Structural barriers create stark racial divide in Americans’ health

A person without stable housing doesn’t have a place to keep insulin cold. A person without a car may not be able to get to the doctor until it’s an emergency. A low-wage worker is less likely to have health insurance, and therefore more likely to skimp on care they might need.

The big picture: The American health care system delivers far better results for white patients than it does for people of color, and those health disparities are in large part a reflection of broader social and economic inequality.

By the numbers: Structural barriers have created a stark racial divide in Americans’ health, at every stage of life.

Some of America’s health inequity stems from problems discretely within the health care system: Hospitals that primarily serve communities of color, for example, tend to be poorer and often provide lower-quality care.

But many of the differences spill into the health care system from the outside world: They’re baked in before a patient ever sets foot inside a hospital or a doctor’s office.

  • The coronavirus pandemic has provided a clear example of how quickly social economic disparities become health disparities, and how that profoundly unequal system just keeps perpetuating itself.
  • Black, Hispanic and Native Americans suffered disproportionately in the pandemic’s early days because it attacked those with the weakest societal safety nets, including frontline workers, multigenerational households, inmates and homeless people.
  • The virus isn’t racist. But a broader economic system that consistently puts people of color into more vulnerable positions in society will also consistently put their health at risk.

What’s next: This is a many-systems problem with no easy solution, but experts and policymakers are increasingly attuned to “social determinants of health” — factors like income, nutrition and housing that affect our health both directly and indirectly.

How it works: Some of those effects are simple and straightforward: A person living in dirty housing is more likely to encounter lead, mold or other toxins.

  • Other effects are more complex: A growing body of research has found a correlation between health outcomes and neighborhood amenities such as parks and mass transit. Having fewer abandoned buildings and more bike lanes helps reduce injuries; having more grocery stores can improve nutrition.

The results seem clear: In Oregon, moving Medicaid recipients into stable, affordable housing led to a big increase in primary-care visits, a big drop in emergency room visits, and significant improvements in both access to care and the quality of that care.

The bottom line: The health care system collects the effects of systemic racism in housing, transportation, employment and many other facets of American life. And because those systems are so deeply unequal, people of color experience worse health outcomes, on average, from childhood all the way through to old age.

Join Axios’ Mike Allen and Hope King on Tuesday at 12:30 p.m. ET for a Hard Truths event on systemic racism in health care, featuring White House senior adviser Andy Slavitt, White House senior policy adviser Cameron Webb and California Surgeon General Nadine Burke Harris.

Source: Axios Breaking News

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