Be Well: Racism As a Public Health Threat. How Did We Get Here?
As our community continues to reel from the killings of George Floyd and Daunte Wright, another crisis is making headlines. Just last week, the Centers for Disease Control and Prevention (CDC) declared racism a “serious public health threat.” Referring to the disproportionate number of COVID-19 deaths in Black communities, the CDC blamed structural racism for such adverse health outcomes. Of course, the pandemic didn’t create these disproportionate rates of disease and premature death; it merely shone a light on them.
For decades, American racism has constructed countless barriers that determine where people of color live, work, and play. Housing discrimination, which has kept Black families out of more desirable neighborhoods, has profoundly impacted health outcomes. The 1930’s racist practice of redlining (deeming Black neighborhoods “hazardous” by circling them in red on city maps) kept housing segregation in place and stunted African Americans’ opportunities to accumulate and pass on generational wealth.
While redlining is now illegal, many of these same communities still struggle in poverty. Most historically redlined neighborhoods remain low-income and lack the amenities of wealthier areas, such as access to green spaces, walkable paths, and healthy foods. The concentrated poverty in redlined areas deters grocery stores from entering these neighborhoods, creating food deserts that leave many Black families without fresh fruits and vegetables.
Culturally sensitive, quality health care also remains elusive in many Black areas. Practitioner understanding of the many consequences of redlining is often missing. For example, redlined neighborhoods have higher infant mortality rates, and up to 40 percent of babies born in these areas are premature. When looking at a map of Minneapolis neighborhoods, infant mortality rates match up almost precisely with these communities. Without this knowledge, medical professionals can lack empathy for a patient’s individual experiences and miss essential pieces of the puzzle.
The Betrayal of Tuskegee
In 1932, the U.S. Public Health Service and the Centers for Disease Control and Prevention began the “Tuskegee Study of Untreated Syphilis in the Negro Male.” They enticed the mostly poor Black participants from rural Alabama to enroll in the study by promising them free meals, health exams, and burial benefits. In 1947, when doctors deemed penicillin the standard of care for syphilis, researchers withheld the drug from the 399 men enrolled in the infamous experiment. Instead, they continued to observe the progression of the untreated disease.
Faith in medical providers is the foundation of good healthcare. The loss of that trust is a devastating effect of the systemic racism experienced by the Black community. “Many African Americans are reluctant to fully engage with the healthcare system because of both personal and collective experiences,” said Tolu Oyelowo, D.C., Ph.D., Professor and Chair at Northwestern Health Sciences University (NWHSU). “The emergency room is often the first or the only place they go for help because they tend to avoid the system until an acute problem arises.” As a result, African Americans have an increased risk of chronic disease.
“I would like to say that mistreatment of Black patients ended with the Tuskegee Study,” said Oyelowo. “Unfortunately, research tells us that is not the case. Implicit racial bias has a significant impact on provider empathy, and in turn, how BIPOC patients are treated.” She points to a 2016 study that found half of the medical students polled thought Black people didn’t feel pain as much as Whites did. The implications of this sort of assumption are staggering.
The Traumas of Internalized Racism
From the history books to the 24-hour news cycle, examples of external racism and the harm it causes are abundant. Unfortunately, a more invisible form of racism is also prevalent. Internalized racism’s effect on individuals and communities can be damaging as well. By inadvertently accepting the dominant narrative about themselves, a person’s internalized racism can manifest itself in practices such as skin whitening.
“We are all subject to the same images. If we aren’t careful, we will associate them with negative emotions about ourselves,” Oyelowo says. The stress of unidentified negative self-worth can be devastating. Add that to the underlying stress of pushing back on microaggressions every day, and health outcomes can be compromised. “We are constantly seeing media stereotypes that feed the narrative of the angry Black woman or the Black man with his fist in the air. Where are the images of Black men being kind and loving fathers or Black women relaxing and laughing with friends?”
In the well-cited 1939 “doll study,” Black children chose White dolls over Black ones when asked which were “pretty and nice.” Even more disconcerting, two-thirds of Black children picked the Black doll when asked which one was “bad.” Ultimately, the study revealed that negative images of Black people, along with the toll of segregation, had negatively impacted the self-esteem and self-image of many Black children, some as young as seven.
The Healing Path Forward
Research shows that trauma-informed, relationship-based care that is empathetic positively impacts health disparities. For the past five years, the North Minneapolis-based Roots Community Birthing Center has helped lower the infant mortality and preterm birth rate in its Black communities. Even with the many obstacles and barriers, the clinic upended the trend. In its five years of operation, it delivered nearly 300 babies. Not one was premature.
The complementary and alternative medicine (CAM) community is also finding ways to improve and increase access to care for diverse communities. With scant insurance coverage, however, out-of-pocket costs add up quickly. Not surprisingly, the people who access CAM are often the ones with the resources to explore it. In addition to cost, CAM is underutilized in BIPOC communities because of its lack of cultural representation and the appropriation of practices that originated in indigenous cultures.
As one of the few people of color in the school leadership, Oyelowo is on a mission to enhance diversity at NWHSU and in the natural healthcare space. She applauds the University’s renewed commitment to address health disparities and increase access to integrative care for BIPOC communities. By recruiting more students of color, partnering with Black communities, and infusing diversity and trauma-informed coursework into its curricula, NWHSU has taken the first steps toward an equitable future in CAM care. Oyelowo is hopeful that commitments like these are just the beginning of our community’s work to close the gap in racial disparities in healthcare and beyond.