African American Community

Health Equity in the African American Community

Section Leader(s): Samantha Casimir, Faith Crittenden, Trisha Kwarko, Nurudeen Osumah, Ezigbobiara Umejiego

 

Introduction:

The kidnapping and enslavement of Blacks from the continent of Africa as early as the 15th century, to work as cheap and free labor in North America, laid the foundation for how the health and welfare of Blacks and minority communities would be regarded centuries later. According to historical reports, an estimated 9 to 35 percent of slaves being transported to the "New World" died during the middle passages of the Atlantic slave trade, with an even higher proportion dying in the course of their enslavement.1,2,3 Worse, the economies of slavery led to the establishment of structural systems aimed at fostering and furthering this exploitative system. 

The abolition of slavery did not end the mental, physical and socioeconomic exploitations, but led to the creation of a new structural and systemic institution. For example, the genesis of American policing in the South began as "Slave Patrol" in the Carolina colonies in 1704 with the following goals: "(1) to chase down, apprehend, and return to their owners, runaway slaves; (2) to provide a form of organized terror to deter slave revolts; and, (3) to maintain a form of discipline for slave-workers who were subject to summary justice, outside of the law, if they violated any plantation rules."4,5 Slave patrols morphed into police departments, backed by legal and political authorities, to enforce segregation "Jim Crow" laws aimed at controlling and denying freed slaves equal rights and access to the medical, political and socioeconomic systems.4,5,6 The 20th century America and the Civil Rights movement exposed how rife and pervasive police brutality was in the United States, wherein the police institutions responded to peaceful protests with sheer brutality and violence. 

Unfortunately, police brutality against Blacks is difficult to quantify. Since 2010, prominent cases such as Tamir Rice, Eric Garner, Sandra Bland, Eric Garner, and Breonna Taylor has taken center stage on the importance and urgency of understanding the effects of police encounters and racism has on Blacks.7,9,10 Blacks are 7-times more likely to experience police brutality than Whites. This is a constant reminder of the devaluation of Black lives in America. Excessive police force and inadequate prosecution of perpetrators might increase feelings of powerlessness in the Black community.7,10 Police brutality also affects the economic productivity of Black communities.7 Observing videos of police brutality causes accelerated heart rate and increased respiratory rate, overtime causing wear-and-tear on the body. 

Black Lives Matter arose to combat the issues of police brutality and racism in general.10,11 Unfortunately, despite their increasing advocacy, systemic and structural issues remain that prevent the barrier for People of Color to feel truly included in American society. Racism and police brutality has caused a host of physiological and psychological effects on minorities in terms of allostatic load stressors, affecting the social determinants of health of Blacks, continuing to perpetuate structural responses that affect quality of life for a segment of the United States population.9,11 Healthcare disparities, especially post Affordable Care Act has further shown the divide in societal structure that minorities face.8,11,12 This ranges from access to healthcare, cultural competency, advocacy, and coverage.7 Especially in the COVID-19 pandemic, all these issues which have been underneath the surface has been brought to light.12 We are often reminded that the system in which we find ourselves in works the way it was set up to work. However, it is possible with advocacy and proper practice recommendations, changes can be implemented to right the injustice Blacks face.8,9,10  

This session is geared towards giving student a glimpse into the complexities of systemic racism in American society and its effect on Black and other minority communities.

 

Learning Objectives

By the end of this session, learners will be able to do the following: 

  1. Discuss the indirect effect the allostatic load of racism and police encounters have on the health of Blacks.
  2. Analyze the role the Black Lives Matter movement has had in addressing issues related to the health of Blacks
  3. Recognize and give examples of how the health of Blacks is managed in the current health care system.
  4. Identify and analyze the racial health disparities faced by Blacks during the COVID-19 pandemic with the current health care system.
  5. Analyze and apply recommendations for how future physicians can address racism in medicine.

 

