Black History Month: Health inequity is a systemic issue. Here’s what that means.

Medically reviewed on December 27, 2022 by Morgan Spicer, Medical Communications Manager. To give you technically accurate, evidence-based information, content published on the Everlywell blog is reviewed by credentialed professionals with expertise in medical and bioscience fields.

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

These were the words Dr. Martin Luther King, Jr. gave in his speech to the Medical Committee for Human Rights in 1966.[1] Now, even as we head into Black History Month 56 years later, those words resonate far too well in reflecting many experiences with the healthcare systems of today.

Experts claim that there has never been a time in the United States without racial health disparities[2] — and the statistics to back it up are certainly not difficult to find. Black Americans have the highest death rate and shortest survival of any racial or ethnic group for most cancers.[3] The American Cancer Society also reports about a third of Black women have reported experiencing racial discrimination at a health provider visit.[3] In recent years, the impact the COVID-19 pandemic had in disproportionately affecting Black communities within the United States only highlighted how broken the system is.

Some findings from the Pew Research Institute further highlight the way Black Americans face health disparities within the healthcare system include the following:

• 35% of Black adults say they’ve felt the pain they were experiencing was not taken seriously either recently or in past interactions with doctors and other health care providers[4]
• About three-in-ten Black adults (32%) say they’ve felt rushed by their health care provider and 29% say they’ve felt they were treated with less respect than other patients[4]
• 40% of Black adults say they have had to speak up to get the proper care either recently or in the past[4]

But these disparities don’t only affect patients. “As a public health professional and as a physician, I’ve witnessed the impacts of both structural and interpersonal racism in almost every part of my career,” said board-certified physician and entrepreneur, Dr. Charlene Brown. “It shows up in the race-based assumptions that physicians make about patients, treatment choices, and the degree to which we trust what patients tell us… It’s present every time we mistake race as a biological construct instead of a social one.”

What is health inequity and what role do social systems play?

According to the World Health Organization, health inequities are systematic differences in the health status of different population groups that happen due to the differences in health status, or the distribution of health resources, between different population groups.[5] These differences arise from the social conditions in which people are born, grow, live, work and age.[5]

In order to understand health equity, it’s crucial to look at the social determinants of health. According to the CDC, social determinants of health encompass economic and social conditions that influence the health of people and communities.[6] And it’s not possible to fully understand those social determinants without discussing the role systemic racism plays in determining health outcomes.

Racism is a system made up of structures, policies, practices, and norms that assign value and determine opportunity based on the way people look or the color of their skin, according to the CDC.[7] These conditions unfairly advantage some and disadvantage others throughout society, making systemic racism so embedded within society that it’s assumed to reflect the natural, inevitable order of things.[8]

According to the CDC, a healthier America requires confronting the systems and policies that have resulted in the generational injustice that has given rise to racial and ethnic health inequities. [7]

What could systemic and structural shifts look like?

To achieve health equity, the systems and policies that have resulted in generational injustices that give rise to racial and ethnic health disparities need to change.[8] This means removing barriers to accessing health care, affordable prices for medication, and educating healthcare professionals on the role inequity plays in how they provide care for their patients.[8]

Achieving health equity means a societal shift needs to take place. Eliminating exclusionary housing practices[9], improving public transportation, ensuring that all houses and workplaces are safe and accessible, and making sure everyone has access to green spaces, parks, and trails[10] are all strategies to help advance health equity. This Black History Month offers a chance to acknowledge how these barriers and systems contribute to health inequity — and only through their removal can true health equity be achieved for all.

“Addressing experiences of inequity affecting the Black community improves overall healthcare systems and that can positively impact other communities seeking care. It’s important to make space for conversations that directly unpack and address racism in healthcare,” said Dr. Charlene Brown. “A win for the health of Black people is a win for everyone.”

Related content:

• Heart Health in the Black Community: Why heart disease disproportionately affects Black Americans
• How to make 2023 the year of advocating for your health and wellness
• Dr. Charlene Brown recognizes the achievements of Black pioneers in healthcare and explores the impacts of racism on health disparities
• The complete checklist to prepare for your next doctor’s appointment

References: 1. What happens to health care quality when the patient pays? NIH. URL. Accessed January 19, 2023. 2. Toward a Historically Informed Analysis of Racial Health Disparities Since 1619. NIH. URL. Accessed January 19, 2023. 3. Cancer Facts & Figures for African American/Black People. Cancer.org. URL. Accessed January 19, 2023. 4. Black Americans’ views about health disparities, experiences with health care. Pew Research Center. URL. Accessed January 19, 2023. 5. Health inequities and their causes. WHO. URL. Accessed January 19, 2023. 6. Social Determinants of Health at CDC. URL. Accessed January 19, 2023. 7. Racism and Health. CDC. URL. Accessed January 19, 2023. 8. What is Health Equity? CDC. URL. Accessed January 19, 2023. 9. Creating the healthiest nation: Health and Housing Equity. American Public Health Association. URL. Accessed January 19, 2023. 10. A Systematic Review on the Potential of Green Space to Reduce Health Disparities. NIH. URL. Accessed January 19, 2023.