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Blog, Health disparities, Health equity

Deadly Discrimination

David Williams, a Harvard University professor with an expertise on the health effects of racism.

David Williams, a Harvard University professor with an expertise on the health effects of racism.

Beware of the small slights in life. Over a lifetime they add up to major loss of health, physical and mental, warns David R. Williams, a professor of public health, sociology and African and African-American studies at Harvard University.

For decades Williams has studied the connection between racism and diminished health. Recently his work percolated up in the news as he’s giving a few talks this week, at the invitation of Canadian health experts eager to close the gap between black and white populations there.

Worldwide, life expectancies are all strongly linked to socioeconomic status – job rank, income and education level. Minority populations typically end up on the lower end of the spectrum, and many nations are working to reduce those life span differences, which reach up to 20 years.

Between 1990 and 2008, the United States began making headway in its quest end the difference, with the most educated blacks gaining 6.7 years in life expectancy. But they still lag in lifespan behind their white counterparts, and Williams points to racism, or what he calls “microaggressions,” as the key hidden factor.

To quantify the effects of racism, Williams developed three statistical tools: The Major Experiences of Discrimination, Everyday Discrimination, and Heightened Vigilance scales.

Everyday discrimination, Williams found, extracts the greatest toll. Black Americans often report poor service in retail outlets or being followed as though they’ll shoplift, being passed over for important positions or promotions, and less attentive treatment from health care professionals, among countless slights. (The Tumblr site, http://microaggressions.tumblr.com, has numerous first-hand examples.)

Among the health ramifications: Greater risk of developing heart disease, depression, and premature delivery, as well as the buildup of abdominal fat, itself linked to diabetes, high blood pressure, and stroke.

Awareness starts the cure, Williams asserts. In a recent article in the (Halifax) Chronicle Herald, he advised pausing before subconsciously categorizing somebody based on the most common traits used to discriminate — race, gender and age. Instead, he suggested making a conscious effort to focus on the person as a unique individual.

1)   Harvard prof coming to HRM for talks on racism’s effect on health; The Chronicle Herald, Clare Mellor, staff reporter. February 7, 2014.

Suzanne Bohan

Blog

Dr. Martin Luther King on health care equity. It’s related, but different from health equity.

Martin Luther King, Jr., speaking at a rally. Source: National Archives

Martin Luther King, Jr., speaking at a rally.
Source: National Archives

In 1966, Dr. Martin Luther King ad-libbed a line in a speech in Chicago to the Medical Committee for Human Rights, saying, “Of all the forms of inequality, injustice in health care is the most shocking and inhumane.”

Almost 50 years later, as attention increasingly turns toward shrinking the gap in disease rates and life expectancy between those lowest on the socioeconomic ladder and those on the top rungs, King’s words are cited more frequently. They’re repeated to show how this towering public figure saw health care as a civil right, as much as voting or equality in education.

Community advocates speak out about health disparities in Los Angeles in Dec. 2013.

Community advocates speak out about health disparities in Los Angeles in Dec. 2013.

Sometimes, though, King’s words are slightly misquoted. It’s a small change, but I’ve twice seen the word “care” dropped, with the quote simply stating, “Of all the forms of inequality, injustice in health is the most shocking and inhumane” (underline added). It’s a small but very significant change, in that the latter implies King was speaking of health disparities from all known causes, such as low social status, poor educational attainment, lack of social cohesion, unemployment and underemployment, or living in substandard housing in crime-ridden areas.

While he’d certainly agree that health inequities are an anathema, in citing health care King was in fact only addressing a limited spectrum of what creates gaps in life expectancy as wide as 20 years between nearby U.S. neighborhoods. Not as much was known then about the multiple social sources of poor health, and how sick neighborhoods create sickness. And he was speaking of the appalling racism that black patients faced in hospitals and clinics.

Still, on average only 15 to 20 percent of the disparities in illnesses and death among U.S. populations are connected to access to health care, according to a 2008 article in the Journal of the American Medical Association. Genetics accounts for another 15 to 20 percent of life expectancy.

The rest has to do with how you live your life, and – critically – the kinds of resources you have available to live well. That’s the real focus of the health disparities movements, creating healthier neighborhoods, homes, schools and workplaces so people can thrive. Certainly adding more clinics and health care practitioners is part of the equation, but they can only go so far toward preventing illness and promoting health. And that’s why more activists are taking on health disparities linked to where you live and play.

As for background on Dr. King’s 1966 speech, this Huffington Post article shows the dogged work a civil rights lawyer did to verify that King actually spoke those words, since there’s no written record.

