Central PA Medicine Fall 2020 - 9

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RACIAL DISPARITIES IN
HEALTH OUTCOMES
Despite the recent progress in the diagnosis
and management of chronic diseases and the
advancement of public health research and
outreach, a 3.6-year gap in life expectancy1
exists between Black and White Americans.
This gap primarily exists due to disparities in
the leading causes of deaths, including cardiovascular disease, diabetes, cancer, homicide,
infant mortality, and increased risk of infections.
According to the Centers for Disease Control
and Prevention (CDC), mortality among Black
Americans was 40% higher 1 than Whites for
all-causes of mortality in 2017. Blacks had
a 48% increase in death rates from diabetes
mellitus, 30% increase from cerebrovascular
disease, 23% increase from heart disease, and
13% increase from malignant neoplasms
compared to Whites1. Additionally, people of
color have higher rates of sexually transmitted
infections,2 teen pregnancy, infant mortality,2
and maternal morbidity and mortality.
In order to mitigate the root causes of these
high mortality rates, the racial and ethnic
disparities in health care must be addressed.
In 2017, the U.S. Census Bureau 3 reported
that racial and ethnic minorities comprise
40% of the total population, and by 2045,
non-Hispanic Whites will no longer be a
majority group. Continued failure to adequately
address the disparities faced by minority groups
will place a profound burden on both the
wellbeing of what will become the majority of
Americans, but also the health care structures
that support them.
It is vital to not only identify the root
causes that contribute to the substantial
differences in health outcomes and mortality,
but furthermore create actionable steps to
address these health disparities.
A HISTORY OF EXPLOITATION AND
ABUSE ON AFRICAN AMERICANS
Beyond the continued disparity in health
outcomes for individuals from minority populations in the U.S., there exists an extended
history of exploitation and abuse perpetrated
by medical institutions. Much of this history
has been obfuscated, overlooked, and ignored

in medical education. This history is critical
in the education and training of healthcare
providers to understand the basis of African
Americans' mistrust in the healthcare system.
The following highlights only a few examples of
the significant injustices suffered by the Black
community in pursuit of medical advancement.

THE INFLUENCE OF STRUCTURAL
RACISM ON HEALTH OUTCOMES

The infamous Tuskegee study4,5 officially
called the Tuskegee Institute of Untreated
Syphilis in the Negro Male was a 40-year
government-sanctioned study from 1932 to
1972 that was supervised by physicians. 399
Black men from Macon County, Alabama,
were deliberately denied treatment for syphilis
to further the study of its natural history. Even
after penicillin was discovered to be effective
against syphilis in 1947, treatment was still
withheld from these men.

Structural racism 8 is the practice of racism
expressed in social and political institutions
and reflected in gaps in wealth, income, health
care, criminal justice, employment, housing,
education, and political power, among other
things. At a glance, structural racism may
seem like a thing of the past during the times
of slavery or the enactment of Jim Crow laws.
Unfortunately, minority populations still suffer
from the effects of past racist policies and the
racist systems that exist today.

Black people when they consider engaging
in the health system for care or choose to
participate in research studies.

One prominent example is the policy of
Henrietta Lacks was a poor Black woman
9
diagnosed with cervical cancer. While under- redlining created in response to housing
going treatment at Johns Hopkins Hospital, shortages after the Great Depression. In the
10
her tumor cells were collected without consent 1930s, several neighborhoods in 239 cities
from her or her family. Her samples became were classified into color-coded groups. Green
the source of the HeLa cell lines that have been symbolized " best, " blue for " still desirable, "
used for decades to advance medical research yellow for " definitely declining, " and red for
and publication. Almost a half-century passed " hazardous. " These classifications were based
before any acknowledgment credited Henrietta primarily on racial and ethnic demographics,
Lacks' crucial contribution to the advancement and unsurprisingly, red neighborhoods consisted mostly of " negroes. " As a result, residents
of stem cell research6.
of redlined regions were subject to food deserts,
In the 19th century Dr. James Marion Sims, denial of insurance and loan opportunities,
a prominent surgeon often memorialized as the and lack of health care services.
" Father of Modern Gynecology, " conducted
Although racial discrimination in housing
several experiments on enslaved Black women
in his quest to develop a surgical technique was banned in 1968, the effects of redlining
for vesicovaginal fistulas. He operated with- still linger. The formerly redlined regions have
out anesthesia and often without consent lower socioeconomic status, lower access to
because he believed that Blacks had higher healthcare, higher rates of unemployment, povpain tolerances than Whites. His invention erty, pollution, crime, youth incarceration, and
of the modern-day speculum and repair of food insecurity. Ultimately, the components
vesicovaginal fistulas came at the cost of many of the social determinants of health (SDH)
enslaved women suffering from complications are grossly dictated by the effects of structural
including infection, chronic pain, infertility, racism, and thus, people of color continue to
and death. Significantly, these techniques suffer disproportionately in wealth, health,
were later used for affluent White women education, and power.
under anesthesia, and Dr. Sims is touted as a
medical trailblazer7.

Continued on page 10

The disregard for Black people by medicine
is another arm of the deep-seated structural
racism that permeates every aspect of American
life. These abuses are unfortunately not ancient
history, and continue to be a real concern for
Central PA Medicine Fall 2020 9

http://www.dauphincms.org https://www.cdc.gov/nchs/data/hus/hus18.pdf https://www.archive.org/details/blackpowerpoliti00carm_0/page/4/mode/2up https://ajph.aphapublications.org/doi/pdfplus/10.2105/AJPH.87.11.1773 https://www.cdc.gov/nchs/data/hus/2018/005.pdf https://www.cdc.gov/nchs/data/hus/2018/005.pdf https://www.npr.org/2017/05/03/526655831/a-forgotten-history-of-how-the-u-s-government-segregated-america https://www.npr.org/2017/05/03/526655831/a-forgotten-history-of-how-the-u-s-government-segregated-america https://www.cdc.gov/nchs/data/hus/2018/011.pdf https://www.washingtonpost.com/news/wonk/wp/2018/03/28/redlining-was-banned-50-years-ago-its-still-hurting-minorities-today/ https://www.cdc.gov/nchs/data/hus/2018/011.pdf https://www.cdc.gov/nchs/data/hus/2018/002.pdf https://www.governing.com/gov-data/census/state-minority-population-data-estimates.html

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