The One Big Union is an idea originating in the late 19th and early 20th centuries amongst trade unionists to unite the interests of workers and offer solutions to all labour problems.
Unions initially organized as craft unions. Workers were organized by their skill: carpenters, plumbers, bricklayers, each into their respective unions. Capitalists could often divide craft unionists along these lines in demarcation disputes. As capitalist enterprises and state bureaucracies
became more centralized and larger, some workers felt that their
institutions needed to become similarly large. A simultaneous
disenchantment with the perceived weakness of craft unions caused many
unions to organize along industrial lines. The idea of the "one big union" is championed by anarchist syndicalists to organize effectively.
As envisioned by the Industrial Workers of the World (IWW), which for many years prior to 1919 had been associated with the concept, One Big Union was not just the idea that all workers should be organized into one big union. In the 1911 pamphlet One Big Union, IWW supporters Thomas J. Hagerty and William Trautmann
enumerated two goals: One Big Union needed to "combine the wage-workers
in such a way that it can most successfully fight the battles and
protect the interests of the workers of today in their struggles for
fewer hours of toil, more wages and better conditions," and it also
"must offer a final solution of the labor problem – an emancipation from
strikes, injunctions, bull-pens, and scabbing of one against the other."
One Big Union was the notional organizational concept, while the
IWW's revolutionary industrial unionism was the organizing method by
which that concept could be realized. "Organizing the One Big Union of
all workers the world over" was meant to achieve "working class
control".
But the One Big Union organizations were resisted by government and
industry, and subverted by existing trade unions. By 1925, only the slogan of One Big Union remained.
One Big Union in practice
The Industrial Workers of the World (IWW) adopted and promoted the concept of the One Big Union after the publication of the One Big Union pamphlet in 1911; the IWW continues to use the phrase.
Members of the IWW historically, and currently, signed and sign letters
(and other communications) with the closing, "Yours for the O.B.U." Many commentators regard One Big Union as synonymous with the Industrial Workers of the World. One of the popular IWW publications was called One Big Union Monthly.
The IWW promoted the One Big Union concept in various ways,
including as an invitation to racial equality. One IWW leaflet
proclaimed:
To Colored Workingmen and Women: If you are a wage worker you are
welcome in the I.W.W. halls, no matter what your color. By this you may
see that the I.W.W. is not a white man's union, not a black man's union,
not a red or yellow man's union, but a working man's union. All of the
working class in one big union.
The IWW used the same sort of arguments to welcome women into the workforce.
The appeal subsequently proclaimed the intent to organize "all wage
workers ... into One Big Union, regardless of creed, color, or
nationality ... An injury to one is an injury to all." The One Big Union idea had the immediate goals of better pay, shorter hours, and better surroundings.
The IWW propagandized, "Organize in one big union and fight for a
chance to live as human beings should live. All together now and victory
will be ours."
The WFM and the ALU then cooperated to found the IWW.
The IWW was conceived as a global union with the goal of organizing the
entire world. The concept of One Big Union, growing out of the IWW's
revolutionary program, evolved over a period of time:
[I]n moving toward revolutionary industrial unionism, Denver's labor
radicals were not building from scratch; rather, they drew upon and
elaborated ideas and strategies generated by the previous twenty years
of Denver's labor history ... [A]lthough the labor wars of 1903–4 may have triggered the formation of the IWW, the ideological synthesis it would uphold had been worked out in the American Labor Union's leadership by the summer of 1903 ...
The WFM had been founded as a conservative trade union after a bitter and violent strike in Coeur d'Alene in 1892. The WFM conducted a successful strike in Cripple Creek in 1894,
notable for the exceedingly rare intervention of the state on the side
of the striking miners. But the strike which some historians believe
shaped the philosophy and tactics of the WFM, and which ultimately
resulted in the WFM embracing revolutionary industrial unionism and the eventual promulgation of the One Big Union concept, occurred against mine owners in Leadville. Out of that struggle came the November 1897 proclamation
of the State Trades and Labor Council of Montana, a document which
broke with the past – declaring that "the old form of organization is
unable to cope with the recent aggressions of plutocracy" – and called
for a new type of labour organization.
The WFM wasn't that organization. It had poured resources into the Leadville strike, and yet was defeated. Additional resources which had been promised by the AFL were not provided. The solution was organizing western labourers and western unions into a new umbrella-like federation
(i.e., the WLU, the ALU, and eventually, the IWW). These conclusions
represented "an absolute rejection" of the AFL, of its conservative
philosophy and its complacent demeanour.
But the WFM did undergo substantial changes. In contrast to the AFL, the WFM,
... opened itself to all potential members and also to ideas and values in conflict with Capitalism.
It accepted any member of a bona fide union without initiation fee upon
presentation of a valid union card. It demanded neither a closed shop
nor an exclusive employment contract. It sought jobs for all, not merely
the organized and highly skilled few.
Members of the WFM "... saw no advantage to huddling within their
traditional crafts; they sought to mobilize all workers across a given
industry to confront employers – and governments – with their aggregate
clout. With little stake in the status quo, they invested their faith in
sweeping political programs to remedy the grim conditions in which they
worked and lived."
In 1905, WFM leaders initiated a meeting of thirty prominent
socialists and labour radicals in Chicago. This group analysed
industrial and social relations from the revolutionary viewpoint and
drafted a manifesto. Enumerating labour's grievances, it criticized
craft unions for creating a skilled aristocracy,
and suggested "one big industrial union" embracing all industries and
"founded on the class struggle". Printed in great quantities, this
invitation to the first convention of the IWW was sent around the country.
The One Big Union concept grows
The IWW organized in the United States, Canada, Australia, and other countries, employed creative tactics, and advocated the general strike
as a favourite method for workers to gain control of industries. But
One Big Union spread far beyond the IWW. The revolutionary character of
the OBU can be appreciated from a statement by the Brotherhood of Metal
Workers' Industrial Union, a 1909 offshoot of the International Association of Machinists. In 1919, this organization published the following,
The workers, not only of America, but of all countries, are determined to get the full value
of the price they paid and will yet pay. There can be no peace until
the workers not only control, but also own, the means of life, liberty,
and happiness. To accomplish this, it necessitates the ownership of all
industries by a government of workers, for the workers, which can and
will be accomplished by the One Big Union.
Also in 1919, the International Federation of Workers in the Hotel,
Restaurant, Lunchroom, Club and Catering Industry (IFWHRLC) called upon
its members to terminate any AFL memberships and was judged by
investigators, on the basis of an explanation of industrial unionism in
the Hotel Worker, one of its publications, to be a "revolutionary
organization based upon the One Big Union principle, having for its
objective the establishment of a new social order and the seizure of
industry." The Hotel Worker stated, in part:
Under industrial unionism, all the Workers in one industry form One Big Union of that industry.
Instead of being split up into a lot of separate units, with
divided and often conflicting interests, they strengthen and unite their
forces in one mighty and irresistible combination.
The Journeymen Bakers' and Confectioners' International Union of
America (JBCIUA) came under suspicion for hosting a delegation of the
IWW, and for forming a committee to explore a merger with the IFWHRLC.
Investigators concluded that such events confirmed "the organization of
One Big Union along I. W. W. lines to control all the workers in the
food industry in this state, as well as in the greater part of the
country." Cognizant of repression of the period that came to be called the Red Scare,
the JBCIUA passed a resolution which stated, in part, "... that our
best friends and advisors are being martyrized by the capitalistic
system, in the present period of worst reaction, and have been thrown
into jail for long terms."
In 1919 in the United States the newly formed Communist Labor Party
(CLP) sought to attach itself to the One Big Union movement, and to
industrial unionism. The CLP urged all its members to join industrial
unions. The IWW concluded that the Russian revolution and local communist activities had a divisive effect on the general anti-capitalist movement, but this effect was not immediately apparent.
In 1919 in Canada, unionists who were discontent with policies of the
Trades and Labour Congress of the Dominion formed a union called "One Big Union" (OBU). The Canadian OBU movement had been inspired by the IWW, and like the IWW, it favoured the general strike. The concept of One Big Union in western Canada did not gain widespread acceptance until the Western Labor News reported that the idea had been adopted by the Australian Workers International Industrial Union in South Melbourne, Australia. That Australian workers' organization went beyond industrial unionism to advocate the abolition of private ownership of the means of production.
Because of recent history in Western Canada, an increasing acceptance
of industrial unionism accompanied a growing appreciation of the general
strike, and the need for an OBU to call it. A mood of militancy had been growing in Western Canada for some time.
The OBU spread rapidly in Canada. Lodges, trades councils, and
provincial federations withdrew from their international organizations,
and joined the OBU, culminating in a membership of nearly fifty thousand
the first year. The OBU also generated considerable support for dual affiliation. This incarnation of the OBU movement was also attacked by mainstream labour, in the person of John L. Lewis and other AFL officials.
The One Big Union organization in Canada differed structurally
from the IWW. While the IWW organized on industrial lines, the OBU of
Canada focused more on organizing workers geographically.
The absence of an existing industrial union structure within the
Canadian OBU resulted in the defection of 20,000 members of the Lumber Workers Industrial Union (LWIU). According to the 1922 publication Industrial Unionism in America, "Their withdrawal was a staggering blow from which the O. B. U. [never] recovered."
When the IWW in the United States was suppressed during the Red Scare and the Palmer Raids, there was pressure to similarly attack Canada's One Big Union movement:
The movement was got well under way with a basis of I.W.W. and
Socialist support; Calgary was a centre of the movement as it had been
in the Alberta mining unrest of these years. So obvious was the current
of thought that the Calgary Herald of Sept. 6th struck a warning
note: "There is an element in Western Canada that is somewhat akin to
the I.W.W. if not actually affiliated with and controlled by it. Let the
I.W.W. of Canada or their imitators, beware lest the strong hand of the
law does not stretch out and grasp them as it has their friends on the
other side of the 49th parallel. There is a feeling throughout the
country that it would be better for all concerned if a few of them were
behind the bars."
The Canadian government imprisoned the most prominent members of the Canadian OBU.
Australia
The One Big Union movement was organized in Australia.
The concept was initially considered in 1908, when the idea of adopting
the preamble of the Industrial Workers of the World was voted upon by
the New South Wales Trade Union Congress, and the first concrete step toward one big union was adopted in 1912. In 1917, George Beeby, the labour minister for the New South Wales government, said in a speech,
... an important conference of Trade Unionists was held in Sydney
to further the idea of one big union. The men responsible for that
gathering openly said that their object was to get the Unionists formed
into a one big union organisation which, at any time, by the
proclamation of a general strike, could stop all production and
transport, and force from any government in office whatever concessions
were demanded. ... The men at the head of this movement are in favour of
direct action
as against political action ... With consummate skill the men who
initiated this idea have got possession of the whole Labour movement.
An organization called the One Big Union Propaganda League (OBUPL) was formed in Brisbane on 10 September 1918, growing out of former IWW strongholds in the north.[43]
With help from IWW members, the OBUPL gained considerable support from
the rank and file of craft unions, emphasizing job control and bottom-up
organizing.
