This is a trying time in our country. Just a few weeks ago, all talk and thought was focused on COVID-19, the economy opening up, and the possibility of a second wave because some states were opening too quickly. Before the video of George Floyd’s brutal death at the hands of police officers. And before large groups of protesters joined together across the country to demand systemic change.
The reality is, there has always been a huge gap when it comes to race and healthcare quality in America. It’s been known for years. Some may say it’s due to culture, faith, religion, socioeconomic status, trust, education, health literacy, experience – this list can go on and on. What it does come down to are resources and access to high-quality and appropriate healthcare. And this is lacking for too many in this country.
The health of black people in the US
As you’re reading through this, here are a few social determinants of health stats to keep in mind:
- In 2017, nearly 40 million people in the US are black making up 1/8th of the population; this is expected to grow to 55 million by 2060
- Non-elderly black people are younger, more likely to live below the poverty level and less likely to have someone residing in their home who has full-time employment
- Non-elderly black people face more disparities in health measures than white people: more likely to be in fair or poor health, be obese, diagnosed with diabetes, and suffer from asthma
- Blacks also have negative societal and environmental factors that lead to poor health: have less than a high school education, reside in a food insecure household, and live in an unsafe neighborhood
- It’s still more likely for black people to be uninsured
Racial disparities and life expectancy
If we take a look at the life expectancy gap between black and white populations, we have seen a decrease in recent years. In 1999, the gap was 5.9 years, and this decreased to 3.6 years in 2013. You may say, “That’s not as bad as I thought,” but this can drastically change when taking a micro-level look. NYU School of Medicine analyzed life expectancy for the 500 largest cities in the US. This analysis showed the largest gap in life expectancy in Chicago, 30.1 years, followed by Washington, DC (27.5 years) and New York City (27.4 years).
The tale of two ‘cities’ in the same city
In Chicago, there are 9 short miles between two very different realities: Englewood and Streeterville. Only 9 miles separate these two neighborhoods, yet this is the largest divide in the country. In Streeterville, residents live to be 90 years old, on average; Englewood, it’s an average of 60 years. Why such a difference?
Streeterville: The pictures people see of Chicago are often Streeterville or the surrounding neighborhoods. It’s home to tourist attractions, hotels, corporations, higher-end shopping, nice restaurants, skyscrapers, gyms, universities, world-renowned hospitals, high-end real estate, and home to affluent, educated, white people. Only 3% of the population is black. 47% hold a Master’s degree or higher. 38% have a Bachelor’s degree. The median household income is $115,000 per year.
Englewood: Located on the South Side, most infamous for the high crime rates. Englewood is consistently named one of the most dangerous neighborhoods in the city. It’s home to low income housing, abandoned buildings, crime, shootings, gangs, and struggling hospitals. Four of these hospitals on the South Side had announced in the beginning of 2020 to create their own health system with the goal of providing better care and access to care for its residents. This was called off just last month. 91% of the population is black. Only 3% of residents hold a Master’s degree or higher. 6% hold a Bachelor’s degree. The median household income is $27,000 per year.
Knowing all of this, it may not be a surprise that healthcare outcomes are worse for black people and that there is such a huge gap in life expectancy between these two neighborhoods. The questions we should all be asking ourselves is how do we improve this? How do we do better?
Death rates of COVID-19
Most recently, the pandemic has brought to light, and to mainstream news, the difference in health outcomes between racial groups. This is evident in the deaths of black Americans from COVID-19. Blacks have died at a rate of 50.3 per 100,000 people; whites at a rate of 20.7 per 100,000 people. More than 200,000 black individuals have died from the disease. Race and income are found to be the biggest factors in life or death. In New York City, neighborhoods with black and Latino, low income residents experienced the highest death rates, while affluent white areas saw very few deaths. In Chicago, blacks make up 30% of the city’s population, but account for 60% of the deaths. A study conducted at our client, Sutter Health, found that race and ethnicity played a huge role, and that blacks diagnosed with COVID-19 were significantly more likely to be admitted to the hospital.
Access to and use of palliative care and end-of-life services
In the US, 72% of hospitals with 50+ beds and 94% of hospitals with 300+ beds have a palliative care team, while only 60% of public hospitals report having a palliative care team. These public hospitals care for ~44 million people, mostly minorities. While access is a challenge, there is also a lack of awareness of the benefits, skepticism around what exactly is palliative care and why it is being recommended. And we can’t forget that this is being recommended by a provider or healthcare system – one that these individuals may not truly trust.
Taking a look at the care individuals receive at end-of-life, a study showed that 50% of whites enroll in hospice before death, while only 1/3 of black people do so. When looking at advance directives, 40% of whites 70+ have completed one, compared to 16% of blacks. Another study found that blacks are more likely to have significantly higher rates of hospital admissions, ED visits, opt for more aggressive treatments, and discontinue hospice care. While some decisions may be based on cultural or religious beliefs, focusing and selecting curative care rather than comfort care, there is a still a lack of community education and awareness. While this is seen in general throughout the US, the results of these studies seem to undeniably allude to the fact that this is more prevalent in minority communities.
We must acknowledge beyond today, tomorrow, a week, and even a month from now that there are systemic disparities in this country based on skin color. This exists in healthcare. So as the country and each of us takes this time to reflect, understand, educate, and listen, the healthcare community must be intimately involved. This is the only way we can ensure everyone in this country has access to high-quality healthcare and improve health outcomes.