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Monday, February 29, 2016

Black Health Matters: Looking Beyond Health Care for Health Equity

Nygel Williams

Villers Fellow
“Of all the forms of inequality, injustice in health care is the most shocking and inhumane.”

—Rev. Dr. Martin Luther King, Jr.

Black History Month inspires us to celebrate the rich history, achievements, and contributions of African Americans in our nation, as well as the hard work that remains to dismantle racism and achieve true racial equality. We agree with Dr. King that fighting injustice in health care is an urgent civil rights issue central to achieving our shared dream of peace, prosperity, and equality for our children. But it is clear that a focus on health care alone will not achieve health equity for African Americans. 

Instead, we must back up assertions that #BlackHealthMatters with action that includes tackling the host of structural factors, ranging from social economic factors to the physical environment, that primarily determine one’s health outcomes, often undermining health in communities of color. 

Flint's water crisis: A harsh lesson in social determinants

The crisis in Flint, Michigan, is a high-stakes example of a community of color whose health is undermined because of where they live, by structural factors outside health care, over which they had no control. Nearly two-thirds minority, and more than half Black, Flint residents were being poisoned by the water they drank because decision-makers chose to cut resources for this community and failed to fully assess the impact it would have on Black lives. 

Flint is just the tip of the iceberg. Lead levels in other communities across the nation are even higher. And there are many more environmental threats that disproportionately affect the health of communities of color, from toxic, degraded housing and schools to air pollution.  

What are social determinants of health?

"Social determinants of health" refer to the conditions in which people are born, grow up, live, and work that affect their health and quality of life. For example, growing up in a highly polluted environment, lack of access to healthy food, or living with a higher risk of violence.

More African Americans have health insurance than ever, but reducing disparities requires a broader approach

Thanks to the Affordable Care Act (ACA), more African Americans than ever enjoy the peace of mind of having health insurance. Between the end of 2013 and the end of 2015, the share of African Americans without health insurance dropped by more than a third, down to 13.5 percent. Even better, the long-standing gap in insurance coverage between Black and white children was completely eliminated

However, despite these historic coverage gains, African Americans and other communities of color continue to experience poorer health and shorter life spans, compared to non-Hispanic whites. What many don’t realize is that these health disparities have more to do with a person’s zip code than genetic code. And because of the persistence of racial segregation in our neighborhoods, these place-based disparities amount to deep racial disparities. 

Moreover, the health care an individual receives plays a limited role in overall health. Estimates vary in terms of an exact percentage, but at most, 20 percent of health outcomes are determined by medical care. There is so much more to health than getting an annual checkup. The bulk of someone’s health depends on a variety of social determinants. The structural conditions in which one lives, works, learns, plays, and prays affect one’s health—from income, education, and employment, a person’s physical and social environment, to the stress of racism. 

As a result, African Americans and other communities of color struggle with disproportionately higher health risks and unjustly reduced opportunities to live healthy lifestyles. Therefore, efforts to improve health care access and quality by themselves will not be enough to eliminated disparities. 

Making health equity a priority

For decades health equity advocates have underscored the importance of addressing social determinants, but not necessarily in connection to health care delivery. In our post-ACA reality, work is underway to reform how health care is delivered and to promote payment for quality, rather than the quantity, of care. Reforming payment systems is a golden opportunity to directly tackle disparities, but some alternative payment models might actually make them worse

For example, paying hospitals less if their patients return too soon for the same condition may seem like a reasonable way to push hospitals to get it right the first time and prevent complications. But what happens to the safety net hospital that serves a lot of low-income, complex, minority patients struggling with multiple barriers to health outside its walls?  And what might some hospitals do to avoid treating the most vulnerable patients?

We need to ensure Black Health Matters in the next phase of health reform

African Americans are a strong and proud people with a rich history. The growth and success of our nation, to a great extent, has been built on Black lives. We have come a long way, from the fields to even the White House, yet we have still so far to go in promoting and protecting Black health. Insidious experiments and forced sterilizations may be a thing of the past, but policies that devalue and imperil Black health are frustratingly commonplace. 

Celebrate today, but tomorrow, roll up your sleeves and get informed, get connected, and get involved. Commit to fighting for health equity.