Australian trade union officials, succeeded in changing the
character of the OBU from that envisioned by the IWW, and also by the Workers' International Industrial Union
(WIIU), a group that had split off from the IWW, and was active in
Australia. The One Big Union movement ceased to challenge capitalism in
Australia, but rather sought to function within capitalism; it evolved
from an industrial to a craft basis; it developed into a top-down
bureaucracy. By 1924 the Australian OBU ceased to be viable.
The
goal of the IWW – as interpreted by government investigators in 1920 –
was "to break up the system of craft or trade unions, and to organize
workers into One Big Union having subdivisions along the lines of
industry, rather than those of trade." That interpretation appears to have been accepted by American Federation of Labor
Gompers who in 1922 expressed his belief that the One Big Union idea
was designed primarily to put the American Federation of Labor out of
business.Gompers undermined any labour actions that he perceived might be related to the One Big Union movement; for example, the Winnipeg General Strike and the Seattle General Strike. A 1919 editorial in Revolutionary Age, the official organ of the Left Wing Section of the Socialist Party, proclaimed:
The union bureaucrats are particularly against industrial unionism,
since industrial unionism ends craft divisions and craft disputes, which
constitute the power of the union bureaucracy. In Canada, the One Big
Union – Industrial Unionism – has captured the imagination of the
organized workers. The One Big Union directed the great general strike
in Canada; but, says an observer, "the International Brotherhoods
have come out against the strikers, shrewdly foreseeing in the One Big
Union the destruction of their organization." This is a damning indictment of the old unionism.
In June 1919, the American Federation of Labor (AFL), in session in Atlantic City, New Jersey,
passed resolutions in general opposition to the general strike. The
official report of these proceedings described the convention as the
"largest and in all probability the most important Convention ever held"
by the organization, in part for having engineered the "overwhelming
defeat of the so-called Radical element" via crushing a 'One Big Union'
proposition and a proposal for a nationwide general strike, both by a
vote of more than 20 to 1."
The AFL amended its constitution to disallow any central labour union
(i.e., regional labour councils) from "taking a strike vote without
prior authorization of the national officers of the union concerned."
The change was intended to "check the spread of general strike
sentiment and prevent recurrences of what happened at Seattle and is now
going on at Winnipeg." The penalty for any unauthorized strike vote was revocation of that body's charter.
In 1919 the Lusk Committee,
charged with exposing and stamping out radicalism of all types, issued a
report that found the AFL to be "free from the taint of revolutionary
radicalism." It found one AFL affiliate, the International Ladies' Garment Workers' Union
(ILGWU), to have "marked radical tendencies ... it is founded upon the
principles of class struggle ... it adopts the One Big Union idea and
seeks to bring about the overthrow of society."
One Big Union Canada also came under considerable pressure from the Canadian Trades and Labour Congress and the AFL. The United Mine Workers (UMW), in particular, came to an agreement with employers to freeze out the Canadian One Big Union.
In June 1919, the UMW revoked the charter of District 18, which
included Alberta and British Columbia, for joining the OBU. The UMW
International persuaded a number of locals to return to the parent
organization. The UMW then came to an agreement with employers which
would effectively lock out the OBU. With One Big Union seen as the
greater threat, employers agreed to require UMW membership on the part
of all employees in and around the mines. The companies implemented the
dues checkoff to seal the new agreement.
OBU members refused to work under circumstances where they were
assessed dues for an organization to which they no longer belonged, and a
number of mines organized by the OBU were therefore closed down. The
OBU sought relief from the courts, but the courts sided with the United
Mine Workers and the employers. The employers and the UMW then together
secured injunctions against any OBU members to prevent any interference
with UMW miners. The O.B.U. Bulletin for 23 October 1920 reported
that the UMW had thirteen such injunctions issued, and had set aside a
million dollars to fight the OBU.
The Canadian OBU concluded that "Officials of the U.M.W. of A. are the
same bunch of crooks who have so often betrayed the miners of the U.S.
in their struggles and strikes at the instance of their government and
the owners."
The OBU felt particularly angry that the UMW invoked the aid of both
the employers and a "ruthless capitalist government" in order to crush a
rival union organization.
Criticism
The
One Big Union organizations adopted some principles of One Big Union as
initially promoted by the IWW. The OBU idea became popular in Australia
at a time when some syndicalist-leaning labour leaders had started moving toward communism.
Although the One Big Union organizations frequently formed with
the help of IWW members or members of IWW offshoot-organizations such as
the WIIU, the OBU organizations frequently incurred criticism from the
original industrial union organizations.
The IWW advocated organizing bottom-up, the OBU in Australia operated
increasingly top-down. The IWW advocated job control, the Australian OBU
did not. Shop committees and rank and file participation which had been so important to IWW members were de-emphasized. The OBU in Australia was described as "the plum extracted from the IWW cake to keep down discontent among the dupes".
The Industrial Union News of the WIIU criticized the
structure of the Canadian One Big Union organization, declaring "the
O.B.U. seeks to masquerade under the guise of industrial unionism while
organized on a territorial plane, without sound foundations and building
from the top down".
The Industrial Union News also criticized the Canadian OBU for not providing for elections of officials by the entire membership. The OBU was described as "not red but pale pink", and in league with the "reactionary Socialist Party of Canada".
The IWW publication Solidarity of 10 July 1920 stated that
labour fakirs had seized control of the OBU, and had organized new
branches of the OBU in the United States in opposition to the IWW.
Marian Dutton Savage, who published a book on industrial unionism
in 1922, saw problems with the organizational structure of the Canadian
OBU:
In neglecting to give adequate recognition to the ties binding
workers of the same industry together and in seeking to rely instead on
the general feeling of solidarity in the working class, the O. B. U.,
like the Knights of Labor,
has failed to understand the psychology of those it has sought to win
and hold. If it is difficult to make skilled and unskilled workers in
the same industry realize their community of interest, it is doubly
difficult to make those in different industries feel a strong bond of
union. The I. W. W. has faced this fact and, unlike the O. B. U., seeks
to unite all who work in an industry in one international union having a
large measure of control over its own affairs. Although it preaches the
brotherhood of all workers as ardently as does the O. B. U., it
recognizes that each industry has its own particular problems which can
best be solved by workers in that industry, and considers that loyalty
to one industry need in no way impair loyalty to the I. W. W. or to the
working class as a whole. If the O. B. U. had adopted the same course it
would not have lost the strongest group which had affiliated with it.
The U.S. Census definition of race
is often applied in biomedical research in the United States. According
to the Census Bureau in 2018, race refers to one's self-identification
with a certain racial group. The Bureau also specifies that its use of
"race" is as a social concept, not a biological or anthropological one. The Census Bureau recognizes five races: Black or African American, White (European American), Asian, Native Hawaiian or other Pacific Islander, and American Indian
or Alaska Native. Despite the fact that the United States continues to
become more diverse, these Census categories have not changed for almost
20 years.
The Census Bureau also recognizes differences in ethnicity among the
population, and it defines ethnicity as whether a person is of Hispanic
origin or not. For this reason, ethnicity is broken out into two
categories in its data, Hispanic or Latino and Not Hispanic or Latino. Hispanics may report as any race.
The 2010 U.S. Census
further specifies the number of Americans who identified with each
racial and ethnic group; in 2010, 38.9 million identified as African
American, 14.6 million as Asian American, 2.9 million as American Indian
or Alaskan Native and 50.4 million as Hispanic or Latino.
Measures of the relationship between race and medicine are
imperfect and inconsistent. The 2000 U.S. Census definition is
inconsistently applied across the range of studies that address race as a
medical factor, making it more difficult to assess racial
categorization in medicine. Additionally, the socially constructed
nature of race makes it so that the different health outcomes
experienced by different racial groups can be connected to social
factors rather than inherent biological ones.
There are significant disparities in health outcomes between the
five racial groups recognized by the U.S. Census. These health
disparities are in part caused by different levels of income across the
five groups recognized by the U.S. Census.
There are also notable differences in access to healthcare and the
quality of healthcare received by those who identify with different
racial categories.
Bias and racism
also contribute to disparities in health outcomes. Non-white racial
groups may experience bias and racism within the medical system,
impacting these groups' access to and quality of care. Additionally, the racism experienced in daily life affects health outcomes. The stress associated with racism can negatively impact a person's physical and mental health
and has been shown to contribute to health problems such as depression,
anxiety, insomnia, heart disease, skin rashes, and gastrointestinal
problems. As a scientifically studied topic in medicine, racism's Medical Subject Headings code for the United States National Library of Medicine's MEDLARS/MEDLINE, PubMed and PubMed Central bibliographic and open accessmedical journal databases is D063505.
Life expectancy
The
twentieth century witnessed a great expansion of the upper bounds of
the human life span. At the beginning of the century, average life expectancy
in the United States was 47 years. By the century's end, the average
life expectancy had risen to over 70 years, and it was not unusual for
Americans to exceed 80 years of age. However, although longevity in the U.S. population has increased substantially, race
disparities in longevity have been persistent. African American life
expectancy at birth is persistently five to seven years lower than
European Americans. By 2018 that difference had shrunk to 3.6 years.
As of 2020, Hispanics had a life expectancy at birth of 78.8
years, followed by non-Hispanic Whites at 77.6 years and non-Hispanic
blacks at 71.8 Years.
A study by Jack M. Guralnik, Kenneth C. Land, Dan Blazer, Gerda
G. Fillenbaum, and Laurence G. Branch found that education had a
substantially stronger relation to total life expectancy and active life
expectancy than did race. While 65-year-old black men had a lower total
life expectancy (11.4 years) and active life expectancy (10 years) than
white men (total life expectancy, 12.6 years; active life expectancy,
11.2 years), those differences were reduced when controlling for
education. The same was not true for females: at 65 years old, black and
white women had similar life expectancies to white women. And at ages
75 and 85, both black men and black women had significantly longer life
expectancies than their white peers, with the black advantage being even
greater when matching for education.
During the 20th century, the difference in life expectancy between black and white men in the United States did not decline.
While socioeconomic status (SES) is a contributing factor in race health disparities, it does not account for all the variation.
Even when controlling for socioeconomic status, racial divides in
health persist. For example, Black Americans with college degrees have
worse health outcomes than White and Hispanic Americans who have high
school diplomas.
Studies on heart disease mortality have found that gaps between Black
and White Americans exist at every education level. A longitudinal study
over more than twenty years found that Black physicians had higher
prevalence of cardiovascular disease, earlier onset of disease, twice
the incidence of hypertension, and higher prevalence of diabetes compared to White physicians. For maternal mortality,
Black women who are college graduates have pregnancy-related mortality
ratios (number of pregnancy-related deaths for every 100,000 live
births) that are 1.6 times greater than White women who had not finished
high school.
Black women have higher maternity mortalilty rates than white women
regardless of socioeconomic status and pre-existing health conditions.
According to the American Journal of Preventive Medicine, a data analysis was performed using The Behavioral Risk Factor System survey to examining the perceptions of racial privilege in healthcare among different races.
These results showed that whites with a higher income and an
educational background had an increase perception in receiving medical
treatment and a decrease in discrimination. Oppose to blacks the
perceptions were the complete opposite compared to whites.
