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A Sociological Lens of Racial Inequality in the Healthcare System for African Americans

The American Health system is systematically entrenched with inequalities that have a significant disproportionate impact on people of color, as well as other minority groups. These inequalities include accessibility to services, poorer health results for some populations, and gaps in health insurance coverage. African Americans, specifically, suffer the effects of these health care discrepancies by great margins. Early on as the 1600’s, America has been founded upon a “white racial framing,” which is still perpetrated in society, evidently seen in healthcare discrepancies between races. The article “Systemic Racism and U.S. Health Care” written by Joe Faegin and Zinobia Bennefield elucidates the historical literature writing on medical and public health practice which produces and maintains structural discrimination that harm African Americans. From their research, they conclude discrimination, white socioeconomic resources, and racialized foundations in America—from centuries of segregation and continuous white oppression—restrict access of black Americans from sufficient health care. Systemic racism is an issue for several minority groups, referring to the practice or belief that have, whether by design or consequence, the effect of limited opportunities—of an individual or group—generally available because of attributed rather than actual characteristics. Systemic racism is a significant problem for health care for African Americans in that centuries of discrimination and segregation perpetrate biases infiltrate medical decisions and treatment for such minority group. If this problem subsists, then life and death seem to be predetermined by race in the United States, despite discrimination being outlawed in 1964.

David Williams’ article “Miles to Go Before We Sleep” illuminates a plethora of racial inequalities in United States health due to historic and ongoing racial discrimination. Examining the 15 leading causes of death in 2007, comparing blacks and whites, blacks experience higher rates in all but 5 categories (lung disease, accidents, Alzheimer’s disease, suicide, liver cirrhosis, and Parkinson’s disease). Even further, in the same year, blacks had an overall death that was 30% higher than that of whites. One may argue that African Americans simply suffer disease and other death-related causes more often than whites; however, life expectancy data refutes this point. In 1950, the life expectancy for blacks was 60.8 years, compared with 69.1 years for whites (National Center for Health Statistics). Although life expectancy for both groups have been on a steady incline in following years, it was not until 1990 that blacks attained the same life expectancy that whites had in 1950 (Williams). Moreover, in 2018, there was still almost a four-year gap for white and black Americans (74.9 and 78.5), despite progressive health care reforms.

An even more relevant issue is the disproportionate effect of COVID-19 amongst African Americans and subsequent treatment in hospitals. Approximately 97.9 out of every 100,000 African Americans have died from COVID-19, a mortality rate that is a third higher than that for Latinos (64.7 per 100,000), and more than double than that for whites (46.6 per 100,000) and Asians (40.4 per 100,000). The overrepresentation of African Americans among confirmed COVID-19 cases and number of deaths underscores the fact that the coronavirus pandemic is amplifying or even worsening existing social inequalities tied to race, class, and access to the health care system.

One does not have to look at end-of-life care to ascertain healthcare disparities for African Americans. Terri Lipman and her team aim to assess racial inequities concerning health treatments and outcomes between non-Hispanic black (NHB) and non-Hispanic white (NHW) children with type 1 diabetes (T1D). The results of the study concluded NHB children had higher HbA1c, more ED visits and hospitalizations, and were less likely to be given insulin pumps than NHW children (P< 0.001 for all). With this, it is evident that diabetes outcomes persist in children diagnosed with T1D, despite insurance status, revealing racial disparities in treatment, specifically in medical technology usage (Lipman).

Although the healthcare system—and general society—have made efforts to minimize the inequities for African Americans, there are still substantial issues that persist. In their article “Understanding Racial-Ethnic Disparities in Health: Sociological Contributions”, Williams and Sternthal reveal how sociological contributions affect overlooked areas of racial-ethnic differences in health care. Their first argument states sociologists “challenged” and “problematized” the biological conception of race. Second, they have enforced a social hierarchy and context as factors of racial disparities in disease. Third, sociologists influenced our perception of the ways in which racism and health are interdependent. Lastly, sociologists have magnified our understanding of the ways in which “migration history” and class affect health. Williams and Sternthal support their arguments by analyzing a series of research studies—including those of the prominent African American Figure W.E.B. Du Bois. They also analyze the conception of race and sociological motivations for creating race, further investigating race through a social structured lens. Although Williams and Sternthal appreciate sociological attempts to understand racial-ethnic issues, they argue these sociological insights on racial disparities in health have significant consequences for the development of creating effectual strategies to better health treatment and lessen health inequalities.

