By Jane Zebrack
Racial disparities exist. We see them systemically—in education, employment, housing, transportation, environment, economic development, social services, the criminal justice system and political power. Moreover, we see them both implicitly and overtly, in the form of discrimination and biases. Over the past few months, the Black Lives Matter movement and protests against police brutality have given momentum to dismantling structural racism and advocating for anti-racist practices and policies.
Racism also has a significant impact on health and wellbeing. This understanding has gained significant traction as a result of COVID-19, with people of color being disproportionately affected by the virus and having higher rates of hospitalization and death.
However, the knowledge that racial health disparities exist is not new. According to a fact sheet provided by the American Psychological Association, studies have shown that several health disparities stem from chronic stressors people of color experience at higher rates, like “perceived discrimination, neighborhood stress, daily stress, family stress, acculturative stress, environmental stress, and maternal stress.”
Allostatic load—the “wear and tear on the body” caused by chronic stress—is a risk factor for “coronary vascular disease, obesity, diabetes, depression, cognitive impairment and both inflammatory and autoimmune disorders.” Thus, racial and ethnic minorities are at increased risk for, and are more affected by, these diseases and conditions.
Several counties, cities and states have recently declared racism to be a public health crisis. Milwaukee was the first city to do so in 2019, which initiated over 20 cities and counties to follow its lead. Michigan, Ohio and Wisconsin are the only three states that have made official declarations thus far.
This Is Reno spoke with Dr. Julie Lucero, an assistant professor in the University of Nevada, Reno, School of Community Health Sciences and the director of the Latino Research Center. Her research focuses on “the identification of modifiable social determinants to reduce the impact of health inequities within marginalized populations.”
When asked if she anticipated that Nevada legislators would declare racism a public health crisis, Luecro simply responded, “I hope so.” She said she recognized “there are some people within the legislature that are well aware” of racial inequalities and are “motivated to make some changes.” People of color in the Nevada government systems “could be tapped for their lived experience” to “create a strategic plan” through collaboration, Lucero said.
In discussing the social determinants of health, Lucero called attention to the intersection between health disparities and built environment. Using the zip code 89502 as an example of a “high poverty” and “high minority community,” she contended that services and resources directed to this area and other areas of low socioeconomic status would help reduce health disparities.
According to Lucero, academics in public health know that “structural racism and biases exist” and “affect people’s daily lives without question.” However, the medical community as a whole, including doctors, nurses, providers, and social workers, should address racism from a health care perspective, as well.
People in the medical field not only need to have greater “representation from underrepresented groups” but also need to better “understand their biases,” Lucero claimed.
The UNR School of Medicine has implemented several programs and resources dedicated to diversity and inclusion. However, at UNR, and most medical schools nationwide, “students start getting public health and social determinants of health education in their third year.”
Lucero insisted that education on these issues “needs to start a lot sooner” to address implicit bias and cultivate an active commitment to social justice.
One of the key areas in which racial health care disparities exist is insurance. For 2019, the Commonwealth Fund ranked Nevada 48th for overall health system performance, and 50th for access and affordability. Although there has been “pushback” from various organizations and sectors across the nation, Lucero said that the public health community is advocating for a universal health care system.
Minority Americans are much less likely to get health insurance through their jobs and, even after taking work status into consideration, are still more likely than whites to be uninsured. According to the Census Bureau’s American Community Survey in 2018, 24% of American Indian/Alaskan Natives, 21% of Hispanics, 12% of Blacks, 9% of Asian/Native Hawaiian and Pacific Islanders and 9% of whites are uninsured in Nevada. Thus, in declaring racism as a public health crisis, policymakers should consider expanding health care access to be a necessary action.
Lucero acknowledged that this issue unfortunately is a “really touchy subject.” There are people who turn a blind eye to racism, as well as people who simply do not believe racism exists. It is challenging to prove something to someone who has never personally experienced or been affected by it. But, “if we can put it into terms that they can understand, such as classism, sexism and ageism,” then they will have an augmented perception of racial disparities.
The crux of Lucero’s perspective: “It’s kind of sad that it takes all of this—it takes COVID, it takes the Black Lives Matter movement, it takes our economic instability. … It takes all of that … to shed a light on racism, when this is something that we have known for years—20, 30 years—that this has contributed to poor health.”
We have to start doing something about it. … It needs to be actionable. … The symbolic stuff that has gone on for years and years just isn’t going to cut it anymore.”
