Commentary: Black History Month – Examining racism’s effects on health
While it’s important to honor and study the richness of Black history in the U.S., we must acknowledge that much of that history is tied to structural racism embedded in many of society’s systems. One example is the role of racism in health outcomes, and the resulting public health crisis.
About half of a person’s health status is based on five key social determinants of health, including their neighborhood, financial stability, access to education and health care services, and social contexts. While these interlinked determinants may initially seem to be the result of personal choices, they’ve been heavily shaped by centuries of racist policies and practices.
For example, until 1968, restrictive housing practices like redlining and other racial covenants existed in many cities, including Ogden. Maps were divided into desirable neighborhoods primarily reserved for white families, and less desirable areas where many people of color were forced to live, including veterans receiving the GI Bill. Those who could invest in desirable properties could establish homeowner equity and build intergenerational wealth, while those restricted from these properties often purchased land that decreased in value or was lost to eminent domain.
The boundaries of this segregation can still be seen in many lower-income housing areas nationwide, disproportionately populated by people of color, which are frequently located near industrial areas and are more likely to have environmental hazards like run-down structures and increased pollution. Businesses are less likely to invest in or be located in these areas, which can reduce convenient access to decent jobs and undermine social mobility.
Also, since public schools are partially funded by local property taxes, schools in these areas are often under-resourced, with high student-to-teacher ratios, few support staff and limited technology. This lack of resources increases the risk of educational deficits and high dropout rates, which can further restrict people to lower-paying jobs.
Employment is a common way that people access health insurance. Those in lower-paying jobs are less likely to afford quality health plans but may also make too much to qualify for Medicaid, falling into the coverage gap. These jobs are often labor intensive, lack flexibility and are more frequently categorized as “front line” positions, all of which increases risks for injury and illness. This is apparent when looking at COVID-19 infection and death rates, disaggregated by race.
It’s also important to note that medical racism influences health outcomes. The U.S. has a long history of inhumane treatment, including experiments on enslaved people, the Tuskegee syphilis study, eugenics and coercive sterilizations. While these practices are now illegal, the consequences still show up as implicit racial biases that can distort health care access and decision making. Examples include racial disparities in how pain is treated, infant and maternal mortality rates, access to preventative screenings and specialist referrals based on computer algorithms, and family planning options.
Finally, social contexts are influenced by structural and overt racism, ranging from the racial fatigue of constant micro-aggressions to hate crimes in which Black people are murdered while grocery shopping. Inaccurate racial stereotypes fuel perceived criminality, seen in skewed representation within the school-to-prison pipeline, police harassment and brutality cases, and mass incarceration linked to inequitable sentencing for similar crimes. Racial trauma associated with these perceptions and social injustices, as well as incarceration itself, can amplify multiple mental and physical health conditions.
While history has shown the Black community to be fiercely powerful and extraordinarily resilient in the face of discrimination, it is inexcusable that even in 2023 much of society continues to uphold, or at least ignore, the structures that perpetually lead to racism being a public health crisis. We must examine and dismantle racist systems, overturn racist policies, embed racial justice in strategic plans, and promote mental and physical health equity for all.
The Annie Taylor Dee School of Nursing is committed to advocating for social justice and advancing equity, diversity and inclusivity in academia and nursing. We recognize that diversity enriches the learning environment for everyone and enthusiastically invite qualified people of ALL identities to apply for our programs, as well as upcoming positions.
“To the wrongs that need resistance. To the right that needs assistance. To the future in the distance. Give yourselves.” — Carrie Chapman Catt
Dr. Kathleen Paco Cadman is an associate professor at Weber State University’s Annie Taylor Dee School of Nursing, which is celebrating its 70th anniversary this year. She is a certified nurse educator and a certified public health nurse who primarily teaches population health for undergrad and graduate students, as well as an anti-racism course in the WSU honors program. She is heavily involved in equity, diversity and inclusion initiatives across campus.