February 1st kicked off both Black History Month and American Heart Month in the United States, so what better time to talk about the health of Black Americans? It’s no secret that being Black in the United States is bad for your health. This blog and the next few are going to talk about exactly why that is. What factors contribute to the clear differences in health between Black and white Americans? Why is it important to consider them when treating patients? Being able to value, answer, and understand these questions will make you a more compassionate, well-rounded healthcare provider. Read on to learn more!
Table of Contents
Health Disparities
Social Determinants of Health
Education
Food Insecurity
Healthcare Resources and Access
Health Disparities
You’ve probably heard this term thrown around, whether in school or even on the news. But what are health disparities? The CDC defines health disparities as “preventable differences in the burden of disease [...] or opportunities to achieve optimal health that are experienced by socially disadvantaged populations.” Health disparities are directly related both to the historical and present unequal distribution of resources among different groups, including economic and political resources or inequities in access to or quality of healthcare. Health disparities can and do exist among people of differing ages, sexual orientations, and gender identities; however, disparities related to race and ethnicity are some of the most historically steadfast.
In the US, Black people often face a higher burden of certain health conditions compared to other racial groups, and experience high rates of premature death compared to white people. Black communities often face higher rates of poverty, limited access to quality education, and inadequate housing. These socioeconomic factors contribute to disparities in health outcomes, as individuals with fewer resources may struggle to maintain a healthy lifestyle and access timely medical care.
To put the scale of health disparities experienced by Black Americans into perspective, let’s take a look at some numbers.
Chances are, if you’ve heard the term “health disparities,” you’ve also heard of social determinants of health. The two go hand in hand; the CDC defines social determinants of health, or SDOH, as the “nonmedical factors that influence health outcomes.” We’ve already established that certain groups, particularly Black Americans, experience a variety of differences in their health compared to non-Black people; SDOH are basically the reasons why these differences exist. Factors like poverty, discrimination, lack of access to healthy food and exercise, and inadequate healthcare resources can significantly impact health outcomes, and are great examples of SDOH in the United States. Addressing these social determinants is crucial for promoting health equity. Let’s look at a few of these a little more closely.
Education
Health disparities can also be directly related to differences in the education of populations. As the CDC reports, dropping out of school is associated with multiple health problems. This is due to a number of complex factors, but put simply, higher levels of education make people more likely to understand health information needed to make good health-related decisions. So how does this relate to Black communities? The connection is an old one founded in systemic racism, with effects that are still being widely felt even today. In 2019, the National Center for Education Studies reported that of the 4.7 million K-12 students enrolled in private schools, 66% were white, and only 9% were Black. Research consistently shows that private school students perform better on standardized tests in almost all subjects, and are more likely to graduate from high school and college. In short, white students across the nation are getting more, and statistically better, education than Black students. This effect, however, is not unique to private schools. In the United States, public schools are funded largely by local property taxes. Discriminatory housing policies and practices established in the 1900s continue to result in homes that are undervalued by nearly a quarter of their actual worth, and place disproportionate burdens on Black homeowners. Therefore, Black communities are statistically more likely to have low property values that, even when taxed at ridiculously high rates, are unable to generate anywhere close to the amount of public school funding that white communities are. The result: public schools with predominantly Black student bodies receive, on average, significantly less funding than schools in other districts. This comes with higher levels of teacher turnover, poorer performance on standardized testing, higher rates of dropout, and lower rates of graduation–aka, lower health literacy and poorer health. As a final point, it’s important to note that these differences are also experienced by Black students who pursue higher education; historically Black colleges and universities in the US are also chronically underfunded.
Food Insecurity
Food insecurity affects millions of Americans and is closely tied to poorer health. This correlation is complex, and disproportionately affects vulnerable populations like racial minorities. Food insecurity refers to the limited or uncertain availability of enough, or nutritionally adequate or safe, food. In the US, Black communities are statistically more likely to experience food insecurity, with nearly a quarter of all Black people having experienced food insecurity in 2022.
One of the primary ways food insecurity affects health is through malnutrition; when people don’t have consistent access to a balanced and nutritious diet, they are at an increased risk of deficiencies in essential minerals and vitamins, as well as sufficient calories. Malnutrition can lead to a weakened immune system, impaired cognitive function, and developmental delays–especially in children.
In the US, an underlying issue related to food insecurity is the cost of food. Often, the types of foods that are more affordable and accessible to people facing food insecurity are high in calories but low in nutritional value. The resulting reliance on inexpensive, processed, calorie-dense foods contributes to higher rates of obesity, diabetes, cardiovascular disease, and hypertension. Furthermore, the stress associated with the uncertainty of food availability–especially in families with children–and the financial strain of making ends meet exacerbates the risk of chronic disease. Children who grow up in food-insecure households face particular challenges, including long-term health issues and academic struggles; Black children are more likely to experience food insecurity than children of any other race.
Healthcare Resources and Access
Another significant contributing factor to race-related health disparities in the US is the varying quality and frequency of healthcare received by different populations. This is another complex issue rooted in financial and educational inequities, but is also hugely impacted by the historical and present-day experiences that Black patients have had with healthcare providers. We’ll dive into this a little deeper in a future post addressing the importance of considering your patients’ individual experiences.
