By Glenn Ellis
Health risk: an adverse event or negative health consequence due to a specific event, disease, or condition.
A health risk is something that increases your chance of developing a disease.
Just being black in America is one the greatest risk factors for your health.
Some won’t find this as news, or hard to believe; others will understandably be shocked, or even offended by that statement. Still others (myself included) are clear that by continuously minimizing, or outright ignoring, this reality does great harm to every part of our society. The human and financial costs of this racial disparity are enormous, and a price that we are not prepared to pay in lost workdays, loss in wages, and the needless loss of life.
Like you, I struggle to accept that all things considered equal, the fact that I was born as a black man, automatically compromises my ability to live a full, healthy life; makes me live sicker and die sooner. Undeniable growing mounds of research and evidence from studies, ultimately, persuaded me to accept this harsh reality.
In the U.S., health disparities between blacks and whites are consistent across the board. Blacks have higher rates of diabetes, hypertension, and heart disease than any other groups. The death from asthma rate for black children is 500 percent higher than white children. HIV/AIDS is still an epidemic in black communities, while for whites across this country, it’s being treated like high blood pressure or diabetes; take a pill a day and live a full, normal life. To put this in more perspective, if blacks and whites had the same mortality rate, nearly 100,000 fewer black people would die each year in the United States.
Even educated African Americans are sicker and die younger than their educated white peers. Black patients are both less likely to be prescribed pain medication, and doctors are twice as likely to underestimate black patients’ pain compared to all other ethnicities combined. Based on research on health inequalities at the University of California, San Francisco, “a black person will live on average about three fewer years than a white person with the same income.”
Look, I get it. Being a doctor, from any racial/ethnic background, requires you to work in a nonstop, stressful environment; providing healthcare to a range of sick people. Oftentimes, this requires a doctor to make quick, intuitive medical decisions or judgments. This frequently results in implicit medical bias.
A Journal of Clinical Oncology study of black cancer patients and their physicians found that, doctors with implicit bias are less supportive and spend less time with their black patients. And hopefully they understand that black patients pick up on these attitudes. This results in black patients having more difficulty remembering what the doctor told them; had less trust their treatment plans would work, and thought it was going to be too difficult to follow the recommended treatments. Think this won’t lead to poorer health outcomes?
A 2018 study confirmed the impact on the doctors who treat these black patients: “American clinicians rated a hypothetical white patient, compared to an identical black patient, as significantly more likely to improve, adhere to treatment, and be personally responsible for his health.”
Sadly, this isn’t just about being a “black person living in poverty”. A study of the 171 largest U.S. cities found that whites living in the worst conditions in urban areas – in terms of poverty rates and single-parent households – are nonetheless living in circumstances that are much better than those of the average black person.
Segregation is considered a fundamental cause of differences in health status between blacks and whites because it shapes socioeconomic conditions at the individual, household and neighborhood levels, ultimately determining blacks’ socioeconomic mobility and residential/environmental risk factor for many older African Americans, education, income, and even wealth do not necessarily translate into less stress exposure due to the unique conditions of living in black neighborhoods.
Bias is a topic that is receiving a lot of attention these days. We have studies that have demonstrated how, for black people, discrimination/racism plays a role in unhealthy behaviors such as cigarette smoking, alcohol/substance use, improper nutrition and refusal to seek medical services.
Bottom line? Black folks get sick at younger ages, have more severe illnesses throughout life, and age, biologically, more rapidly than whites. Scientists call this the “weathering effect,” or the result of cumulative stress. So, no there’s nothing wrong with our being black, there’s something wrong with the society in which we live.
Surely, with all of the studies, anecdotal experiences, and all of the research confirming this inequity in health outcomes for blacks, something can be done…if only we had the political will”.
Glenn Ellis, is Research Bioethics Fellow at Harvard Medical School and author of Which Doctor?, and Information is the Best Medicine. For more good health information visit: www.glennellis.com.