Several studies suggest that race is a positive association with
socioeconomic (SES) and education when providing health services. Currently, there are future research being conducted to understand the concept behind racial privileges in the healthcare.
Specific diseases
Health disparities are well documented in minority populations such as African Americans, Native Americans, and Latinos.
In the year 1985, a report, known as the Heckler Report, was released
to address the state of concern regarding African American and minority
populations.
This report sought to look at statistical data that showed its
prevalence and the action towards bridging this health equity gap. The
report identified six areas of health concern: cancer, cardiovascular
disease and stroke, chemical dependency related to cirrhosis of the
liver, diabetes, homicides and accidents, and infant mortality. When compared to European Americans and Asian Americans, these minority groups have higher incidence of chronic diseases, higher mortality, and poorer health outcomes. More importantly noted are the number of lives that could have been saved if healthcare were the same between both populations.
That is, African Americans and minority populations having access to
healthcare that meets their needs and seek to address this much needed
change.
Minorities often have higher rates of cardiovascular disease, HIV/AIDS, and infant mortality than whites.
U.S. ethnic groups can exhibit substantial average differences in
disease incidence, disease severity, disease progression, and response
to treatment.
African Americans have higher rates of mortality than does any other racial or ethnic group for 8 of the top 10 causes of death. The cancer incidence rate among African Americans is 10% higher than among European Americans and the mortality rate from asthma is twice the rate of European Americans.
African Americans are found to have some of the highest rates of
chronic Hepatitis C and Hepatitis C-related deaths in comparison to
other populations.
U.S. Latinos have higher rates of death from diabetes, liver disease, asthma, and infectious diseases than do non-Latinos.
In 2015, nearly 2.2 million Hispanics/Latinos nationwide reported
having asthma, with Puerto Rican Americans possessing almost tripled the
asthma rate of the overall Hispanic population. A part of this
disparity can be said to be due to the higher rates of pollution found
in communities of people of color.
Adult African Americans and Latinos have approximately twice the risk as European Americans of developing diabetes.
Asian Americans are 60% more likely to being at risk of developing
diabetes in comparison to European Americans and are more likely to
develop the disease at lower BMIs and lower body weights. South Asians
are especially more likely to developing diabetes as it is estimated
South Asians are four times more likely to developing the disease in
comparison to European Americans.
Native Americans suffer from higher rates of diabetes, tuberculosis,
pneumonia, influenza, and alcoholism than does the rest of the U.S.
population.
Disparities in diabetes and cardiovascular disease have been
hypothesized to be linked to higher rates of suboptimal sleep in this
population.
European Americans die more often from heart disease and cancer than do Native Americans, Asian Americans, or Hispanics.
White Americans have far higher incident rates of melanoma of the
skin or skin cancer than any other race/ethnicity in the US. In 2007
incident rates among white American males were approximately 25/100,000
people, whereas the next highest group (Hispanics and natives) has an
incidence rate of approximately 5/100,000 people.
According to the NIH, African Americans are more likely to develop
diabetes. Usually, type 2 diabetes is more prominent in middle-aged
adults. Being obese or having a family history can also affect this.
Over the past 30 years in the US, "black adults are nearly twice as
likely as white adults to develop type 2 diabetes."
Besides this difference just being between black and white adults, we
see the greatest margin of comparison between black and white women.
In 2015, 87 percent of all TB cases in the United States occurred in
those that are identified as racial and ethnic minorities, especially
Hispanics, Asians, and African Americans.
Even more recently, African Americans are considered the group with the
highest rate of infection, totaling more than 1,000 cases in 2019.
Socioeconomic factors are the related cause, alongside it presenting
barriers to treatment in the disease.
Sickle cell disease
is more susceptible to be found in those of descent from places such as
those in the Mediterranean, Italy, Turkey, and Greece, as well as
Africa and regions of South and Central America.
The disease affects how oxygen is delivered to the red blood cells and
is often diagnosed at a young age, discovered through a diagnosis of
anemia.
In a 2019 study on racial discrimination and dental health in the U.S. the authors found that the "emotional impact of racial discrimination" results in fewer visits to a dentist.
According to the National Health and Nutrition Examination Survey
data, childhood obesity is more common among Hispanic (25.8%) and Black
children (22.0%) compared to white children (14.1%). In other studies the same results are seen in adults from the same race and ethnicity.
A 2021 systematic review on hearing loss in adults found an absence
of racial and ethnic diversity in studies that did not represent the
diversity of the US population.
Disparities in health and life span among blacks and whites in the US have long existed before today. Many African Americans
and minorities weren't subjects of outreach, nor attended to for
communicable or non-communicable conditions. Several incidents
throughout early history show maltreatment, neglect, and being denied
healthcare in comparison to the white population. Foregoing early
treatment progresses infection, leads to disability, or ultimately
death, dependent upon the disease. One of those namely events in history
is the flu epidemic of 1918. The virus infected more than 675,000
people, with a total of 500 million worldwide.
Black communities were either refused care, received subpar attention,
or, where available, expected and pursued aid from black nurses.
Although current information reflects that minorities in the United
States have lower life expectancies and encounter a larger number of
health conditions than their white counterparts, the health of black
people has not always been documented.
Accurate numbers showing the number of African Americans infected,
disabled, or died—or succumbed to it—aren't available; records remain
scarce, since so few of those victims were able to get to institutional
healthcare providers or agencies.
David R. Williams and Chiquita Collins write that, although racial
taxonomies are socially constructed and arbitrary, race is still one of
the major bases of division in American life. Throughout US history
racial disparities in health have been pervasive.
In a 2001 paper, Williams and Collins also argued that, although it is
no longer being legally enforced, racial segregation is still one of the
primary causes of racial disparities in health because it determines socioeconomic status by limiting access to education and employment opportunities.
Clayton and Byrd write that there have been two periods of health
reform specifically addressing the correction of race-based health
disparities. The first period (1865–1872) was linked to Freedmen's Bureau legislation and the second (1965–1975) was a part of the Civil Rights Movement.
Both had dramatic and positive effects on black health status and
outcome, but were discontinued. Even though African-American health
status and outcome is slowly improving, black health has generally
stagnated or deteriorated compared to whites since 1980.
The Tuskegee study was another prime example of health disparities among African Americans. The study showed lack of medical treatment and discrimination among blacks.
African Americans find it difficult to participant in clinical trials
due to lack of understanding and knowledge received by researchers.
In 1932, the Tuskegee study was involved with 600 black men, 399 with syphilis and 201 with no disease.
Researchers explained to the men they were being treated for "bad
blood," a term used in the study to describe several ailments, including
syphilis, anemia, and fatigue.
The men were told by researchers and health professionals that they
would be participating in a study to cure their current illnesses.
The men in the study later found they were not being treated for the
purpose they agreed upon. This study resulted in a class action lawsuit
due to lack of evidence, no consent, misleading information, and medical
neglect.
As a result, by July 1972 when the study ended, over 100 participants
had died, 40 spouses had been diagnosed, and disease had been passed to
19 children at birth.
In one study, researchers found medical professionals perceive
black patients to be less susceptible to pain than their white patients.
White patients are given better treatment and access than black
patients. As a result, black patients are more vulnerable to disease
than white counterparts.
Demographic changes can have broad effects on the health of
ethnic groups. Cities in the United States have undergone major social
transitions during the 1970s, 1980s, and 1990s. Notable factors in these
shifts have been sustained rates of black poverty and intensified
racial segregation, often as a result of redlining.
Indications of the effect of these social forces on black-white
differentials in health status have begun to surface in the research
literature.
Race has played a decisive role in shaping systems of medical
care in the United States. The divided health system persists, in spite
of federal efforts to end segregation, health care remains, at best
widely segregated both exacerbating and distorting racial disparities.
Furthermore, the risks for many diseases are elevated for socially,
economically, and politically disadvantaged groups in the United States,
suggesting to some that environmental factors and not genetics are the
causes of most of the differences.
Racial differences in health often persist even at equivalent
socioeconomic levels. Individual and institutional discrimination, along
with the stigma of inferiority, can adversely affect health. Racism can
also directly affect health in multiple ways.
Residence in poor neighborhoods, racial bias in medical care, the
stress of experiences of discrimination and the acceptance of the
societal stigma of inferiority can have deleterious consequences for
health.
Racism is a key determinant of socioeconomic status (SES) in the United
States, and SES, in turn, is a fundamental cause of racial inequities
in health. Using The Schedule of Racist Events (SRE), an 18-item self-report inventory that assesses the frequency of racist discrimination. Hope Landrine
and Elizabeth A. Klonoff found that racist discrimination was frequent
in the lives of African Americans and is strongly correlated to
psychiatric symptoms.
A study on racist events in the lives of African American women
found that lifetime racism was positively correlated to lifetime history
of both physical disease and frequency of recent common colds. These
relationships were largely unaccounted for by other variables.
Demographic variables such as income and education were not related to
experiences of racism. The results suggest that racism can be
detrimental to African Americans' well-being. The physiological stress caused by racism has been documented in studies by Claude Steele, Joshua Aronson, and Steven Spencer on what they term "stereotype threat."
Kennedy et al. found that both measures of collective disrespect
were strongly correlated with black mortality (r = 0.53 to 0.56), as
well as with white mortality (r = 0.48 to 0.54). A 1 percent increase in
the prevalence of those who believed that blacks lacked innate ability
was associated with an increase in age-adjusted black mortality rate of
359.8 per 100,000 (95% confidence interval: 187.5 to 532.1 deaths per
100,000). These data suggest that racism, measured as an ecologic
characteristic, is associated with higher mortality in both blacks and
whites.
Princeton Survey Research Associates found that in 1999 most
whites were unaware that race and ethnicity may affect the quality and
ease of access to health care.
There is a great deal of research into inequalities in health care. In 2003, the Institute of Medicine
released a report showing that race and ethnicity were significantly
associated with the quality of healthcare received, even after
controlling for socioeconomic factors such as access to care.
In some cases these inequalities are a result of income and a lack of
health insurance, a barrier to receiving services. Almost two-thirds (62
percent) of Hispanic adults aged 19 to 64 (15 million people) were
uninsured at some point during the past year, a rate more than triple
that of working-age white adults (20 percent). One-third of working-age
black adults (more than 6 million people) were also uninsured or
experienced a gap in coverage during the year. Blacks had the most
problems with medical debt,
with 31 percent of black adults aged 18 to 64 reporting Past-Due
Medical Debt, vs. 23 percent of whites and 24 percent of Hispanics.
Compared with white women, black women are twice as likely and Hispanic women are nearly three times as likely to be uninsured.
However, a survey conducted in 2009, which examined whether patient
race influences physician's prescribing, found that racial differences
in outpatient prescribing patterns for hypertension,
hypercholesterolemia, and diabetes are likely attributable to factors
other than prescribing decisions based on patient race. Medications were
recommended at comparable rates for hypercholesterolemia, hypertension
and diabetes between Whites and African Americans.
