by Ben and Zoraida, Healthcare-NOW! National Staff
January 19, 2015
In honor of Martin Luther King day, we’ve developed a readers’ guide to understanding racial inequities in healthcare and how we can eliminate them. We are just scratching the surface here, and to keep things readable all links point to reviews of books or news coverage of research findings.
To start, it’s important to understand that there is no biological basis for race. Race is purely a social construct, and racial inequities in health all have social roots (although health impacts on a social group can lead to genetic consequences for that group’s descendents, such as in sickle cell or Tay-Sachs disease).
The history of race politics in the U.S. is deeply intertwined with the unique development of our inequitable healthcare system, in ways that may surprise you. Gerard Boychuk’s book National Health Insurance argues that a primary reason universal healthcare passed in Canada was the national government’s attempt to prevent Quebec from seceding by instituting essential national services. In the United States on the other hand, segregationist politics in Congress blocked national healthcare for much of the 20th century – not, as is often claimed, the growth of employer-based insurance during WWII.
The growth and political entrenchment of a healthcare system that links access to care with ability to pay creates a dangerous dynamic in the U.S. as other large systems characterized by racial discrimination – such as access to employment, income, family wealth, housing, loans, social services, and more – lead to healthcare barriers. The literature here is vast, but we recommend Ira Katznelson’s history of how large federal programs that created the middle-class in the U.S. (Social Security, the right to unionize, the GI Bill, etc) largely excluded people of color, leading to a massive wealth gap, as well as recent studies showing the continued prevalence of racial discrimination across all areas of life, often due to “implicit bias” as opposed to intentional discrimination.
These barriers to healthcare are all the worse since racial discrimination leads to greater health needs for some communities of color. In particular, a new body of a research in the last decade is showing that the daily experience of racism and the stress/self-doubt it causes, is a major cause of poor health itself, particularly for African Americans. This “embodied inequality” may also explain why immigrants, who are generally much healthier than native U.S. residents, experience declining health outcomes the longer they live here.