Poverty, Racism and the Public Health Crisis in America

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Black families in the United States have on average about one-twentieth the wealth of their white peers.

Bettina Beech, Head of Population Health at UH

Bettina Beech, Clinical Professor of Population Health in the Department of Population Health Systems and Sciences at the University of Houston College of Medicine and Head of Population Health at UH, examines poverty and racism as factors influencing health.

Although extreme poverty in the United States is low by global standards, the United States has the worst index of health and social problems based on income inequality. In a recently published article, Bettina Beech, Clinical Professor of Population Health in the Department of Population Health Systems and Sciences at the University of Houston College of Medicine and Head of Population Health at UH, examines poverty and racism as factors influencing health.

“A common narrative of the relatively high prevalence of poverty among marginalized minority communities is based on racist notions of racial inferiority and a frequent denial of the structural forms of racism and classism that have contributed to public health crises in the United States. United and in the world, ”Beech reports in Frontiers in public health. “Racism contributes to and perpetuates economic and financial inequalities which diminish the prospects for improving the health of the population among marginalized racial and ethnic groups. The United States has one of the highest poverty rates in the developed world, but despite its collective wealth, the burden falls disproportionately. on communities of color. The goal of population health is to achieve health equity, so that each person can reach their full potential.

Although overall wealth has increased in recent years, the growth in economic and financial resources has not been evenly distributed. Black families in the United States have on average about one-twentieth the wealth of their white peers. For every dollar of wealth in white families, the corresponding wealth in black households is five cents.

“Inequality of wealth is not a function of work ethics or the difference in working hours between groups. On the contrary, the widening gap between the rich and the poor may be linked to unfair policies and practices that favor the rich, ”Beech said. “The impact of this form of inequality on health became evident during the COVID-19 pandemic, as economically disadvantaged people were more likely to be infected with SARS CoV-2 and die. “

A very old problem

In the mid-1800s, Dr. James McCune Smith wrote one of the earliest descriptions of racism as the cause of health inequalities and ultimately health disparities in America. He explained that a person’s health “is not primarily a consequence of their innate makeup, but rather reflects their intrinsic membership in groups created by a racially structured society.”

Over 100 years later, the Heckler Report, the first government-approved assessment of racial disparities in health, was released. He noted that the inequality in mortality was linked to six leading causes of preventable death among blacks compared to the white population (cancer, cardiovascular disease, diabetes, infant mortality, chemical dependence and homicide / unintentional injury).

This report and others have led to a stronger focus on population health in recent decades, which has included a renewed interest in the impact of racism and social factors, such as poverty, on people. clinical results.

The myth of meritocracy

Beech argues that structural racism harms marginalized populations at the expense of granting greater resources, opportunities and other privileges to mainstream white society.

“Public discourse has been largely shaped by a narrative of meritocracy that is interwoven with ideals of opportunity without any consideration of the realities of racism and racial inequalities in the structures and systems that have locked up individuals, families and communities living in poverty for years. generations, “she said.” Coupled with the lack of a national health program, this condemns oppressed populations such as blacks and Hispanics, American Indians, and non-immigrant and refugee English speakers disproportionately remain in poverty and suffer from suboptimal health. “

The keys to improvement

The World Health Organization has identified three keys to improving health at the global level, each of which reinforces the impact of socio-economic factors: (1) improving the conditions of daily life; (2) address the inequitable distribution of power, money and resources; and (3) develop a workforce trained and sensitized by the public to the social determinants of health.

The report’s findings underscore the need to implement health policies to increase access to care for low-income people and underscore the need to ensure that these associated policies and programs reach those in need.

Health care providers can directly address many of the factors critical to closing the gap in health disparities by recognizing and trying to reduce the implicit race-based biases that many physicians carry,” as well as by using their privilege to fight against the elements of institutionalized racism rooted in the fabric of our society, starting with social injustice and human indifference, ”Beech said.

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