It has been argued that other cases of inequalities in health care reflect a systemic bias in the way medical procedures and treatments are prescribed for different ethnic groups. Raj Bhopal writes that the history of racism in science
and medicine shows that people and institutions behave according to the
ethos of their times and warns of dangers to avoid in the future.
Nancy Krieger
contended that much modern research supported the assumptions needed to
justify racism. Racism contributes to unexplained inequities in health
care, including treatment for heart disease, renal failure, bladder cancer, and pneumonia.
Raj Bhopal writes that these inequalities have been documented in
numerous studies. The consistent and repeated findings that black
Americans receive less health care than white Americans—particularly
where this involves expensive new technology—is an indictment of
American health care.
The infant mortality rate for African Americans is approximately
twice the rate for European Americans, but, in a study that looked at
members of these two groups who belonged to the military and received
care through the same medical system, their infant mortality rates were
essentially equivalent.
Recently a study was conducted by the KFF, the Henry J Kaiser Family
Foundation, in order to learn more about the infant mortality rate
throughout the United States. All fifty states were surveyed. Different
distributions of racial categories used in the study includes,
"Non-Hispanic White, Non-Hispanic Black, American Indian or Alaska
Native, Asian or Pacific Islander, or Hispanic".
The infant mortality rate was compiled by the number of infant deaths
per one thousand live births. In 2015, on an average nationwide, the
United States reported that for Non-Hispanic white had an infant
mortality rate of NSD meaning there as not enough sufficient data,
Non-Hispanic black's rate was 11.3, Indian or Alaska Native's was 8.3,
Pacific Islander was 4.2, and the infant mortality rate on average for
Hispanic was 5.0.
Recent immigrants to the United States from Mexico have better
indicators on some measures of health than do Mexican Americans who are
more assimilated into American culture.
Diabetes and obesity are more common among Native Americans living on
U.S. reservations than among those living outside reservations.
The number of Native Americans diagnosed increased by 29% just between
the years of 1990 and 1997. The prevalence of this among women and men
shows that women more often have diabetes than men, especially in
communities of Native American people.
A report from Wisconsin's Department of Health and Family Services showed that while black women are more likely to die from breast cancer,
white women are more likely to be diagnosed with breast cancer. Even
after diagnosis, black women are less likely to get treatment compared
to white women. University of Wisconsin African-American studies Professor Michael Thornton said the report's results show racism
still exists today. "There’s a lot of research that suggests that who
gets taken seriously in hospitals and doctors’ offices is related to
race and gender," Thornton said. "It’s related to the fact that many
black women are less likely to be taken seriously compared to the white
women when they go in for certain illnesses."
Krieger writes that given growing appreciation of how race is a
social, not biological, construct, some epidemiologists are proposing
that studies omit data on "race" and instead collect better
socioeconomic data. Krieger writes that this suggestion ignores a
growing body of evidence on how noneconomic as well as economic aspects
of racial discrimination are embodied and harm health across the
lifecourse. Gilbert C. Gee's study A Multilevel Analysis of the Relationship Between Institutional and Individual Racial Discrimination and Health Status found that individual (self-perceived) and institutional (segregation and redlining) racial discrimination is associated with poor health status among members of an ethnic group.
In the 2020 covid pandemic, a disproportionate rate in the amount
of covid deaths in the African American communities compared to other
racial groups has been demonstrated in some part of the United States.
Many cases such as covid and AIDs has led more African Americans to lose
trust in healthcare intuitions and the government that is supposed to
protect their rights. Milwaukee County is just one of many examples of
such communities that were hit hard by covid. African American
represented three fourths of covid deaths. This has been a common factor
for many parts of the countries major populated cities that have has
high percentage of African Americans.
Race-Based Diagnoses
Racial groups, especially minority groups, are frequently exposed to different types of barriers when in need of medical treatment. The World Health Organization identifies some of these barriers, including unequal access to health services, lack of cultural sensitivity, differing quality of services, timeliness of access to such services, and general discrimination in healthcare systems. Certain racial groups can receive different courses of treatment, diagnoses, and prescription medications than those that self-identify as other races. These differences can be commonly linked to correction factors in medical calculators, algorithms that are unable to account for variables rooted in social disparities, and drugs designed for specific racial populations. BiDil is a drug used to treat congestive heart failure in black people. The Food and Drug Administration
initially rejected applications of the medication since their clinical
trials did not demonstrate any efficacy for a general racial population
within the United States, except for African Americans.
BiDil's manufacturer, NitroMed, then completed a clinical trial that
solely enrolled African Americans. They found a decrease in mortality
for this exclusive group and in 2005, the FDA approved the drug's usage
exclusively for black patients. It is currently still in use with the same stipulation.
BiDil has been considered to be a "race drug"
by some in the medical community. Backlash stems from a debate on
whether race can be a reliable factor in making diagnoses and
prescriptions. Those that oppose its usage believe its prescription
process to be unscientific. With respect to BiDil's racialization, Sheldon Krimsky wrote, “'self-identified race' is a subjective term, influenced by cultural factors, and not even grounded in the ancestral genomics."
Ziad Obermeyer M.D., et al. found that a specific algorithm,
which determines what patients need further care, favors additional
medical attention towards white people over black people. This analysis was based on data concerning average health costs
that are incurred by these specific races. The same article puts
forward the claim, "Bias occurs because the algorithm uses health costs
as a proxy for health needs," as African Americans have been found to
face disproportionate poverty levels in the United States and are forced
to spend less on healthcare than white patients.
This bias caused the algorithm to find that black patients are
generally healthier than white patients and a conclusion was created by
the algorithm that black patients do not need extra care in such
instances.
Estimated glomerular filtration rate (eGFR) is a scored measurement of a patient's kidney
function. Once measured, healthcare providers can utilize the test
score to determine the quality of kidneys' filtering ability in a given
patient. According to a study by Dr. Darshali Vyas, et al., the equation
for eGFR reports a higher score for black patients by a factor of
1.210,
which the study's authors doubt the validity of. The algorithm's
developers backed the results, citing that black people have higher creatinine levels, which can be a lurking variable
in eGFR calculations. Vyas makes a rebuttal to this idea, stating,
"Explanations that have been given for this finding include the notion
that black people release more creatinine into their blood at baseline,
in part because they are reportedly more muscular." In reality, this generalization may not be the case and can be harmful to minorities that encounter such correction factors.
Similarly, the vaginal birth after Caesarean section (VBAC) medical calculator is used to estimate the probability that a patient will successfully complete a vaginal birth if they have already had a birth via Caesarean section.
There are correction factors based on race that have been commonly used
in this calculator; self-reported African American patients' results
are multiplied by a factor of 0.671.
The VBAC calculator is in the process of being altered by the
Maternal-Fetal Medicine Units Network, as of December 2021, to omit race
and ethnicity in the interest of ignoring such "socially constructed variables" that may be inaccurate.
Mental health
Stress
can be derived from many individualistic factors or experiences, has
multiple effects on health. Stress is also associated with chronic
diseases. Stress that is derived from racism has specific contextual
factors, which adds a daily burden to African-Americans and other
demographic groups that are discriminated against. These demographic
groups do not often realize that these stressors may be contributing to
the state of their mental health.
Groups of people are also affected in ways that may not be outward acts
of racism by another person, but through education, economics, the
justice system, and largely through law enforcement. It is also possible
that people who hold racist ideals have mental health problems as well,
such as self-centeredness, inability to empathize, and paranoia over
groups of people they are discriminating against. Individuals can
develop complexes about ethnic groups and races, automatically
displaying emotions without learning about the people themselves, and
will cut off all friendliness to them.
There are many barriers
that exist in the relationship for African Americans accessing mental
health services. These barriers can range from family dynamics,
institutional racism, socioeconomic status, and a host of other reasons.
This is particularly true for African Americans in need of mental
health services who could benefit from effective treatment. “Effective
treatment exists for many mental disorders, an indicator of need for
mental health services (MHS), receive any treatment. This
underutilization is more pronounced among African Americans than Non
Hispanic whites (Villatoro & Aneshensel, 2014).
There is something to be said about the lack of utilization of mental
health services amongst African Americans. There are several possible
explanations for the state of mental health use in African American
communities. While many African Americans do not receive mental health
services, those who do receive services are negatively impacted by the
institutional bias that exists between them and non-black counselors. In
a study of 47 clinicians and 129 African Americans who sought therapy,
researchers found that African Americans tend to have a healthy cultural
paranoia about their non-black therapists. Interviews with them found
Black patients simultaneously engaged in and ‘‘scanned’’ the encounter
for feelings of comfort; safety in disclosing personal information;
being trustful of the provider; and being listened to, understood, and
respected by the provider. For some patients, judgments about the
initial encounter seem to have less to do with clinical expertise or
experience of the provider and more with perceptions of empathy and the
quality of the interpersonal connection between the two individuals
(Earl, Alegría, Mendieta, & Diaz Linhart, 2011).
In order to improve the outcomes of therapy for African Americans, it
is imperative that non-black therapists are culturally competent.
Increasing cultural competence of mental health clinicians will help
foster an empathetic relationship between clinicians and their clients.
In addition, the social environment in which African Americans
live in plays a role in their mental health. As it relates to African
Americans, it is not enough to deal with them independent of the world
they exist in. Mental health clinicians must strive to see their African
American clients within the context of the environments they move
through. How these social factors impact the African American client
must be examined and thoroughly processed by both the clinician and the
client. The examination of how social factors influence individual
thought and behavior is particularly critical for African Americans.
Social environment constructs, psychosocial mediators, and
sociodemographic are factors that have to be considered when it comes to
African Americans and mental health. Ecological approaches that aim to
systematically modify how the world interacts with blackness, life
experiences that African Americans perceive as stressful, depression,
and perceived racial discrimination, may have the greatest impact on
mental health in African Americans and may lead to additional
improvements in the holistic well-being of African Americans (Mama, Li,
Basen-Enquist, Lee, Thompson, Wetter, Nguyen, Reitzel, & McNeill,
2015).
For example, there must be institutional efforts at a national and
grassroots level that address the numerous social issues impacting
African American communities. Particularly, programs that enhance their
life outcomes. In other words, there must be advocacy for African
American clients who are engaging in therapy, and that advocacy must
extend to the world they live in outside of their therapy sessions.
African American millennial's mental health has also raised
concerns due to the lack of being able to find employment. African
American males between the age of twenty and twenty-four were studied
and were found to experience unemployment at almost double the rate of
their white peers. Mental issues are presented in the form of addictions
such alcohol and smoking. Conditions of depression have reported as
well. Societal pressure of gender norm is one factor that leads to
mental health issues for African American males.
0:54Tamara speaks about feeling "ignored" as a Black mother in the United States in 2019.
African American women are three to four times more likely to die in
childbirth than white women, while their babies are twice as likely to
die than white babies, even when controlled for many factors such as
education, income, and health. Danyelle Solomon argues that "White
racism” is the highest cause of unrest in communities, pushing them
further apart, and causing more black women and infants to die because
of it.
Racism affects several components of a black woman's life in regards to
being able to give birth or currently carrying. Racism found in the
delivery of health care and social service means black women often
receive substandard care in comparison to white women.