One reform that should be implemented is expanding access to Medicaid nationwide—especially in Southern states—which would further support people who lost employer insurance due to COVID-19 job losses. The Affordable Care Act’s (ACA) Medicaid expansion has shown major progression to minimize longstanding racial disparities in health coverage for the 36 states (including the District of Columbia) that have implemented expansion. This expansion has provided Medicaid coverage to over 12 million people, with people of color holding the largest coverage gains, for example, lowering the COVID-19 infection and mortality rates (Cross-Call). Medicaid expansion provides health insurance coverage for many people with underlying conditions or demographic characteristics that worsen outcomes if they contract COVID-19. For example, among non-elderly adults with incomes below $25,000 a year, over 27 percent of Black people have an underlying health condition like heart disease, asthma, or diabetes that makes them more likely to get seriously ill, compared to 21 percent of all such adults. Thus, Medicaid expansion gives African Americans an economic cushion if they were to contract the illness, and, in turn, ease stress caused by the burden of sickness and money (Cross-Call). According to the Center on Budget and Policy Priorities, if the remaining states implemented expansion—primarily focusing on southern states—at least 4 million additional uninsured adults would become eligible for Medicaid coverage, whereby 60% are people of color. One issue with ACA, is that many insurance companies are reducing their provider networks to cut costs while implementing ACA requirements. This would leave customers with less providers that are available, or “in network” (Dolan and Mokhatri). Ways to mitigate these effects, however, could involve federal mandates in order to equalize access to healthcare benefits for people protected by the ACA, improving quality of life for African Americans and other groups that benefit from the ACA.

Furthermore, nationwide unprecedented opportunities for improving treatment for African Americans provided by Patient Protection under Affordable Care Act could provide new avenues for improvement given the legislation’s success. Patient Protection aims to help doctor-patient relations for blacks by diversifying the healthcare workforce and strengthen its cultural competency. African American physicians currently make up around 6.3% of national physician (McMorrow, et al.). However, initiatives in the ACA aim to increase this number by making it easier for people with disadvantaged backgrounds to become health professionals. These initiatives will help caretakers understand and respond better to the needs of African Americans, as well as ease distrust amongst African Americans with the medical community. By informing African Americans with these initiatives, this may reduce many inequities in treatment access and quality for African Americans’ mental health, which, in turn, would enhance overall living quality in all domains of community living for African Americans.


Edited by: Sara Be

Graphic Designed by: Diego Diaz


References

  1. Dolan, E.M., Mokhtari, M.M. The Patient Protection and Affordable Care Act (ACA): Pros and

  2. Cons. J Fam Econ Issue 34, 1–2 (2013). https://doi.org/10.1007/s10834-013-9352-5.

  3. Feagin, Joe, and Zinobia Bennefield. “Systemic Racism and U.S. Health Care.” Social Science & Medicine, vol. 103, 2014, pp. 7–14., https://doi.org/10.1016/j.socscimed.2013.09.006.

  4. Jesse Cross-Call, et al. “Medicaid Expansion Has Helped Narrow Racial Disparities in Health Coverage and Access to Care.” Center on Budget and Policy Priorities, 21 Oct. 2020, www.cbpp.org/research/health/medicaid-expansion-has-helped-narrow-racial-disparities-in-health-coverage.

  5. Lipman, Terri H, et al. “Racial Disparities in Treatment and Outcomes of Children with Type 1 Diabetes.” Pediatric Diabetes, vol. 22, no. 2, 2020, pp. 241–248., https://doi.org/10.1111/pedi.13139.

  6. Stacey McMorrow, et al. “Uninsurance Disparities Have Narrowed for Black and Hispanic

  7. Adults Under the Affordable Care Act.” Health Affairs 2015 34:10, 1774-1778.

  8. https://doi.org/10.1377/hlthaff.2015.0757

  9. Penner, Louis A., et al. “Reducing Racial Health Care Disparities.” Policy Insights from the Behavioral and Brain Sciences, vol. 1, no. 1, 2014, pp. 204–212., https://doi.org/10.1177/2372732214548430.

  10. Snowden, Lonnie R. “Health and Mental Health Policies' Role in Better Understanding and Closing African American–White American Disparities in Treatment Access and Quality of Care.” American Psychologist, vol. 67, no. 7, 2012, pp. 524–531., https://doi.org/10.1037/a0030054.

  11. Williams, David R. “Miles to Go before We Sleep.” Journal of Health and Social Behavior, vol. 53, no. 3, 2012, pp. 279–295., https://doi.org/10.1177/0022146512455804.

  12. Williams, David R., and Michelle Sternthal. “Understanding Racial-Ethnic Disparities in Health: Sociological Contributions.” Journal of Health and Social Behavior, vol. 51, no. 1_suppl, 2010, https://doi.org/10.1177/0022146510383838.


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