The COVID-19 pandemic affects us all, but it has taken a particularly severe toll on residents of black and Hispanic states, amplifying the inequalities that have long produced worse health outcomes for people of color.

Photograph of Petronella

Tiffany donelson

This reality has led to many policy proposals to address health inequalities, as well as conversations centered on the role of racism in producing disparate health outcomes. In response, some have asked why the focus is on race or racism, rather than other factors, such as income, education or geography.

As the leader of a foundation Focused on health equity, I often hear these questions and would like to provide some answers.

First, why focus on race?

It’s important to understand that even taking income, education, and other factors into account, people of color face worse health issues than their white counterparts. For example, a black woman with a college degree or higher is 1.6 times more likely to die of causes related to pregnancy than a white woman without a high school diploma. While other factors, like income, play a role in health, we will not achieve equitable results if we do not treat race.

People often assume that there could be genetic differences behind these disparities. Although genetics contribute to some conditions, such as sickle cell anemia, there is no genetic explanation for the racial and ethnic disparities we see in conditions such as diabetes, heart disease, infant mortality, and adverse maternal outcomes. .

So what causes the worst health outcomes for people of color?

There are several explanations, both inside and outside the health system.

Research shows that black and Hispanic patients receive less aggressive treatment than white patients. One study found that Hispanic patients were half as likely receive pain medication in the emergency room for a bone fracture. Another study in pediatric patients with appendicitis found that black children and adolescents were much less likely receive opioids to treat pain.

Among patients with heart problems, black patients were significantly less likely than white patients to receive therapeutic interventions this could prolong long-term survival. While most healthcare providers aim to treat their patients equally, studies show that health care providers have implicit biases that include negative attitudes towards people of color. Whatever the cause, entering the health care system as a person of color can put you at a disadvantage.

Racism and discrimination have physiological consequences. The stress of racism and discrimination can have harmful consequences. Discrimination has been linked to negative health consequences, including depression, anxiety, hypertension, breast cancer, and premature delivery or have a low birth weight baby. One mechanism is the repeated activation of the body’s stress response system, which can have adverse health effects.

Racism also affects health more broadly.

Racism is often conceived of as hateful acts or attitudes of individuals. Yet this only concerns part of the picture. Instead, we also need to recognize the impact of structural racism – that is, how policies, practices and norms reinforce racial inequity. The policies of years ago, designed to treat racial groups differently, created a level playing field that still affects our society. Just getting rid of overtly racist policies has not dismantled the uneven playing field they created. We need to create new policies that openly overrule the policies of the past.

An example is redlining, which began in the 1930s when a federal agency developed color-coded maps of neighborhoods and considered those with more residents of color to be “at high risk.” These classifications have been used to deny home loans in “high risk” neighborhoods. As a result, black and Hispanic families were much less able to create wealth through home ownership, contributing to a wealth gap that persists today. It also meant that some regions had less funding for education and other essential services. Redlining is no longer legal, but its legacy continues today. A recent study found that among neighborhoods deemed “high risk” by redlining, 74% are struggling economically and in almost two-thirds the majority of residents are people of color.

Given this, it may not be surprising that people of color face many economic challenges that make it difficult to access resources that can help stay healthy. For example, black and Hispanic residents of Connecticut are much more likely suffer from food insecurity and unstable housing, not having access to a car and not having health care coverage.

The health care system is a challenge for just about everyone. Focusing on fairness does not mean that only people of color will benefit from improvements; it means ensuring that interventions designed to improve the system work for everyone, with particular emphasis on interventions for those most often left behind. A system that works best for those who face the greatest obstacles will be a system that works better for everyone.

None of this is to say that race is the only factor in inequitable health outcomes. There are many ways that people can be at a disadvantage in trying to be as healthy as possible. At the same time, we must recognize the role that race and racism play. The use of indicators such as income, education or geography is not enough to eliminate existing disparities.

We can’t properly solve a problem if we don’t understand its causes. Understanding the role of race and racism in inequitable health outcomes is a critical piece of the puzzle and must inform our actions and policy solutions.

Tiffany Donelson is President and CEO of the Connecticut Health Foundation.

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