As well, denial of care to black women that seek help when enduring
pain, or that health care and social service providers fail to treat
them with dignity and respect when it comes to their wellbeing.
African American women face greater chances than white women to have
chronic stress which can stem from living in impoverished neighborhoods
or encountering discrimination. These embedded stressors as a result of
societal inequities and prejudice could largely explain the underlying
health disparities in negative birth outcomes. Although studies
examining the effects of prenatal stress are limited, for a few reasons,
evidence does support the consequences of high levels of stress or
anxiety.
Women are said to bear low birth weight or preterm infants from
elevated stress or anxiety, and even more so with a lack of social
support.
In the aftermath, newborns become predisposed to issues, such poor
physical development, from the mother's stress during pregnancy. With
that being said, stress from racism not only affects mental and physical
wellbeing, but disproportionately place black infants at a disadvantage
for future attainment.
Racism in education has decreased significantly over the past
century, however this does not help increase the income for black
people, and increased incomes do not provide better health
opportunities, especially for mothers and infants.
Higher education and income levels for black mothers does not affect
this mortality rate. There are also higher chances that a complication
will occur during birth. Solomon argues that the ‘toxin’ of these rates
is racism, which has created a toxic environment for minority groups to
live in with multiple stressors that effect health.
In 2012, a study was conducted on early pregnancy women which
followed their children from birth to 5 years old to determine the risk
factors of obesity among low-income black children.
However, the study showed that children of overweight and obese mothers
are more than likely to become obese or overweight by the age of 5. According to the U.S. Department of Health and Human Services Office of Minority, African American women have the highest rates of obesity or being overweight compared to any other groups in the United States.
Research has explored the effect of encounters with racism or
discrimination on physiological activity. Most of the research has
focused on traits that cause exaggerated responses, such as neuroticism,
strong racial identification, or hostility. Several studies suggest that higher blood pressure
levels are associated with a tendency not to downplay racist and
discriminatory incidents, or that directly addressing or challenging
unfair situations reduces blood pressure. Personal experiences of racist behaviors increase stress and blood pressure.
Although the relationship racism and health is unclear and
findings have been inconsistent, three likely mechanisms for
cardiovascular damage have been identified:
Institutional racism
leads to limited opportunities for socioeconomic mobility, differential
access to goods and resources, and poor living conditions.
Personal experiences of racism acts as a stressor and can induce psychophysiological reactions that negatively affect cardiovascular health.
Negative self-evaluations and accepting negative cultural stereotypes as true (internalized racism) can harm cardiovascular health.
According to the U.S. Department of Health and Human Services Office
of Minority Health, in 2018, African Americans were 30% more likely to
die from heart disease than non-Hispanic whites.
Alzheimer's disease (AD) is a progressive, irreversible neurodegenerative disease and it is the leading cause of dementia.
African Americans are disproportionately affected by Alzheimer's, with
higher prevalence and incidence in African Americans than the overall
average. Genetics are a huge risk factor for Alzheimer’s, but known high-risk
genes for the disease have different effect sizes in African Americans
compared to other racial groups.
Many of the risk factors for Alzheimer's such as high blood
pressure and diabetes are more prevalent in African American
communities. Therefore making Alzheimer's disproportionately impact
black communities within America. The Alzheimer's Impact Movement is an association that seeks to advance the care for those who have Alzheimer's and Dementia.
The Washington Heights-Inwood Columbia Aging Project in 2020 collected
data on the percentages of people aged 65 or older with Alzheimer's
disease or other types of Dementia. For each demographic ages 65-74,
75-84, and 85+, the proportion of African Americans with Alzheimer's
were two times larger than the proportion of white individuals within
those age groups. Although African Americans are more likely to develop
Alzheimer's, they are only 34% more likely to receive a diagnoses for
their condition. If diagnosed, it's typical for the disease to have
already developed into the later stages with further deteriorated
cognition. As a result, African Americans tend to pay substantially more
for health services.
For African Americans in 2014 it was discovered that the average
per-person Medicare payment was 35% higher than white individuals with
Alzheimer's. Another study set on by The Chicago health and Aging
project in 2018 found that the higher risk of Alzheimer's disease could
stem from disparities within educational attainment. Findings from the
study portray a contradiction between cognition decline and cognition
and Dementia risk. The findings could reflect upon lacking cognitive
reserves developed over their lifespan. Exposure to racism, access to
resources, and exposures to neurotoxins have consequentially leading to
poorer cognitive function and disproportionately develop Dementia.
It has been argued that while actual racism continues to harm health,
fear of racism, due to historical precedents, can cause minority
populations to avoid seeking medical help. For example, a 2003 study
found that a large percentage of respondents perceived discrimination
targeted at African American women in the area of reproductive health.
Likewise beliefs such as "The government is trying to limit the Black
population by encouraging the use of condoms" have also been studied as
possible explanations for the different attitudes of whites and blacks
towards efforts to prevent the spread of HIV/AIDS.
Infamous examples of real racism in the past, such as the Tuskegee Syphilis Study
(1932–1972), have injured the level of trust in the Black community
towards public health efforts. The Tuskegee study deliberately left
Black men diagnosed with syphilis untreated for 40 years. It was the
longest nontherapeutic experiment on human beings in medical history.
The AIDS epidemic has exposed the Tuskegee study as a historical marker
for the legitimate discontent of Black people with the public health
system. The false belief that AIDS is a form of genocide
is rooted in recent experiences of real racism. These theories range
from the belief that the government promotes drug abuse in Black
communities to the belief that HIV is a manmade weapon of racial
warfare. Researchers in public health hope that open and honest
conversations about racism in the past can help rebuild trust and
improve the health of people in these communities. In 2001 the Journal of the National Medical Association
has concluded that this fear causes those within the African American
community to avoid clinical trials. Although these trials are now set up
to protect participants, black communities remain wary. This also has
its downsides, as it's impossible to know if drugs will impact white and
colored persons the same without these trials.
Past medical malpractice has led to distrust, which in turn makes
creating necessary medicine for the black community more difficult.
Perpetuating the lack of resources and health care available to black
communities. The experimentation and abuse set onto black bodies in the
pursuit of medical development has a long and treacherous history. The
Tuskegee experiment is one of the more well known experiment, where
black men with Syphilis
were left untreated to ease the doctors' curiosities concerning the
natural course of the disease when left untreated. Many of the men were
told that their study was concerning "bad blood" and nothing more. The
doctors would dissuade these individuals from seeking outside help,
while performing blood draws, spinal taps, and autopsies.
The Tuskegee experiments have had generational consequences in the
belief of health care. There are many in the black community who believe
the government injected syphilis virus into those men in the
experiment. Although this has not been factually proven, rumors within
the community were enough to create long withstanding distrust. The same
goes for agreeing to being an organ donor on a drivers license. Many
African Americans will immediately say no, as there's a belief that
their organs will be misused.
Many of the violent and inhuman actions taken towards people of
color have shaped how African Americans within the U.S view health care.
The Mississippi Appendectomy is where many black slaves were used as
test subjects to treat vesicovaginal fistulas, an experiment performed by Dr. James Marion Sims.
Dr. Sims was heralded as a brilliant physician, despite his inhumane
experimentation on black women to further his career. Experiments such
as these transformed after the 15th Amendment,
where many white citizens were afraid of black populations gaining too
much power. The forceful sterilization of black women without their
knowledge is one of the many examples of white Americans attempting to
regulate and control populations within black communities. Although
injustice like this has become illegal in recent years, the fear it has
created remains, resulting in the distrust of health care professionals
and birth control methods. Many woman have not received justice for the
things done to them. Medical research has historically been a form of violence for black communities living within the United States.
In 2001 the Journal of the National Medical Association
has concluded that this fear causes those within the African American
community to avoid clinical trials. Although these trials are now set up
to protect participants, black communities remain wary. This also has
its downsides, as it's impossible to know if drugs will impact white and
colored persons the same without these trials.
Past medical malpractice has led to distrust, which in turn makes
creating necessary medicine for the black community more difficult.
Perpetuating the lack of resources and health care available to black
communities. The experimentation and abuse set onto black bodies in the
pursuit of medical development has a long and treacherous history. The
Tuskegee experiment is one of the more well known experiment, where
black men with Syphilis
were left untreated to ease the doctors' curiosities concerning the
natural course of the disease when left untreated. Many of the men were
told that their study was concerning "bad blood" and nothing more. The
doctors would dissuade these individuals from seeking outside help,
while performing blood draws, spinal taps, and autopsies.
The Tuskegee experiments have had generational consequences in the
belief of health care. There are many in the black community who
believe the government injected syphilis virus into those men in the
experiment. Although this has not been factually proven, rumors within
the community were enough to create long withstanding distrust. The same
goes for agreeing to being an organ donor on a drivers license. Many
African Americans will immediately say no, as there's a belief that
their organs will be misused.
Hospitals have long been spaces that have made black persons
within the United States feel unwelcomed. Hospitals that were available
to black communities have a history of being underfunded and racially
discriminatory environments. A study performed in early 2022 by Lown Institute
identified hospitals which still used segregation practices that would
underserve patients from colored communities. Meanwhile, some of the
more inclusive hospitals gain less revenue than these hospitals with
exclusionist practices.
Many of these hospitals receive lower payments for patient care. This
could be the direct result of the present wealth imbalances between
races within the United States. Research done by the Journal of General Internal Medicine
has determined that persevering funding disparities have led to less
quality resources for hospitals that predominantly serve black patients.
Studies by the Health and Human Rights Journal
in 2020 have determined widening health disparities in the wake of
COVID-19. Testing kits were initially provided equally among the labs
within the U.S., however, there was a lack of consideration of
population density within those communities. It was determined that many
African Americans lacked access to these tests. Within Kansas, out of
roughly 94,780 tests, only 4,854 were used by African Americans, while
50,070 were used by white individuals. African Americans within the
state made up roughly one third of all COVID-19 related deaths,
demonstrating how Black communities were disproportionately impacted.
The predisposal of low wage jobs to communities of color impact the
ability to access necessary health resources. Black communities' fear
and distrust within health professionals has led to underlying health
issues becoming untreated. When a person with these health issues comes
into contact with COVID-19, it becomes a much more lethal situation.
Environmental racism is the intentional or unintentional targeting of minority communities for the siting of pollutingindustries such as toxic waste
disposal, through the race-based differential enforcement of
environmental rules and regulations and exclusion of people of color
from public and private boards and regulatory bodies, resulting in
greater exposure of the community to pollution. RD Bullard writes that a
growing body of evidence reveals that people of color and low-income
persons have borne greater environmental and health risks than the
society at large in their neighbourhoods, workplaces and playgrounds.
Environmental racism stems from the environmental movement of the
1960s and 1970s, which focused on environmental reform and wildlife
preservation and protection, and was led primarily by the middle class.
The early environmental movement largely ignored the plight of poor
people and people of color who, even in the mid-20th century, were
increasingly exposed to environmental hazards.
Policies related to redlining and urban decay can also act as a form of environmental racism,
and in turn, affect public health. Urban minority communities may face
environmental racism in the form of parks that are smaller, less
accessible and of poorer quality than those in more affluent or white
areas in some cities.
