Black Americans experience disproportionately poor health outcomes and higher morbidity rates.1 ADOS were subject to medical exploitation on the plantation. Antebellum clinics relied on black bodies for experimentation, leading to the development of teaching hospitals as medical institutions. Being subject to anatomical dissection and placed on display under the medical gaze is one of a host of atrocities visited upon ADOS for the benefit of the medical community. Also, eugenic control was practiced to breed out Black Americans. Health disparities are rooted in pervasive structural inequities and social determinants of health,2 such as lack of nutritious food sources, quality healthcare facilities and access to safe spaces to exercise, to name just a few.
In 1985, the Heckler Report of the Secretary’s Task Force on Black and Minority Health identified six areas of health concern. They are cancer, cardiovascular disease and stroke, chemical dependency related to cirrhosis of the liver, diabetes, homicides and accidents and infant mortality.3 The infant and maternal mortality rates are higher and life expectancy lower for Black Americans. According to the Center for Disease Control and Prevention (CDC), Black women experience a maternal mortality rate
2-3 times higher than that of white women and an infant mortality rate more than twice that of white, Hispanic and Asian Americans.4 Compared to white Americans, Black Americans are generally at higher risk for heart diseases, stroke, cancer, asthma, influenza and pneumonia, diabetes, and HIV/AIDS. The death rate for Black Americans is generally higher than whites for heart diseases, stroke, cancer, asthma, influenza and pneumonia, diabetes, and HIV/AIDS.5
- Black Americans are more likely to die at early ages for all causes, as young Black Americans are living with diseases that are typically more common among older age groups of other races. For example: high blood pressure is common in 12% of Black Americans vs. 10% of white Americans aged 18-34 years and is common in 33% vs. 22% of those aged 35-49 years, respectively.
- The rate of diabetes in the Black American community is almost double that of their white counterparts of the same age.
- Black Americans suffer from kidney failure as much as 3 times the rate of white Americans. Black American patients represent as much as one-third of all patients in the U.S. receiving dialysis for kidney failure.
- Stroke is present in 0.7% of Black Americans aged 18-34 compared to 0.4% of whites the same age. 2% of African Americans suffer a stroke compared to 1% of whites aged 35-49 and 7% vs. 4%, respectively, for those aged 50-64.6
Cancer is another indicator of the differences in health outcomes between white and Black Americans. The American Cancer Society says that, for most cancers, African Americans have the highest death rate and the lowest 5-year survival rate.7According to the Census Bureau, the 2020 life expectancies at birth for Black Americans are 77.0 years, with 79.8 years for women, and 74.0 years for men. For non-Hispanic whites the projected life expectancies are 80.6 years, with 82.7 years for women, and 78.4 years for men.8
Mental health disparities between Black Americans and white patients persist. Black Americans are 20% more likely to report psychological distress and 50% less likely to receive counseling or mental health treatment.9
The daily conditions in which people live have a strong influence on their health. There are unique features of urban regions as well as unique population characteristics and barriers to health that shape the disparities.10 The food environment is a widely examined feature of urban areas that shapes health outcomes. When examining the 10 counties with the highest number of food-insecure individuals in the country, all of the 10 counties spanned over large urban cities (e.g., Chicago, Illinois; Houston, Texas; Los Angeles, California; New York, New York; Phoenix, Arizona).11
In addition to the nutritional impact of urban food deserts, there is a social dynamic process that affects health disparities in these urban environments. Violence, in addition to the resulting injuries and trauma, affects urban regions at higher rates than in other regions. Approximately two-thirds of all U.S. firearm homicides occur in large urban areas, with inner cities being the most affected by firearm homicide.12 Youth violence is highest in cities (469 per 100,000) and less in metropolitan counties (259 per 100,000) and suburban areas (252 per 100,000).13 One of the downstream effects of violence is the chronic stress that is associated with living in an unsafe community.
