About 15 years ago, Anthony Iton and his colleagues conducted a study with a half million death certificates at its core—and some stunning numbers in its conclusions.
The study revealed major disparities in life expectancy between different sections of Alameda County, California. In Oakland, for instance, Black residents of the flatlands area had an average life expectancy nearly 12 years shorter than Whites in the hills (70.5 years, compared with 82.3).
Iton, a lecturer of health policy at the University of California, Berkeley, discussed the study during the Federal Reserve’s September 9 “Racism and the Economy” virtual event, which focused on health. His point, echoed throughout the conference, was that racial health disparities are about much more than flaws in the health care system. For instance, his study showed that those areas with lower life expectancy lacked decent housing, healthy food, and even drinkable water.
People there lived life “shrouded in this fog of chronic stress,” Iton said. The impact on overall health was obvious, and a lack of investment in social benefits to address contributing factors preserved a miserable status quo.
“We experience a very tattered social contract in this country,” Iton said.
But speakers emphasized that better policy can address and reverse health problems caused by bad policy. First, we must earn the trust of communities of color that have been neglected, exploited, or mistreated by the health care system, said Ana Valdes of HealthRIGHT 360, a primary care provider for marginalized communities in San Francisco.
“The communities we work with do not have a lot of trust in the health care system,” she said.
Williams: Healthy economy impossible without healthy people
In prerecorded opening remarks, New York Fed President John Williams said the implications of health on the nation’s economy are clear.
“To put it simply, we need healthy people to have a healthy economy and workforce,” Williams said. “That’s why understanding the nexus of race, health, and the economy is central to achieving our goals.”
Several speakers said the racial health inequities discussed at the event are imbedded in the various systems that influence health and health care.
“Structural racism is a fundamental cause of persistent health disparities in the United States,” said William Frist, a heart surgeon and former U.S. Senate majority leader.
Frist used food as an example, saying a chronic lack of access to healthy food in communities of color is a result of policy decisions that end up having huge health implications.
“Our food choices aren’t made in a vacuum,” he said. “It’s an ecosystem: federal ag and dietary policies. We can change that.”
But numerous speakers said real change won’t happen if policies are developed outside of the places most affected by them. Health care providers must be deeply involved in communities of color and make sure residents are “at the forefront of the change they want to see,” said LaShyra Nolen of We Got Us, a Boston-based public health advocacy group.
Abdul El-Sayed, a University of Michigan policymaker in residence, agreed. “To understand where racial inequities in health exist, you have to leave the clinic and hospital to put yourself in places where people live and work and play for 99.9 percent of their lives,” he said.
Policy proposals include $1,000 payments, more patient-centered care, better data
Three policy proposals were introduced for discussion:
- Zea Malawa of the San Francisco Department of Public Health said racist policies have created a huge White-Black wealth gap in her city, and they have fed a higher incidence of premature births or maternal deaths among Blacks. “There is no pill for centuries of racism,” she said. But Malawa said her proposal to pay $1,000 per month to Black mothers from the first trimester to two years postpartum could have huge health benefits by relieving poverty, a major health stressor.
- Wayne Frederick, president of Howard University, said the health care system is not centered on patients, their schedules, or overcoming their obstacles to getting care, but on increasing patient visits and profits. Among multiple reforms he proposes: deploying more mid-level providers (physician assistants, nurse practitioners) to underserved, majority-Black communities to reach people where they live and building a national telemedicine network so patients can be treated at home more frequently.
- Stella Yi, an assistant professor at New York University, said health data are undercollected on some groups, while data from other groups are wrongly lumped together—despite vastly different histories, cultures, and demographic patterns (for example, Whites and Arab Americans). Then, she said, policymakers use the flawed data to make decisions and allocate resources, and certain groups don’t get needed help. Yi proposes a commitment of major resources to fix the complex problem, with guidance from community-based stakeholders.
In the event’s concluding discussion, Minneapolis Fed President Neel Kashkari said it was clear that closing racial disparities in health care isn’t just about dealing with the effects of past racist policies—it is about changing current policies.
“We have active, ongoing policies that need to be addressed now that are leading to disparate health care outcomes,” he said.
Boston Fed President Eric Rosengren said the COVID-19 pandemic has made change even more urgent, because of its disproportionately negative health impacts on communities of color.
“The statistics on infections, hospitalizations, and deaths by race and ethnicity are horrifying,” he said. “And if ever there was a time for us to focus on these different outcomes, it’s now.”
To Dallas Fed President Robert Kaplan, the pandemic has laid bare a corrosive lack of trust in authority and institutions, including the health care system, and that’s affecting the nation’s health and its workforce.
“We’re suffering from decelerating workforce growth in the United States, and it’s going to affect the entire country and growth and prosperity,” he said. “So this is really all of our problem.”