This may have an indirect effect on health since young people have
fewer places to play and adults have fewer opportunities for exercise.
Although impoverished or underdeveloped communities are at
greater risk of contracting illnesses from public areas and disposal
sites, they are also less likely to be located near a distinguished
hospital or treatment center. Hospitals relocate to wealthier areas
where the majority of patients are privately insured, thus reducing the
number of low-income patients.
Whereas hospitals were previously established in the areas with the
greatest need, most are now focused on economic gain from private
insurance companies, and are threatened by Medicare funding cuts.
Robert Wallace writes that the pattern of the AIDS outbreak during the 80s was affected by the outcomes of a program of 'planned shrinkage'
directed in African-American and Hispanic communities, and implemented
through systematic denial of municipal services, particularly fire
extinguishment resources, essential for maintaining urban levels of
population density and ensuring community stability. Institutionalized racism
affects general health care as well as the quality of AIDS health
intervention and services in minority communities. The
overrepresentation of minorities in various disease categories,
including AIDS, is partially related to environmental racism. The
national response to the AIDS epidemic in minority communities was slow
during the 1980s and '90s showing an insensitivity to ethnic diversity
in prevention efforts and AIDS health services.
Institutionalized racism
A
major downfall of the U.S. healthcare system is the unconscious racial
biases held by many white American doctors, often resulting in decreased
quality of care for African American patients. One such example is the
discrepancy in cardiovascular surgical procedures between white and
black patients. Compared to their white counterparts, black patients are
less likely to receive necessary coronary bypass surgeries and
lipid-lowering medications upon discharge from the hospital.
This means that black patients leave treatment centers with a
significantly different health outcome. African American patients are
also less likely to receive a referral for Cardiac rehabilitation following a cardiac event and/or surgery.
As a result, this potentially exacerbates other issues, creates
development of ancillary conditions, disability, or even death from a
lack of care due to subliminal racism. It is actions like these from
White doctors that contribute to the higher incidence of
non-communicable disease, such as heart disease, in the black community
and shorter life expectancy. Some White health care providers also
maintain problematic, overt ideas about their Black patients, with being
seen as less intelligent, less able to abide by treatment regimens, and
more inclined to be subjects of risky behavior than their White
counterparts. Institutionalized racism exhibits itself both in material conditions and in access to power.
Whether through differential delivery and access to a quality
education, appropriate housing, necessary employment, or any others that
are regarded as the basics or necessities in life, reflect material
conditions.
An education is foundational to being able to achieve and attain for a
better standards of living and longevity in life. However, with inequity
in an education comes being place at a disadvantage, which doesn't
level the playing ground for equal attainment. In the case of the black
community, not only is the population discriminated against on the basis
of race, but socioeconomic status, which gives rise to even greater
inequality. In the aspect of access to power, examples include
differential access to information (including one's own history),
resources and expressing concerns or rights as equal members of the
public.
One potential cause of this discrepancy in treatment is the
systematic racism present in the medical field that targets the work of
African American scientists. Research shows that doctors and scientists
of color are significantly underfunded in the medical community, and are
less likely than their white colleagues to win research awards from the
National Institute of Health (NIH).
Since patients of color are often treated by white doctors,
miscommunication is common; research shows that many Americans feel
their doctors do not listen to their questions or concerns, or are too
uncomfortable to ask certain medical questions.
To help build trust in the health care system amongst the African
American community one step would be the need to address the lack of
African American doctors. Studies have shown that African Americans make
up thirteen percent of the United States population and only represent
four percent of doctors in the country. One example is the lack of
“Black” OGBYN. Many African American women have stated that their
preference for a black doctor is derived from adverse issues coming from
childbirth, and Black women are three times more likely to die from
complications of childbirth than white women. This is only one example
among many where the lack of representation is hurting a community that
makes up a high percentage of the United States healthcare cases.
Segregation
Some
researchers suggest that racial segregation may lead to disparities in
health and mortality. Thomas LaVeis (1989; 1993) tested the hypothesis
that segregation
would aid in explaining race differences in infant mortality rates
across cities. Analyzing 176 large and midsized cities, LaVeist found
support for the hypothesis. Since LaVeist's studies, segregation has
received increased attention as a determinant of race disparities in
mortality. Studies have shown that mortality rates for male and female African Americans are lower in areas with lower levels of residential segregation. Mortality for male and female European Americans was not associated in either direction with residential segregation.
In a study by Sharon A. Jackson, Roger T. Anderson, Norman J.
Johnson and Paul D. Sorlie the researchers found that, after adjustment
for family income, mortality
risk increased with increasing minority residential segregation among
Blacks aged 25 to 44 years and non-Blacks aged 45 to 64 years. In most
age/race/gender groups, the highest and lowest mortality risks occurred
in the highest and lowest categories of residential segregation,
respectively. These results suggest that minority residential
segregation may influence mortality risk and underscore the traditional
emphasis on the social underpinnings of disease and death.
Rates of heart disease among African Americans are associated
with the segregation patterns in the neighborhoods where they live (Fang
et al. 1998). Stephanie A. Bond Huie writes that neighborhoods
affect health and mortality outcomes primarily in an indirect fashion
through environmental factors such as smoking, diet, exercise, stress,
and access to health insurance and medical providers. Moreover, segregation strongly influences premature mortality in the US.
Racism towards doctors and health care professionals
Many
healthcare professionals have experienced hate and racist remarks
towards them at work. Whether it be at a hospital, a walk-in clinic, or a
family doctor's office, people are hit with bias-based comments
concerning "general bias, ethnicity / national origin, race, age,
gender, accent, religion, political views, weight, medical education
from outside the US, sexual orientation, and more". This study conducted features the races of "African American/Black, Asian, Caucasian, and Hispanic"
Training for doctors to handle this type of prejudice at their work is
very low. The even greater downfall are men and women who become faced
with bigotry from unruly, demeaning, and complicated patients that
disrupt delivery of care. Doctors and healthcare professionals could
feel years of education could have been unworthy of such circumstances,
unappreciated, and uninspired for continued service. Although all
healthcare professionals could be at risk for discrimination from
patients, some populations come to experience it a greater rate. While
the number of doctors and other critical healthcare professionals are in
need, the thoughts of dealing with racism or any other prejudice can be
discouraging.
The group that comes to greatest experience racism are black
healthcare professionals, such as doctors and nurses that are tasked
with the duty of providing care to the general public. Like much of the
views held by white doctors regarding black patients, reflect the same
perspectives of white patients regarding black doctors. A patient's
denial of care based on the attending physician's race or background can
raise thorny ethic, legal, and clinical issues that could have been
avoided in the first place. Even more, black faculty members have
encountered a lack of mentorship and sponsorship, barriers to promotion
and advancement, and lack of supportive, alongside hostile, work
environments as factors in attrition from academic medical centers.
Experiencing discrimination is associated with several negatives
including career outcomes and an unwelcoming work environment.
Professionals can often feel alone and reluctant to be accepting of
racism as a part of the profession. A greater initiative from healthcare
organizations surrounding policy that protects not only black doctors,
but other professionals that deliver unsurpassed care retains the much
needed diversity and leadership in medicine.
Homicide
Homicide
plays a significant role in the racial gap in life expectancy. In 2008,
homicide accounted for 19% of the gap among black men, though it did
not play a significant role in the decline in the gap from 2003 to 2008. A report from the U.S. Department of Justice states "In 2005, homicide victimization rates for blacks were 6 times higher than the rates for whites." Research by Robert J. Sampson
indicates that the high degree of residential segregation in African
American neighborhoods is responsible for the high homicide rate among
African Americans.
Trends
Based on
data for 1945 to 1999, forecasts for relative black: white age-adjusted,
all-cause mortality and white: black life expectancy at birth showed
trends toward increasing disparities. From 1980 to 1998, average numbers
of excess deaths per day among American blacks relative to whites
increased by 20%.
David Williams writes that higher disease rates for blacks (or African
Americans) compared to whites are pervasive and persistent over time,
with the racial gap in mortality widening in recent years for multiple
causes of death. Junk food advertisements target African Americans.
Latinos and Hispanics
History
While Latino and Hispanic
populations are not considered a race category by the U.S. Census, this
section of the article refers to Latinos or Hispanics as an ethnic
group, as classified by the Census Bureau. Hispanic usually refers to
the language and individuals whose ancestry comes from a
Spanish-speaking country. Latino usually refers to geography,
specifically to Latin America, including Mexico, the Caribbean, Central
America and South America.
References to the Latino and Hispanic community in the United States
are frequently linked to discussions about immigration. The geographic
origins of Hispanic and Latino influxes of immigration have changed
through the years. During the 2010s Latin American and Caribbean countries have accounted for the main source of immigrant populations migrating towards the United States.
The Hispanic Paradox
is an important aspect of discussions around the history of the health
of Latino and Hispanic populations in the United States. In 1986, Prof.
Kyriakos Markides conceived the term “the Hispanic paradox” to refer to
the epidemiological phenomenon that Hispanic individuals in the US live
longer than their white non-Hispanic counterparts despite the general
lower socioeconomic status of the population and their relative lack of
access to healthcare. The US Centers for Disease Control and Prevention
published a report on May 5, 2015, relating to the general status and
causes of deaths of Hispanic population in the United States. The report
utilized mortality indicators and national health surveillance of
Hispanic populations compared to their White counterparts to explore the
possibility of Markides' paradox.
Primarily results indicated that Hispanic deaths from diabetes, liver
disease, and homicide were substantially higher than in non-Hispanic
white populations. Nevertheless, Hispanics generally had a 24% lower
risk of all-cause mortality and lower risks of nine of the leading 15
causes of death in the USA (most notably, cancer and heart disease).
Tied to the health status of Latinos and Hispanic in the United
States is an observed mistrust of doctors and the health system. This
mistrust can stem from language barriers, threat of discrimination and historical events that dismissed the consent of patients like the sterilization of Latina women in California until 1979. According to a study conducted by the United States Census Bureau,
Hispanics were the population that was most likely to have never
visited a medical provider, with 42.3 percent reporting that they had
never done so. The U.S healthcare system
is largely geared toward serving English speakers which creates an
issue for Latino and Hispanic individuals that don't speak English.
Five(55%) of the nine studies examining access to acre found a
significant adverse effect of language; three (33%) found mixed or weak
evidence that language affected access. Six (86%) of the seven studies
evaluating quality of care found a significant detrimental effect of
language barriers.
Mental health
In many Hispanic and Latino communities, mental health problems are viewed as a sign of weakness and are not necessarily validated. Hispanics/Latino are often cited as a high-risk group for mental health issues, particularly for substance abuse, depression, and anxiety.
A study conducted from 2008 to 2011, sampled more than 16,000
Hispanics/Latinos ages 18 to 74 in four diverse communities in the
states of New York, Chicago, San Diego, and Miami. The findings
demonstrated that 27 percent of Hispanics/Latinos in the study reported
high levels of depressive symptoms.