Learning Materials 

  1. Casimir S, Crittenden F, Kwarko T, Osumah N and Umejiego E. No justice, no health: Police brutality and COVID-19, two pandemics plaguing Black American community. https://kaltura.uconn.edu/media/Equity+for+the+African+American+Community/1_c3yrirey  
  2. Noonan AS, Velasco-Mondragon HE, Wagner FA. Improving the health of African Americans in the USA: an overdue opportunity for social justice. Public Health Rev. 2016;37:12. Published 2016 Oct 3. doi:10.1186/s40985-016-0025-4
  3. Alang S, McAlpine D, McCreedy E, Hardeman R. Police Brutality and Black Health: Setting the Agenda for Public Health Scholars. Am J Public Health. 2017;107(5):662-665. doi:10.2105/AJPH.2017.303691. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5388955/
  4. Jee-Lyn García J, Sharif MZ. Black Lives Matter: A Commentary on Racism and Public Health. Am J Public Health. 2015;105(8):e27-e30. doi:10.2105/AJPH.2015.302706. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4504294/
  5. Godoy M, Wood D. What Do Coronavirus Racial Disparities Look Like State By State? https://www.npr.org/sections/health-shots/2020/05/30/865413079/what-do-coronavirus-racial-disparities-look-like-state-by-state. Published May 30, 2020. Accessed September 15, 2020. 
  6. The Lancet. Medicine and medical science: Black lives must matter more. Lancet. 2020;395(10240):1813. doi:10.1016/S0140-6736(20)31353-2. https://www.sciencedirect.com/science/article/pii/S0140673620313532

     

    Optional Reading Materials

    1. MT Bassett, MD, MPH, Jarvis T. Chen, ScD, Nancy Krieger, PhD. HCPDS Working Paper. 2020 June 12; 19(3).
    2. Trust for America's Health. The impact of Chronic Underfunding on America's Public Health System: Trends, Risks, and Recommendations, 2019. https://www.tfah.org/report-details/publichealthfunding2020/
    3. Buchmueller TC, Levinson ZM, Levy HG, Wolfe BL. Effect of the Affordable Care Act on Racial and Ethnic Disparities in Health Insurance Coverage. Am J Public Health. 2016;106(8):1416-1421. doi:10.2105/AJPH.2016.303155
    4. McIntyre A, Song Z. The US Affordable Care Act: Reflections and directions at the close of a decade. PLoS Med. 2019;16(2):e1002752. Published 2019 Feb 26. doi:10.1371/journal.pmed.1002752

     

    References

    1. Noonan AS, Velasco-Mondragon HE, Wagner, F.A. Improving the health of African Americans in the USA: an overdue opportunity for social justice. Public Health Rev 2016; 37,12. https://doi.org/10.1186/s40985-016-0025-4 
    2. Cohn RL, Jensen RA, Miller JC. Mortality in the Atlantic slave trade. J Interdiscip Hist. 1982;13(2):317-336. https://europepmc.org/article/med/11635245 
    3. Klein HS, Engerman SL, Haines R, Shlomowitz R. Transoceanic mortality: the slave trade in comparative perspective. William Mary Q. 2001;58(1):93-117.
    4. The History of Policing in the United States, EKU School of Justice Studies. https://plsonline.eku.edu/sites/plsonline.eku.edu/files/the-history-of-policing-in-us.pdf. 
    5. Hansen, C. Slave Patrols: An Early Form of American Policing. BLOG: ON THE BEAT. https://lawenforcementmuseum.org/2019/07/10/slave-patrols-an-early-form-of-american-policing/#_edn5 Accessed December 1, 2020.
    6. Waxman, OB. How the U.S. Got Its Police Force. TIME. https://time.com/4779112/police-history-origins/ Updated May 18, 2017. Accessed December 1, 2020.
    7. Alang S, McAlpine D, McCreedy E, Hardeman R. Police Brutality and Black Health: Setting the Agenda for Public Health Scholars. Am J Public Health. 2017;107(5):662-665. doi:10.2105/AJPH.2017.303691. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5388955/
    8. Adepoju OE, Preston MA, Gonzales G. Health Care Disparities in the Post-Affordable Care Act Era. Am J Public Health. 2015;105 Suppl 5(Suppl 5):S665-S667. doi:10.2105/AJPH.2015.302611 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4627524/
    9. Jee-Lyn García J, Sharif MZ. Black Lives Matter: A Commentary on Racism and Public Health. Am J Public Health. 2015;105(8):e27-e30. doi:10.2105/AJPH.2015.302706 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4504294/
    10. The Lancet. Medicine and medical science: Black lives must matter more. Lancet. 2020;395(10240):1813. doi:10.1016/S0140-6736(20)31353-2. https://www.sciencedirect.com/science/article/pii/S0140673620313532
    11. Millett GA, Jones AT, Benkeser D, et al. Assessing differential impacts of COVID-19 on black communities. Ann Epidemiol. 2020;47:37-44. doi:10.1016/j.annepidem.2020.05.003 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7224670/
    12. Khatana SAM, Groeneveld PW. Health Disparities and the Coronavirus Disease 2019 (COVID-19) Pandemic in the USA. J Gen Intern Med. 2020;35(8):2431-2432. doi:10.1007/s11606-020-05916-w https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7251802/