Racial Equity in Healthcare

Just this Monday, we celebrated Martin Luther King Day, a tribute to one of the great leaders of the movement for racial justice – but something that often gets forgotten in the flurry of MLK quotes that become memes this time of year is that equity in healthcare was a crucial part of King’s vision. Throughout his career in activism, he often stated his conviction that “Of all the forms of inequality, injustice in healthcare is the most shocking and inhuman.” Sadly, over 50 years after his death, racial inequity in healthcare is even more shocking and inhuman. Today, we’re joined by public health expert Walter Tsou to do a deep dive into the horrifying world of racial health injustice, how we got here, and how we make real change. https://www.youtube.com/live/yiq7TBVYc6g?si=QCbGU114cZviZe0G Show Notes The show is joined on MLK Day by Dr. Walter Tsou - past president of the American Public Health Association and former health commissioner of Philadelphia! Gillian asks how Walter dedicated his life to health access and health equity. When Walter graduated from med school he stumbled into a job at a public health clinic in West Philadelphia that treated patients lacking private insurance or the money to afford medications, which gave him his first window into the deep economic, racial, and health divides in the U.S. This launched his career in public health advocacy. Walter served as the Health Commissioner of Philadelphia from 2000 - 2002, and to him the most stark racial inequity he had to deal with was the gap in infant mortality - black infants at that time were 2.5 to 3 times as likely to die before reaching age 1 than white infants. Walter looked up the most recent statistics in preparation for the podcast, and the number had barely changed. The traditional way that states are pretending to do something about infant mortality is to create an Office of Equity contained inside their Department of Health that has maybe two staff people. To make a real difference in infant mortality, Walter says, you have to tackle the largest social determinants of health - education, job opportunities, housing, transportation, and so on. Two or four people in an Equity Office aren't going to make a difference - it's window dressing. On top of this, Walter says, the U.S. has abandoned most of its community health work, which was widespread under LBJ's Great Society programs after WWII, when community nurses would go into communities and address social determinants of health. Gillian backs up to share some of the big-picture distressing findings from the Commonwealth Fund's scorecard on racial equity in U.S. healthcare: Provisional life expectancy report released by the CDC in 2020 shows that Black and American Indian/Alaskan Native people live fewer years on average than white people (see data here) Black/AIAN individuals more susceptible to chronic diseases like diabetes, hypertension Higher rate of pregnancy related complications, higher infant mortality rate (see our episode on maternal health for more details) Poor healthcare outcomes are driven by higher poverty rates, higher-risk environments, less access to healthcare among communities of color Less likely to have health insurance, more likely to incur medical debt, more cost-related barriers to care, less preventative care These unequal health outcomes persist across all states in the U.S. Black women are more likely to be diagnosed with breast cancer at later stages and to die from breast cancer than white women Uninsured rates are much higher in communities of color, particularly states that have not adopted Medicare expansion Black Medicare beneficiaries are more likely than white beneficiaries to be admitted to a hospital or to seek care in an emergency department for conditions typically manageable through good primary care Lower rates of vaccination - example - Black, AIAN,