U.S population
is made up of 17.8% Hispanic and Latino individuals. Out of those
individuals, 15% had a diagnosable mental illness. This means 8.9
million people who are Latino or Hispanic suffered from a mental
illness. Immigrants in this community face inequalities in socioeconomic
status, education, and access to health care services. Hispanics are one of the lowest races/ethnicities to receive treatment based on research from 2013.
Research have signaled multiple sources of stress that could
potentially impact mental health outcomes in Hispanic/Latino
communities. For example, language influences the way patients are
evaluated. Several studies have found that bilingual
patients are evaluated differently when interviewed in English as
opposed to Spanish and that Hispanics are more frequently under-treated.
Furthermore, Hispanics/Latinos are more likely to report poor
communication with their health provider. Income has also proven to be a
significant factor that impacts the mental health of Latino
communities, as low-income individuals may have limited access to mental
health services. Nationally, 21.1% of Hispanics are uninsured compared
to 7.5% non-Hispanic individuals. Low insurance coverage affects this
group of people because ethnicity plays a role, immigration status, and citizenship status. Only 1 in 10 Hispanics with a mental disorder
utilizes mental health services from a general health care provider.
Moreover, only 1 in 20 Hispanic individuals receives such services from a
mental health specialist.
According to the Census Bureau, while the number of non-Hispanic
white women of childbearing age (15–44 years) is projected to decrease
from 36.5 million in 2010 to 35.2 million in 2020, the number of
Hispanic women of childbearing age is projected to increase from 11.8
million in 2010 to more than 13.8 million Hispanic women. The increase
in the Hispanic population in the United States is driven in part by
high fertility rates. During 2012, the fertility rate for Hispanic
identifying women was 74.4 births per 1,000 women of ages 15–44. In
2012, Hispanic women accounted for 23 percent or 907,677 of all of the
3,952,841 live births in the United States. Within the Hispanic
population, the majority of births occurred among those of Mexican
descent (61.2%), followed by Central/South American (14.5%), Puerto
Rican (7.4%), and Cuban (1.9%).
There is high medical disparity amongst hospitals contributing to
high mortality rates based on resources compared to non-Hispanic and white mothers. Examining the data from 2010, the infant mortality rate (death during the first year of life) among Hispanic women was 5.3 per 1,000 live births.
This rate accounted for more than 20 percent of all infant deaths in
the United States during the year 2010. According to the National Center
for Health Statistics, “when specific causes of infant mortality are
examined the leading cause of infant deaths in 2010 among Hispanics was birth defects (136.5 per 100,000 live births), followed by prematurity/low birth-weight
(85.0 per 100,000 live births), maternal complications of pregnancy.
Hispanic mothers were 70 percent as likely to receive late or no
prenatal care as compared to non-Hispanic white mothers, in 2017.
Research suggests that improving quality of the lowest-performing
hospitals could benefit both non-Hispanic white and Hispanic women while
reducing ethnic disparities in serve maternal morbidity rates.
Access to healthcare
Hispanic health is often shaped by factors such as language/cultural barriers, lack of access to preventive care, the lack of health insurance, illegal immigration status, mistrust, and illiteracy.
The Centers for Disease Control and Prevention has cited some of the
leading causes of illness and death among Hispanics, which include heart
disease, cancer, unintentional injuries (accidents), stroke, and
diabetes. Latino and Hispanic communities have a hard time communicating
with health professionals due to a language or cultural barrier; as a
result, they turn to outside sources for help and medication.
The survey finds that half of those who have faced these barriers
turned to a family member or to another health care provider for
assistance. Many hospitals and offices lack trained interpreters and
rely on ad hoc interpretation by bilingual staff or even the children of
patients.
Latino and Hispanic communities have concerns when it comes to long
care services in the United States. Some have concerns about finding
nursing homes and assisted-living facilities that will respect their
religious or spiritual beliefs, though fewer have the same concern about
home health aides.
The lack of education creates another barrier for individuals in these
communities that are bilingual but can't understand medical terms.
According to a 2017 U.S. Census Bureau report, 68.7 percent of Hispanics
in comparison to 92.9 percent non-Hispanic whites had a high school diploma.
More than one-fourth of Hispanic adults in the United States lack a
usual health care provider, and a similar proportion report obtaining no
health care information from medical personnel in the past year. Latino adults receive information from an alternative source, such as television and radio, based on a PHC survey.
Not only are most Latinos obtaining information from media sources, but
a sizeable proportion (79 percent) say they are acting on this
information. Many Latinos are accustomed to self-treating because most
pharmaceuticals are available without prescription in their home
countries. Immigrants may face additional obstacles to care, including
illegal immigration status (fears of deportation), illiteracy, and a
radically different set of health beliefs.
Native Americans and Alaska Natives
History
American Indian and Alaska Native populations
in the United States have experienced disproportionately negative
health outcomes compared to non-Hispanic whites since colonists arrived
at the continent in the 15th century, particularly due to epidemics
introduced by colonial groups and violent encounters with colonists. A disparity
in health outcomes between American Indians and Alaska Natives and the
general U.S. population persists today, largely due to a lack of access
to adequate medical care, language barriers, and decreased quality of
medical services in regions with significant American Indian and Alaska
Native populations. One of the elements of the inequality involves the
lack of research that begins to look into access to medical care for
Native Americans, and when research does exist, it tends to be broad and
not focus on specific elements, including childhood.
As of October 2019, American Indian and Alaska Native people who are
born today have a life expectancy of 73 years, compared to the 78.5
years for the general American population.
The Indian Health Service (IHS)
is a federal agency committed to serving the health needs of American
Indian and Alaska Native populations. Two pieces of legislation, the Snyder Act of 1921
and Indian Health Care Improvement Act of 1976, obligated the United
States government to provide healthcare to federally recognized Native
American tribes. This responsibility moved to the IHS, housed under the U.S. Department of Health and Human Services, in 1955.
The IHS currently serves over 2.3 million American Indians and Alaska
Natives population from 573 different federally-recognized tribes.
Since its implementation, IHS has been criticized for its
treatment of patients. Most notably, throughout the 1960s and 1970s, IHS
forcibly sterilized thousands of American Indian and Alaska Native women.
A study by the General Accounting Office of the United States
government found that, between the years of 1973 and 1976, physicians at
four IHS facilities – those in Albuquerque, Oklahoma City, Phoenix, and
Aberdeen, South Dakota – sterilized a total of 3406 women, 3001 of
which were of childbearing age at the time of sterilization.
The federal government has also been criticized for the lack of
funding granted to IHS. Expenditures per capita for IHS have been
substantially lower than those for other federally funded healthcare
programs.
Studies have found that physicians employed by IHS express a need for
increased funding for the agency to adequately meet the healthcare needs
of American Indians and Alaska Natives in the United States.
Because IHS serves only federally-recognized tribes, not all
people in the United States that identify with this racial group have
access to IHS resources. The American Indian and Alaska Native
population includes, but is not limited to, those who are affiliated
with federally recognized tribes – there are also state-recognized
tribes and unrecognized tribes, and individuals who do not live on
tribal lands but identify as Native American.
Thus, while IHS plays a role in the health outcomes of American Indian
and Alaska Native identifying people in the United States, it is not the
sole determinant of health outcomes for this census group.
Mental health
American
Indian and Alaska Native identifying people are more likely to have
unmet mental health needs and to experience major depressive episodes
than the non-Hispanic white population. Compared to only 5.4% of the
non-Hispanic white population, 6.7% of American Indian and Alaska Native
adults reported having needs for mental health services that had been
unmet in the last twelve months. Furthermore, 8.3% of American Indian
and Alaska Native adults reported experiencing a major depressive
episode in the past twelve months, whereas only 7.4% non-Hispanic white
adults did so.
American Indian and Alaska Native adolescents are also more likely to
have experienced a major depressive episode in their lifetime, with
16.7% of adolescents reporting such an episode compared to 14.4 of
non-Hispanic white adolescents.
The 2014 White House Report on Native Youth noted that Native Americans
between the ages of 15 and 24 years were 2.5 times more likely to
commit suicide than the national average.
Rates of post-traumatic stress disorder (PTSD) are also higher for
American Indians and Alaska Natives than the general United States
population.
Historical trauma is also an issue faced by Native Americans. Dr. Maria Yellow Horse Brave Heart
first described historical trauma for Native Americans in the 1980s as,
"cumulative emotional and psychological wounding", which in turn
affects both physical and mental health. The traumatic events she references include imprisonment and genocide, among other causes.
She outlines the six steps of the historical trauma as follows: 1)
First Contact (including the grieving period and following colonization
period), 2) Economic Competition, 3) Invasion (causing more death and
grieving), 4) Reservation Period, 5) Boarding School Period (focusing on the destruction of cultural aspects, including family structure and language), and 6) Forced Relocation.
Some critics of current mental health practices have argued that
mental health professionals working with American Indian and Alaska
Native communities should adjust their practices to patients' cultures,
particularly by increasing attention to spirituality. There have also been efforts to increase understanding of how the symptoms of DSM-recognized disorders may differ in indigenous communities as a result of different cultural practices.
American Indian and Alaska Native youth are slightly less likely
than non-Hispanic white youth to receive specialty mental health
services, they are significantly more likely to receive non-specialty
mental health services such as counseling from social workers, school
counselors, and pediatricians.
Alcoholism
in American Indian and Alaska Native populations has often been
studied, although the rates found depend on both the statistics used and
how the statistics are divided. One study from 1995 found that 26.5% of
deaths for American Indian and Alaska Native men were alcohol-related,
while about 13.2% were for women. Another study from 1996 found that in 1993, 34% of adolescents (grades 7–12) reported they had ever been drunk.
Historically, the perceived rates of alcoholism in Native Americans led
to the stereotype that they are genetically more prone to alcoholism. This stereotype has been called into question, with modern researchers instead focusing on how historical trauma and PTSD are correlated with alcoholism.
Maternal mortality rates are 4.5 times higher for American Indian and
Alaska Native women than they are for non-Hispanic white women in the
United States.
Between 2008 and 2012, 5.3% of American Indian and Alaska Native women
giving birth were diagnosed with gestational diabetes compared to just
3.7% of non-Hispanic white women.
American Indian and Alaska Native women also are less likely to
receive prenatal care than non-Hispanic white women in the United
States. Only 60.4% of American Indian and Alaska Native women receive
prenatal care in their first trimester, compared to 81.6% of
non-Hispanic white women. Additionally, American Indian and Alaska
Native women are significantly more likely to not begin receiving
prenatal care until their third trimester – 9.3% of American Indian and
Alaska Native women compared to 2.9% of non-Hispanic white women.
Whereas only 0.8% of non-Hispanic white women do not receive any
prenatal care throughout their pregnancy, 2.3% of American Indian and
Alaska Native women go entirely without prenatal care.
The infant mortality rate for American Indian and Alaska Native
populations also exceeds that of non-Hispanic white identifying people
in the United States. American Indians and Alaska Natives experience an
infant mortality rate of 8.4 per 1000 live births, compared to 4.1 per
1000 non-Hispanic white live births. Additionally, 15.2% of infants born
to American Indian and Alaska Native women are born prematurely
compared to just 10.7% of infants born to non-Hispanic white women.
