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Racial Health Disparities in America

Michelle A. Gourdine

In 2012, Trayvon Martin, a seventeen-year-old boy dressed in a hoodie, carrying a bag of Skittles and iced tea while walking through a neighborhood where he “didn’t belong,” was approached and eventually shot and killed by George Zimmerman, a resident on “neighborhood watch.”

Like so many African American parents, I was at once mad, and afraid. Almost immediately, protective instincts kicked in, and my husband and I had “The Talk” with our children, starting with our then fifteen-year-old son.

Imagine a mother and father, having to teach their son—their wide-eyed, PlayStation-playing, manga-cartoon-reading, food-inhaling, too-shy-to-let-his-mom-kiss-him-in-public son—how NOT to be killed by someone who doesn’t know him, yet assumes the worst about him.

It’s been eight years since that talk. And outrageously, little has changed. If it had, we wouldn’t know the names of Philando Castile and Michael Brown and Eric Garner and George Floyd and so many others who belong to an exclusive club where the cost of membership is the violent taking of your life.

So “The Talk” was not a one-and-done. We repeated it, reinforced it, retaught it. We asked our children to review it, rehearse it, reiterate it. Because, as parents, our job is to protect our children, to see around dark corners that they can’t, to anticipate and keep them from danger. Like not darting out into traffic. And looking both ways before you cross the street. And teaching them how to respond to being confronted by someone who doesn’t know you, but because of your skin color, assumes that you have dangerous intent, which takes “stranger danger” to a whole new level, doesn’t it? 

According to a recent study, police use of force is the sixth leading cause of death for young black men in America and is but one of many examples of the reality that African Americans get sicker and die younger. As a physician who has spent my thirty-year career working to understand these racial health disparities, and as I processed our country’s seeming inability to learn from past wrongs, I began to recognize a connection between the need to have “The Talk” and racial health disparities in America. Both are the result of differential assumptions made in the context of the majority culture, the requirement to adapt to the majority culture, and the differential distribution of resources reflective of privilege.

Traditional explanations for why we get sicker and die younger are faulty. Poverty is blamed, yet many affluent African Americans are sicker than poorer white Americans.

Unhealthy diets and lack of exercise are blamed. But behavior occurs in the context of our environments, which are shaped by an unequal distribution of the resources needed to be healthy.

Genetics is blamed. But racial classifications do not reflect genetic or biological differences. Race is a social construct. We are still living under the Tuskegee legacy of racial eugenics built on the faulty foundation that African Americans are differentially susceptible to disease due to inferior genetic qualities.

In the same way that a young black male dressed in a hoodie walking through a nonblack neighborhood is labeled threatening, a patient who does not follow the doctor’s recommendations is labeled uncooperative, or noncompliant. This implicit bias affects treatment decisions, the quality of healthcare received, and the patient’s health outcomes. For example, patients with sickle cell anemia legitimately seeking pain relief are often denied because they are accused of exhibiting “drug-seeking behavior.” 

In America, good health is shaped by the places we work, live, learn, and play. And although the Civil Rights Act removed legal barriers to equality, it did not remove systemic barriers to opportunity. Overcrowded and under-resourced black neighborhoods didn’t manifest on their own. They are the result of housing policies like redlining and restrictive covenants that determined where African Americans could, and could not, live. Furthermore, many of the places where African Americans work don’t offer health insurance as a benefit. Many of the places where African Americans live expose their children to lead paint. Many of the neighborhoods where African American children play have no recreational centers or parks. And many of the places where African American children learn have overcrowded classrooms and outdated textbooks that are insufficient in quantity. These places directly affect the health of African Americans.

We must confront the truth. Too many of the same structures and systems that created inequality decades ago are still present today. Our current system produces exactly the results that it has been designed to produce.

Today, in America, we are all born equal, but we are not treated equally.

Structural racism in America is real and is costing black lives. It’s time to acknowledge it, confront it, and change it.

We’ll know we’re successful when black people no longer get sicker and die younger; when health becomes a human right, not a byproduct of privilege; and when no other black parent has to explain to their child that the color of their skin places their lives at risk.

Until then, I’ll continue to have “The Talk” with my children.

Michelle A. Gourdine, M.D. is Interim Chief Medical Officer and Senior Vice President, Population Health and Primary Care, at the University of Maryland Medical System.

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