What’s Race Got To Do With It?The Impact of Racism on Health

1st Annual Northeast Regional Community Health Network Area (CHNA) Networking

Forum

May 15, 2012

RACISM

BPHC Mission

The mission of the Boston Public Health Commission is to protect, preserve and promote the health and well-being of all Boston residents, particularly those most vulnerable.

What are disparities in health?

The NIH defines health disparities as “differences in the incidence, prevalence, mortality and burden of diseases and other adverse health conditions that exist among specific population groups in the United States.”

Health InequitiesDifferences in health

that are not only unnecessary and avoidable but, in

addition, are considered unfair and

unjust.

References: Braveman P. Health disparities and health equity: concepts and measurement. Annual Review of Public Health 2006;27:167-194:Whitehead M, Dahlgren G. Levelling Up (Part 1): A Discussion Paper on Concepts and Principles for Tackling Social Inequities in Health. World Health Organization. Available at http://www.euro.who.int/ document/e89383.pdf.

Health Disparities

Differences in the presence of disease, health outcomes, or access to health care between population

groups.

So, why are some people sicker and die sooner than others?

IS IT ABOUT ACCESS TO HEALTH CARE?

Racial and Ethnic Inequities in Breast Cancer Mortality

Racial and Ethnic Inequities in Cervical Cancer Mortality

IS IT ABOUT EDUCATION OR INCOME?

Racial & Ethnic InequitiesInfant Mortality & Education

African Americans

16+ years of schooling

White Americans <9

years of schooling

Per 1,000 Live Births

NCHS 2002

10.2

6.8

Racial & Ethnic InequitiesInfant Mortality & Household Income

African Americans

with Household

Income $35,000+

White Americans with

Household Income

<$10,000

Per 1,000 Live Births

16.6

11.2

IS IT ABOUT HEALTH BEHAVIOR?

Racial & Ethnic InequitiesInfant Mortality & Cigarette Smoking

African American Non-

Smokers

White American

Smokers

Per 1,000 Live Births

NCHS 2002

13.2

9.2

Racial & Ethnic InequitiesInfant Mortality & Prenatal Care

African Americans

First Trimester

Prenatal Care

White Americans

Prenatal Care After

1st Trimester or

None

Per 1,000 Live BirthsNCHS 2002

12.7

7.1

IS IT ABOUT RACE?

• Race has no clear biologic or genetic basis…”there are no characteristics, no traits, not even one gene that turns up in all members of one so-called race, yet is absent from others” (L. Adelman. Race and Gene Studies)

• The meanings of racial designations- White, Black, Asian- are subject to historical, cultural and political forces; “race justified social inequalities as natural”.

RACE

Racial & Ethnic InequitiesInfant Mortality & Nativity

0

2

4

6

8

10

12

14

16

Foreign Born United States Born

Black Women

9.2

14.2

Per 1,000 Live Births

NCHS 2002

Low Birth Weight by Maternal Birthplace - Boston, 2004

8.1% 7.3%

4.9%

12.5%

10.0%

12.3%

6.8%

15.1%

10.5%

13.8%

7.2%8.1%

0.0%

4.0%

8.0%

12.0%

16.0%

20.0%

Pe

rce

nta

ge

of B

irth

s W

ithin

Birt

hp

lace

SOURCE: Boston resident live births, Massachusetts Department of Public HealthANALYSIS: Boston Public Health Commission Research Office

WHAT ABOUT RACISM ?

The Experience of Racism & Discrimination

2.9%

18.1%20.8%

0.0%

10.0%

20.0%

30.0%

40.0%

Black Latino White

Per

cent

age

of r

espo

nden

ts

1.9%4.0%8.3%

0.0%

10.0%

20.0%

30.0%

40.0%

Black Latino WhiteP

erce

nta

ge

of

resp

on

den

ts

Boston Adults Who Report Having Been Treated Worse Than People of Other Races At Work During the Previous Year, By Race/Ethnicity

Boston Adults Who Report Having Been Treated Worse Than People of Other Races When Seeking Health Care During the Previous Year, By Race/Ethnicity

Note: Data about Asian residents not shown due to inadequate sample sizeSOURCE: Behavioral Risk Factor Surveillance System, Massachusetts Department of Public Health and Boston Public Health Commission

Community Voices

“My doctor ignored my complaints that I was in pain as he removed my post-op tubes in the Emergency Room”

“My physician never looks me in the eyes or treats me like a person”

“When I was seeing the doctor for the flu, he wanted to talk about AIDS and drugs. It was like he thought all Latinos were addicts”

BPHC definition - adapted from a number of sources

RacismRacial and cultural prejudice and discrimination, supported intentionally or unintentionally by institutional power and authority, used to the advantage of one race (Whites) and the disadvantage of other races.

The critical element which differentiates racism from prejudice and discrimination is the use of institutional power and authority to support prejudices and enforce discriminatory behaviors in systemic ways with far-reaching outcomes and effects.

In other words…Racial Prejudice + Power = Racism

Levels of Racism

Racism operates on four levels:

• Internalized Racism• Interpersonal Racism• Institutional Racism• Structural Racism

A Health Equity Framework

Racism

Transportation

Food Access

SocioeconomicStatus

Environmental Exposure

Health Behaviors

Access to Health Services

Housing

Public Safety

Health Outcomes

Employment

Social Capital

Education

BPHC Overarching Goals

• Reduce the low birth-weight rate among Boston infants and reduce the gap between the White and Black LBW rate by 25%

• Reduce obesity rates among Boston residents and reduce the gap between White and Black/Latino overweight/obesity rates by 30% for children and 20% for adults

• Reduce Chlamydia rates among Boston teens and young adults and reduce the gap between Black/Latino and White Chlamydia rates by 25%

Racial Justice & Health Equity Initiative

Goals

• Align all BPHC programs, policies, practices, and operations within a racial justice and health equity framework

• Build capacity of BPHC to effectively reduce inequities across the city

Anti-Racism Advisory Committee (ARAC)

ARAC’s Charge:“to review, assess and develop recommendations on policies, practices, structures and systems at the Commission in an inclusive process that engages all Commission staff”

Professional Development Series

RACIAL JUSTICE AND HEALTH EQUITY INITIATIVE Professional Development Series

Goal:To ensure that all BPHC staff apply the principles and practices of health equity and racial justice to all of the Commission’s work.

Objectives:• Increase staff understanding

• Equip staff with strategies, resources, and tools

• Create a culture of ongoing learning

How Can CHNAs Address Racism?

• Acknowledge the problem• Educate ourselves and our partners• Use data• Be intentional about ensuring those

most affected are at the table• Focus on policy & system changes