8.2.2: Racial and Ethnic Health Inequities
A recent report from the Office of Minority Health, an agency of the U.S. Department of Health and Human Services (DHHS), outlines how federal policies have caused and maintained structural disadvantages to obtaining long, healthy lives in minoritized communities. This report also uses the term minoritized groups rather than minority or minorities to further describe how structures and policies have affected populations, rather than these disparities being a result of numbers of a specific demographic in a population. (These terms will also be adopted in this text). The assertion is that racial and ethnic disparities in health and health outcomes are significantly caused or made worse by historical or existing governmental policies, and therefore a path toward health equity involves new federal policies and accountability (National Academies of Sciences, Engineering, and Medicine, 2023).
As discussed in Chapter 3 of this text, the United States’ early history of Native American extermination, land seizure, kidnapping of native children and required assimilation has caused, and continues to perpetuate significant health repercussions for American Indians and Alaskan Natives (AIAN). Concurrently, the forced immigration and enslavement of Africans, subsequent Jim Crow laws, and even purposeful public health abuses (such as the Tuskegee Syphilis Study), have negatively affected the health of Black Americans for centuries. Additionally, federal policies relating to immigration and social services also play a role in health disparities, particularly those experienced by immigrants and asylum seekers, and their children. Although health disparities are also correlated with poverty and lack of education, those racial and ethnic inequities exist at all socioeconomic strata - indicating that the explanation lies beyond income or education alone. A section in the report summarizes just some of the health inequities in America:
There are higher rates of childhood asthma among low-income households, higher morbidity and mortality from chronic diseases among individuals with lower educational attainment, and higher exposure to air pollution among residents of disinvested communities—disproportionately individuals who are racially and ethnically minoritized. Moreover, the effects of the structural determinants of health on many health outcomes persist when accounting for income and education (National Academies of Sciences, Engineering, and Medicine., 2023).
According to an earlier DHHS Health Equity Report in 2019-2020, significant racial disparities in health and social determinants of health have persisted across the decades. Although measures like life expectancy and educational status have improved for all Americans, there are still differences in these and other measures between racial groups. Racially minoritized groups have twice or higher the poverty rates as non-Hispanic Whites do (U.S. Department of Health and Human Services, Health Resources and Services Administration, Office of Health Equity., 2020). According to the most recent report from the U.S. Census Bureau tracking poverty rates for the year 2022, the poverty rate for those identifying as non-Hispanic White or Asian was 8.6%, whereas it was 17.1% and 16.9% for those identifying as Black and Hispanic respectively, and 25% for American Indian and Alaskan Natives (Shrider & Creamer, 2023).
This disparity in poverty rates is also reflected in the increased likelihood of minoritized populations living in impoverished zip codes. Southeastern and Southwestern states tend to have the highest poverty rates, a trend which has remained consistent over time, and is consistent with higher unemployment rates in these areas. Neighborhoods that have been historically racially segregated as “non-White” have associations with lower life expectancy and higher rates of homicide, infant mortality, and all-cause mortality, as well as higher rates of mental distress, community violence, excessive drinking and smoking, and HIV prevalence (U.S. Department of Health and Human Services, Health Resources and Services Administration, Office of Health Equity., 2020). These neighborhoods often also have higher exposures to environmental toxins like air pollution and lead (Doctrow, 2022).
According to the KFF (formerly known as the Kaiser Family Foundation) health tracking polling, many disparities exist with how safe minoritized groups feel in their homes and neighborhoods, and how discrimination impacts everything from housing to healthcare. This foundation conducted a survey on racism, discrimination, and health in a representative sample of 6,000 Americans in 2023. Hispanic, Black, Asian and AIAN individuals are less likely to report feeling safe in their neighborhoods. About twice as many racially minoritized respondents reported a family member being victimized by violence as did White respondents. Also consistent with earlier surveys, minoritized groups are significantly more likely to have a family member who has experienced mistreatment from law enforcement (Artiga, 2023). “Nearly half of Black Americans say they have been afraid their life was in danger due to their racial background,” (Reich, 2022). All of these disparities impact health on multiple levels across the lifespan; not the least of which is the heightened chronic stress due to discrimination, racism, and poverty.