In urban areas where violence is pervasive, community-level trauma can manifest in which residents experience psychological trauma, with some exhibiting signs of PTSD.14 According to the Prevention Institute, 35 percent of urban youth exposed to community violence develop PTSD, a rate higher than that among soldiers deployed to combat. Unsafe neighborhoods can also lead to anxiety, depression, and stress, all of which are in turn associated with preterm births and low birth weight.15
Urban communities have been characterized by a high burden of asthma for decades. For children, specifically, the data reveal higher rates of morbidity due to asthma for those living in crowded, urban neighborhoods.16 This association has been attributed to the presence of environmental hazards such as pollution, pest allergens, and exposure to indoor and outdoor smoke.17
The COVID-19 pandemic led to massive layoffs and the reimagining of the term “essential worker”. Black American frontline workers are experiencing higher exposure rates to the virus due to the nature of their work such as being in the customer service, food service and healthcare industries. Black Americans are experiencing 2.6 times higher cases, 4.7 times higher hospitalization rates, and 2.1 times more death from COVID-19 compared to their white counterparts.18
To combat these gross health inequities, we require the following:
- We require the pillars of public health, which are health promotion and disease prevention, be upheld and promoted by our government to guarantee equitable health outcomes.
- The data generated and used in reporting on descendants of chattel slavery in the U.S. must be disaggregated.
- The Biden-Harris administration must make permanent the White House Health Equity Task Force. The Task Force must revise their mission statement to extend beyond a response to pandemics. It must commit to removing the barriers to access healthy food sources and adequate healthcare structures.
- The Biden-Harris administration must set aside $2.25 billion in federal funding for public health departments to promote health equity. While the average grant is projected to be approximately $20 million, we require $45 million for the purpose of permanently establishing an ADOS Healthcare Ombudsman. The healthcare ombudsman will manage and mitigate risks specific to Black Americans. Decisions must be informed by a comprehensive understanding of the cultural needs and historic relationship to the institution of medicine.
- We require a specific allocation of the Biden-Harris’ 2022 FY Budget for funds expanding access to culturally competent care to include mental health professionals and ADOS Lineage Therapy. We require an allocation of the $153 million for CDC’s Social Determinants of Health program that is proportional to our population, and which supports states and territories in improving health equity and data collection for racial and ethnic populations. In the budget, there is a lack of specificity required to ensure the emphasis is on the equitable health and well-being of Black Americans who are the most marginalized.
- ADOS Lineage Therapy must be developed and made widely available to the descendants of chattel slavery in the U.S. to manage the mental and emotional turmoil that has been inflicted upon ADOS multi-generationally. The impact of living in a society that has used lineage to bottom caste this group, through sophisticated (public policy) and unsophisticated (racial violence) means, has greatly impacted ADOS health outcomes including but not limited to the onset of PTSD. The therapists must be culturally and historically competent to fully assess and treat ADOS. The therapy should refocus ADOS away from self-blame about their societal position and focus on healthy, transformational mechanisms that promote healing and well-being. In addition, the therapy services must be offered free of charge to ADOS and encompass a wide network of competent therapists.
- The Biden-Harris administration must solve the problem of gun violence in Black communities by addressing the root causes of crime via a targeted, federal job guarantee program for Black youth and adults; address concentrated poverty via housing policy; make lineage and other forms of therapy widely accessible; fully fund public schools to ensure smaller classroom sizes, safe and updated facilities, functioning equipment, and offer salaries that will attract highly trained educators; provide incentives to educators who make sure their students read and write on grade level; and, invest in community centers that include wellness programs that promote conflict resolution strategies, meditation, and other evidence-based best practices to properly address anger management.
- Congress unveiled the Health Equity, Access, Resources and Treatment (H.E.A.R.T.) Package which is a $1Bil COVID-19 relief package that aims to address the racial health inequities exacerbated by the pandemic and targets relief for vulnerable and underserved communities. While the bill adopts the relatively new BIPOC term, the designation is insufficient to address the specific needs of Black Americans. As such, we require a unique designation for the descendants of chattel slavery in the U.S. We require a $560 million down payment towards Black Americans to address racial health inequities, with additional investments until health outcomes between white and Black Americans are equal.
