Health care: black and white

The Covid-19 pandemic has brought into sharp relief the failings of the U.S. health care system to give adequate priority to public health: our woeful performance in testing, contact tracing and availability of personal protective equipment. It has also highlighted the marked social disparities in how we deliver health care.

Across the United States, the death rate from Covid-19 per 100,000 among non-Hispanic whites is 22.7, among Asian-Americans 24.3, among Hispanics 24.9 and among African Americans 54.6. The strikingly higher death rate reflects many factors. Blacks are more likely to live in crowded housing, making “social distancing” more difficult; they are more likely to have to depend on crowded public transportation; they have a higher incidence of such medical conditions as hypertension and diabetes that increase mortality; and they are more likely to work in such “essential” jobs as meat packing, nursing homes and home health care and grocery stores, and less likely to be able to work from home.

The racial disparity in health care exposed by the pandemic is not new. Overall deaths per 100,000 in the U.S. in 2018 were 725 for non-Hispanic whites and 852 for African Americans. The maternal death rate in this country has been (or should have been) an embarrassment for a long time. While the death rate per 100,000 live births in most of the western world ranges from 5 to 8 and has been falling, in the U.S, during the decade 2007-2016, it rose from 15 to 17. Here too there was a marked racial disparity. The maternal death rate among white women averaged 12.7/100,000 in the most recent figures, while it was 40.8 among black women. Poverty alone is not the explanation; among women with at least a college degree, the maternal death rate of black mothers was 5.2 times that of whites.

Too often, minority populations live in the least safe housing, are less likely to have health insurance and have less access to health care.

As detailed in Prescription for Bankruptcy, some 80% of a nation’s health, as measured by factors such as our life expectancy at birth, is determined by social factors rather than the traditional health care delivery system. To lead healthy lives, people need safe housing, access to healthy food, green spaces, educational opportunity, social support and, most important of all, a living wage.

Whether through development of a vaccine or the gradual development of effective treatment and herd immunity, the pandemic will end. The racial disparity in health and health care will not unless we make a conscious decision to make societal change.

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