Suzanne Bohan
January 20, 2014 – MLK Day

Health, Health disparities

Health disparities – and solutions – examined in depth

In June 2012, I embarked on research to examine the wide disparities in health and longevity between neighborhoods just miles apart. It’s not unusual, especially in urban areas, to find that people living 10 or so miles from each other will have up to a 20-year gap in life expectancy.

I reported on this topic as a science and health writer with the Bay Area News Group (Contra Costa Times, San Jose Mercury News and Oakland Tribune) including this four-part series called “Shortened Lives.”

And poorer communities are on the losing end of this gap, coping for with more heart disease, diabetes, cancer, asthma and other diseases, as well as mental challenges. Deprivation and stress account for much of the disease burden. And the term “deprivation” covers a lot of issues – lack of access to good food and safe places to exercise, limited job and educational opportunities, lacking a feeling of security in one’s neighborhood and financial strain, to name a few.

But my research goes far beyond just examining this crisis. It’s focusing on what’s being done to shrink this gap. The problem is well known, but what far fewer know about are promising interventions that are making a difference.

Many advocates rightly point to this wide gap in health and life span as unfinished business of the Civil Rights Movement, as it largely affects blacks and Hispanics in the United States. (But not exclusively: Poor whites in the United States, largely in rural areas, also suffers similar gaps compared to wealthier whites.)

I’ll be examining a few major initiatives around the nation, especially the largest privately-funded one run by the California Endowment. It’s called “Building Healthy Communities,” and I spent much of the summer reporting on it. This current crop of blog posts come from that reporting. Rather than explaining the healthy communities’ campaign with each post, I’ll summarize it here and provide a link in all blog posts that reference it.

It came about because Dr. Robert Ross, the CEO of the California Endowment, grew disillusioned with the limits of what medicine could heal after working in a Camden, NJ community clinic as the crack epidemic broke out in the early 1980s. He realized his Ivy League medical education hadn’t given him the tools to deal with healing the social ills that create so many medical emergencies and chronic sicknesses. So he turned his attention to healing communities, not just individual patients. From that pivot in his career, the Endowment’s “Building Healthy Communities” initiative was ultimately born.

The California Endowment is the state’s largest private foundation, with some $3.7 billion in assets. In 2010, Ross and the board of directors launched the “Building Healthy Communities” campaign, and committed most of the organization’s grantmaking to it – $1 billion over 10 years. The nonprofit thoroughly researched the most distressed communities in the state, and found ones with the organizing strength and resiliency to create a better future – with some outside assistance. In exchange for hard work and inspired thinking on the part of the 14 communities, the Endowment committed to leaving them on a trajectory toward far better health and well-being, especially for the community’s children, when the initiative winds down in 2020.

These are the 14 communities participating in the campaign: Del Norte County, a rural area on the Oregon border; neighborhoods in Sacramento, Oakland, Richmond, Long Beach, Santa Ana and San Diego, near the Mexican border; two in Los Angeles – South Los Angeles and Boyle Heights; five rural or semi-rural communities – Salinas, Coachella Valley, South Kern, Fresno and Merced.

The initiative is deploying the best strategies known to bring about social change at the community-wide level, based upon examining several decades of successes and failures. In short, it rests on local leaders and community-based organizations engaging residents and local politicians to tackle major challenges stymieing progress and growth in the area. It’s all about organization, community enthusiasm, rigorous research and measuring results along the way. The initiative is strongly focused on improving schools, because health is so strongly linked to educational status and the critical thinking that education instills. And prevention is the mantra, as it’s so much more cost-effective and humane than coping with illnesses after they emerge.

And the campaign works with the nonprofits that the Endowment funds, meeting regularly and agreeing upon long-term outcomes to improve the community. The nonprofits still operate independently, but expand their mission to include the broader shared mission. The results can be exciting, as I describe in this post.

The initiative, however, goes beyond community level work by leaders, nonprofits and residents, as they alone don’t have the resources to completely turn things around – not after decades of deprivation. It takes broader policy changes and new  infrastructure to secure lasting change, and that can only come from regional, state or federal policy shifts.

To that end, the initiative also deploys a statewide team to educate citizens and lawmakers about important policy decisions in the works.

This is a thumbnail sketch, and you can find more information here. I can attest that there are inspiring and exciting developments underway in these communities, with scores of smart, dedicated people determined to create real change. And there are some fantastic stories that never made the press. Some of these blog posts aim to partially fill that gap.

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