This is a guest post by Lynn Todman, PhD, the executive director for population health at Spectrum Health Lakeland in St. Joseph, Michigan, where she also serves on the City Commission. She is a Robert Wood Johnson Foundation Culture of Health Leadership Fellow.
Asking recently in the New York Times, “Does Your Education Level Affect Your Health?” Austin Frakt pinpoints to education as a social determinant that frames the complexity of health and well-being in our country.
Education is one of many critical social determinants of health. In fact, Healthy People 2020 notes, “Our health is also determined in part by access to social and economic opportunities; the resources and supports available in our homes, neighborhoods, and communities; the quality of our schooling; the safety of our workplaces; the cleanliness of our water, food, and air; and the nature of our social interactions and relationships. The conditions in which we live explain in part why some Americans are healthier than others and why Americans more generally are not as healthy as they could be.”
Access to these key resources and opportunities varies, but communities of color are much less likely to consistently have that access. This issue, however, is no longer simmering on the back burner.
As Frakt points out, “African-Americans have higher rates of mortality than white Americans, even after adjusting for income and education…. African-American infants are more likely to be born preterm and with lower birth weights.
“African-American patients are also less likely to receive preventive health care and more likely to live in areas with lower-quality hospitals and doctors. Disadvantages and stress stemming from a history of discrimination and community segregation underlie these and other disparities.”
Sadly, structural racism in all its ugly forms is at the heart of this discrepancy. According to Dr. Camara Jones, senior fellow at the Satcher Health Leadership Institute at Morehouse College’s School of Public Health, “racism is a ‘system,’ not an individual character flaw or moral failing.”
In an interview with WBUR’s “On Point” Dr. Jones elaborated on how racism is a system of power that structures opportunity and assigns value based on the social interpretation of how we look (i.e., “race”). This system of racism has identifiable and addressable mechanisms. They are in our decision-making processes – our structures, policies, practices, norms, and values. These mechanisms are the Who, What, Where and How of decision making – especially who’s at the table and who’s not, and what’s on the agenda and what’s not. Policies are the written “how” of decision making.
Recognizing, acknowledging and addressing racism are important actions for ALL members of a community, not just black people and other minorities. Imagine what our country could be if the powers of all its citizens were tapped and were not squandered in jails and depleted neighborhoods and schools?
But far from being discouraged, I’m heartened that local communities are answering Frakt’s question by taking actions that point the way to policy changes to reduce inequities in the health of all our neighbors.
The Centers for Disease Control, together with the Robert Wood Johnson Foundation, is tackling health disparities by analyzing data from the 500 largest U.S. cities and approximately 28,000 census tracts within those cities. These estimates can be used to identify health problems at a hyper-local level, and then to develop a targeted public health prevention response. Big data can drive big decisions.
Milwaukee County isn’t waiting for the CDC. It has already declared racism a public health crisis. One of the explicit goals of the Milwaukee County resolution is to encourage other local, state and national entities to recognize racism as a public health crisis. County leaders have been trained on racial equity and another 4,000 county employees will be trained in 2019.
And in our own community of Berrien County, Michigan, where a black baby is twice as likely to be born with a low birthweight, or three times more likely to die as an infant, we are educating our physicians and other health care providers, plus community members, on the dangers of implicit bias, outright racism, and the inherent biases built into our health care and other systems. Community Grand Rounds is a three-year speaker/education series that examines how the trauma of racism affects the health of the people we serve. Our Community Grand Rounds events are complemented by community conversations taking place in living rooms and community centers throughout southwest Michigan.
Using data and determination, plus more equitable policies, we must engage in this fight for greater health equity and healthy outcomes for all our communities.