced many things that other races have not: a combination of segregation, racism and slavery. As slaves the African American population were obviously denied access to physicians and nurses so they had to rely on folklore and home remedies to treat illnesses which are still passed on from generation to generation to this current day. When slaves would run away to freedom, they would be diagnosed with drapetomania or “runaway slave syndrome”. Running away from slavery was classified as a disease and would usually result in some sort of amputation of body parts as the treatment. At one point, white doctors came up with the idea there was no way blacks could survive in a free society because their minds wouldn’t be able to cope. These are just some of the many cases of institutional racism that African Americans had to deal with. Because of these circumstances, African Americans have developed their own set of beliefs, attitudes and standards. In order to close the door of distrust between African Americans and healthcare systems, it is a must for them as well as other minority groups see professionals of their culture practicing and representing them.
In the year 2002, about one-third of African Americans aged 18 to 64 were uninsured compared to one of five white Americans. In 2017 that rate has declined to 11.2% of African Americans being uninsured compared to 7.4% of white Americans. Although there is still a gap between the two races, that gap is steadily closing with help from the Affordable Care Act (ACA) which was introduced as Obamacare in March 2010. In 2017 6 in 10 uninsured African Americans qualified for Medicaid or found lower costs on monthly premiums through the Health Insurance Marketplace. 7.8 million African Americans who has private insurance now have access to preventative medical services like mammograms, flu shots or vaccines with no deductible and co pay. Over 500,000 African Americans from the ages of 19-26 who would’ve become uninsured are now able to be covered under their parent’s insurance plan. 2.3 million African Americans gained health insurance coverage through ACA, which decreased the uninsured rate by over 7 percentage points.
The ACA was the first move made from a policy and institutional standing that actually addressed the disparities in the healthcare systems. It was an absolute critical key to dealing with the health outcomes for the African American population as well as other minorities. Healthcare coverage is essential to the African American population and other minorities because they are the populations who have the worse health status and outcomes compared to white Americans. African Americans often live with chronic diseases (which obviously cost more money to treat) at a greater rate than other ethnicities such as diabetes, HIV, and heart disease. Although ACA has made strides across the country, there are still a few other states that have not yet adopted the ACA expansion for low income adults which is causing a holt in closing the gap. To this day, 31 states have adopted the ACA while in the 19 states that have not adopted it African Americans are stuck in what’s called a “coverage gap”. A coverage gap meaning they’re income is too high to be considered for Medicaid but make but too low to be qualified for subsidized market place coverage. Subsidized coverage is health coverage that is reduced or no cost to people who make below a certain amount. The rate of underinsured African Americans was at or below the national average in the states that have expanded in 2015. Among the ten states with the highest populations of African Americans, the states who chose not to expand have higher uninsured rates of the African American population.
TABLE 1
Uninsured Rate in Ten States with Largest Non-Elderly African American Populations
State Percent of non-elderly African Americans without health insurance Total number of non-elderly African Americans
Florida* 17.3% 2,741,661
Louisiana** 16.1% 1,304,363
Texas* 15.9% 2,838,733
Georgia* 15.8% 2,804,597
Virginia* 13.0% 1,341,799
North Carolina* 12.7% 1,854,281
New York 9.1% 2,435,595
Illinois 8.7% 1,555,624
Maryland 7.9% 1,510,023
California 7.0% 1,844,384
* Non-expansion state
** State did not expand Medicaid until 2016
Source: 2015 American Community Survey
Recently the ACA has been under threat by the Trump administration. GOP wanted to repeal and replace the ACA which could leave over 23 million people in America left uninsured. Congress failed the bill to replace the ACA and some changes were made to the health law. If the ACA were to be replaced, it would’ve exposed the structural racism that lies in America.
Racism isn’t only an individual set of attitudes and beliefs as most of the time it can spread into an institutional level as well and can go on to affect policies, practices, and society norms and health outcomes.