- The Biden-Harris administration must direct the Centers for Disease Control and Prevention to immediately conduct a nationwide comprehensive COVID-19 study. This study must produce a nationwide database that accounts for all cases, hospitalizations, complications, and deaths from the pandemic that is disaggregated by both race and ethnicity. The Administration must also commit to producing follow-up studies, as experts are yet unaware of the full scope of deleterious health effects from COVID-19. The data collected from these studies must inform future budget appropriations.
- Washington, Harriet A. Medical Apartheid: the Dark History of the Medical Experimentation on Black Americans from Colonial Times to the Present. Anchor Books, 2008.
- “The State of Health Disparities in the United States.” Communities in Action: Pathways to Health Equity. U.S. National Library of Medicine, January 11, 2017. https://www.ncbi.nlm.nih.gov/books/NBK425844/
- A, Sheiham. “Closing the Gap in a Generation: Health Equity through Action on the Social Determinants of Health. A Report of the WHO Commission on Social Determinants of Health (CSDH) 2008.” Community dental health. U.S. National Library of Medicine. Accessed June 5, 2021. https://pubmed.ncbi.nlm.nih.gov/19385432/
- “Office of Minority Health.” Infant Mortality and African Americans – The Office of Minority Health. Accessed June 5, 2021. https://www.minorityhealth.hhs.gov/omh/browse.aspx?lvl=4&lvlid=23
- Office of Minority Health Resource Center. “Profile: Black/African Americans.” Black/African American – The Office of Minority Health, 22 Aug. 2019, www.minorityhealth.hhs.gov/omh/browse.aspx?lvl=3&lvlid=61
- “African American Health.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 2 May 2017, www.cdc.gov/vitalsigns/aahealth/infographic.html
- American Cancer Society. Cancer Facts & Figures for African Americans 2019-2021.Cancer Facts & Figures for African Americans 2019-2021
- “Office of Minority Health.” Black/African American – The Office of Minority Health. Accessed June 5, 2021. https://minorityhealth.hhs.gov/omh/browse.aspx?lvl=3&lvlid=61
- “African-American Health Disparities.” Cigna. Accessed June 5, 2021. http://www.cigna.com/health-care-providers/resources/african-american-black-health-disparities https://www.cigna.com/static/www-cigna-com/docs/health-care-providers/african-american-health-disparities.pdf
- Sciences, National Academies of, Engineering, and Medicine. “The State of Health Disparities in the United States.” Communities in Action: Pathways to Health Equity. U.S. National Library of Medicine, January 11, 2017. https://www.ncbi.nlm.nih.gov/books/NBK425844/
- Gundersen C. Map the Meal Gap 2016: Highlights and findings for overall and child food security. Chicago, IL: Feeding America; 2015.
- Sciences, National Academies of, Engineering and Medicine. “The State of Health Disparities in the United States.” Communities in Action: Pathways to Health Equity. U.S. National Library of Medicine, January 11, 2017. https://www.ncbi.nlm.nih.gov/books/NBK425844/
- Martinez, Linda, and Henry O’Lawrence. “The Factors Influencing Urban Health Services among Ethnic Groups in the U.S.” MDPI. Multidisciplinary Digital Publishing Institute, March 17, 2020. https://www.mdpi.com/2227-7102/10/3/77/htm
- Pinderhughes H, Davis RA, Williams M. Adverse community experiences and resilience: A framework for addressing and preventing community trauma. Oakland, CA: Prevention Institute; 2015.
- Egerter S, Barclay C, Grossman-Kahn R, Braveman PA. Violence, social disadvantage and health. Princeton, NJ: Robert Wood Johnson Foundation; 2011.
- Gern JE. The urban environment and childhood asthma study. The Journal of Allergy and Clinical Immunology. 2010;125(3):545–549. [PMC free article] [PubMed]
- Kozyrskyj AL, Mustard CA, Becker AB. Identifying children with persistent asthma from health care administrative records. Canadian Respiratory Journal. 2004;11(2):141–145. [PubMed]
- “COVID-19 Hospitalization and Death by Race/Ethnicity.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 10 Aug. 2020, www.cdc.gov/coronavirus/2019-ncov/covid-data/investigations-discovery/hospitalization-death-by-race-ethnicity.html