Environmental Racism
Native American tribes in 2012 occupied 95 million acres of various ecosystems across the United States. Climate change affects the wildlife and resources that many tribes rely on, and activities such as fracking threaten their access to clean water. Alaskan Native Americans use surrounding resources for approximately 80% of their diets and have faced coastal flooding as a result of climate change, so they are an especially vulnerable group.
The tribes will sometimes be willing to stay on the same land they have
occupied for many years, even if the environment becomes threatening,
which leads to health problems such as consuming contaminated water.
One of the most recent examples of environmental effects on American Indian and Alaska Native people is the Keystone XL Pipeline affair, which involves a 1,200-mile pipeline crossing through the territory of the Fort Belknap Indian Community of Montana and the Rosebud Sioux Tribe of South Dakota. While then-President Barack Obama
halted construction in 2015 following protests citing fears of water
contamination and the lack of research on the impact for Native
communities, President Donald Trump approved construction shortly upon entering office.
In 2018, Native groups put forward a lawsuit against the 2017 permit
citing a failure to respect historically established borders and to
conduct a risk assessment. In October 2019, over 380,000 gallons of crude oil were spilled by the Keystone Pipeline in North Dakota, affecting nearby wetlands.
Asian
Americans have been a prominent group in the United States for the past
200 years. According to the U.S. Census Bureau, there were estimated to
be more than 22 million Asian Americans in the United States as of
2018.
The five most prominent subgroups amongst Asian Americans are: Chinese
Americans, Indian Americans, Filipino Americans, Vietnamese Americans
and Korean Americans.
Asian immigration in large numbers began in the 19th century with
significant populations of Chinese Americans, Korean Americans and
Japanese Americans entering the United States. However, in the 20th
century, other groups such as Indian Americans began to immigrate in
larger numbers due to more specialized jobs available in the United
States.
Asian Americans have often been subject to racism like other
minority groups within the United States. This can be seen in events
like the Japanese Internment camps like Camp Manzanar that were built
during World War II for Japanese Americans to live in and were subject
to inhumane treatment.
As Asian Americans have not been coming to America in the numbers
of Hispanic immigrants and African Americans, there have been fewer
instances in which they have been used in medical trials and unfairly
compensated. In addition, as the wave of migration of Asians to the
United States has happened more recently, the history of this group in
the United States is relatively young. As a result, there have not been
governmental efforts to address health disparities between Asian
Americans and the general populations like there have been with other
groups like Hispanic Americans, African Americans, and Native Americans.
Asian Americans are the fastest-growing major racial or ethnic
group in the United States according to a Pew Research Center analysis
of U.S. Census Bureau data.
As this race has become more of an integral part of US population more
initiatives have been implemented such to address health needs
specifically such the Initiative on Race implemented by President
Clinton to eliminate health disparities in and among all racial and
ethnic groups.
Further research within the past 20 years has shown that Asian
Americans are at high risk for hepatitis B, liver cancer, tuberculosis,
and lung cancer, among other conditions.
The Asian American cancer burden is unique as they are the only
racial/ethnic population to experience cancer as the leading cause of
death and it has unusual aspects such as experiencing proportionally
more cancers of infectious origin, such as human papillomavirus‐induced
cervical cancer, hepatitis B virus‐induced liver cancer, and stomach
cancer, than any other racial/ethnic population and, at the same time,
experiencing an increasing number of cancers associated with
“Westernization.”
Similarly, Asian Americans have a heightened risk of type 2 diabetes as
its presence makes up 21% of the Asian American population, twice as
high as non-Hispanic whites.
Finally, cardiovascular disease, the leading cause of death for all
Americans, continues to disproportionally affect the Asian Americans who
are disadvantageous in society due to various social determinants.
These social determinants leading to health disparity include but not
limit to lack of language proficiency, health illiteracy due to lower
educational attainment, racial discrimination, economic instability and
poor community engagement.
In 2002, it was reported that Asian American births accounted for
5.2% of the births in the United States. One study that compared births
among Indian Americans and non-Hispanic white Americans revealed that
Indian Americans had significantly lower birth weights than did
non-Hispanic white Americans. It was also revealed that Indian American
mothers and non-Hispanic white American mothers had similar rates of
adequate prenatal care.
In addition, when the infant mortality rates were compared between the
groups, Asian Americans (excluding Pacific Islanders) had a lower rate
than did non-Hispanic white Americans. However, Pacific Islanders had an
infant mortality rate that was much higher than did the Asian Americans
and the non-Hispanic white Americans.
Similarly, Asian Americans had a maternal mortality rate that was
lower than that of non-Hispanic whites as well as the national average
in the United States.
The demographic overview of Asian Americans shows that the birth
rate for Asian American and Pacific Islander women is higher than for
all other groups except Hispanic women, those mothers tend to be older
on average than mothers of other races with the highest rate of births
occurring among women aged 30–34 years, older than for other groups, and
teen birth rates are overall lower for this population.
One of the main concerns remains the disparity of prenatal care
utilization among Asian American women in communities across the United
States and research has shown that subgroups of Asian American mothers
are less likely than others to receive early and adequate prenatal care.
According to HealthIndicators.gov, explaining the data, “APNCU is a
measure of prenatal care utilization that combines the month of
pregnancy prenatal care begun with the number of prenatal visits. Rates
can be classified as “intensive use,” “adequate,” “intermediate,” or
“less than adequate.” For this measure, adequate prenatal care is
defined as a score of either “adequate” or “intensive use.””
On a more positive note, The rate of mortality for Asian American
and Pacific Islander babies is 4.78 per 1,000 live births, lower than
what is found in the general population.
Mental health
There
are not many studies concerning mental health outcomes among Asian
Americans. Mental health in this group is reported to be relatively
better than that of the general population. The Chinese American
Psychiatric Epidemiological Study (CAPES) was commissioned to determine
the incidence of mental health problems in the DSM III in Chinese
American populations. The results of the study showed that roughly 4.9%
of the population of Chinese Americans experienced depression this
compares to 17.1% of White Americans were classified as clinically
depressed.
However, this may not be entirely indicative of the true trends with
respect to mental health in the population of Asian Americans. According
to the NGO Mental Health in America, 5.4% of Americans identify as
Asian American, and 13% of this population reported having a diagnosable
mental illness in the past year.
This proportion of Asian Americans experiencing depression is lower
than that of non-Hispanic white Americans. This may be a result of
underreporting or lack of diagnoses in the Asian American community due
to cultural stigmas surrounding mental health.
Further the cultural factors play an important role in assessing
the statistics related to mental health in this population. Mental
illness is highly stigmatized in many Asian cultures, so symptoms are
likely underreported. Asian Americans thus express more somatic symptoms
than their European American counterparts when under mental or
emotional distress. Because of this kind of cultural variation in
mental disorders and expression of symptoms, lack of health care access,
and an underutilization of mental health resources, researchers have
difficulty obtaining accurate statistics about Asian American mental
health
Further, many Asian Americans are prone to the same conflicts
from language barriers a different language and intergenerational
conflicts. For instance, a varying English proficiency among immigrant
Asian parents can be a source of conflict between parents and children.
One study shows that in immigrant Chinese families, the level of English
proficiency in the parental generation correlates with indicators of
child and adolescent psychological well-being.
It has been hypothesized that racism in the US may also affect the
health of White Americans. While they have better health than
historically oppressed groups, the health of White Americans is poorer
than that of Whites in other wealthy countries.
This line of argument posits that racism in Whites towards other ethnic
groups has caused White opposition towards social welfare programs, the
implementation of which would also benefit a large number of White
Americans. Internalized feelings of racial superiority could have a role
in the rising number of deaths of despair among low-income Whites.
The opioid epidemic in the United States
is overwhelmingly white, sparing African-American and Latino
communities because doctors unconsciously prescribe narcotics more
cautiously to their non-white patients. "Racial stereotyping is having a
protective effect on non-white populations," according to Dr. Andrew
Kolodny, the co-director of the Opioid Policy Research Collaborative at
Brandeis.
Vaccination
In 2020, Moderna
slowed enrollment in its COVID-19 vaccine testing for the purpose of
increasing representation of minorities. In Phase 1a, vaccination
eligibility was extended solely to public health workers and residents
of long-term care facilities. 60% of public health workers were white. 75% of long-term care facility residents were white. Prior to the September 2020 announcement, 20% of enrollees were Hispanic/Latino and 7% were black. At Pfizer, 25% of enrollees were Hispanic or nonwhite, including 8% who were black.
A government representative cited "historical abuse", "present racial
injustices and health care disparities", and "recent social unrest (and)
the faltering economy" as factors impeding recruitment of blacks.
Health care workers
Minority representation in medicine
It
is estimated that minority populations will represent about half the
U.S. population by 2050 which means that there will be a crucial need
for more representation in medicine. Studies have shown that having a
diverse physician workforce is essential for the future of health care
because minority students are more likely to provide health services to
underserved communities. A 2012 study done in California found that
physicians from minority backgrounds were more likely to practice in
underserved or areas of health shortages than their white counterparts,
no matter what their specialty. When looking more into the study, it was
discovered that doctors from minority backgrounds were more likely to
work in underserved areas because many of them grew up in those same
underserved communities and saw many of the health disparities that
existed. As a result, they looked at working in underserved communities
to give back.
Other research has also shown that representation of minorities
in the healthcare workforce has many positive influences such as
healthcare access for underserved demographics, better cultural
effectiveness between healthcare providers, and new medical research
that includes all individuals of the population
Trends in admission
An
area of where this representation needs to happen really begins in the
admissions offices of professional schools such as nursing, medicine,
dentistry, and pharmacy. According to Cheney (2019), the number of
students from underrepresented backgrounds applying to professional
medical schools has increased, but this increase has not been enough to
keep up with the rapidly increasing minority population. Overall, the
numbers of underrepresented minority medical school students such as
African Americans, Hispanics, and American Indians, or Alaska Natives
enrollees increased slightly. However, the only group that showed a
statistically significant increase in representation was Hispanic
females. The article faults a lack of early educational opportunities
for minority groups which is contributing to the low numbers of
minorities pursuing careers in the health care field.
Flores and Combs (2013) detail the barriers at the organizational
level when it comes to recruiting minority applicants. Organizations,
such as nursing schools, tend to operate on “normative actions.” As a
result, societal stereotypes became so instilled within the culture of
organizations that it becomes difficult to change the climate of the
organization. For long as history has existed, stereotypes of minorities
have placed their roots into society and many still that hold true
today. Because of this, many organizations tend to still display varying
levels of both intentional and unintentional biases toward minorities
(Flores & Combs, 2013). For example, it explores the field of
nursing. Nursing is one of the many healthcare careers where acceptance
into school is very competitive. In the year 2006, minority applicants
had an only 40% chance of being accepted into nursing school compared to
over 85% of white applicants. Acceptance rates for minority
applications have improved only slightly since 2006.
Data from the American Medical Association indicates that the
combined percentage of minority groups entering medical school such as
African Americans, Native Americans, Latino backgrounds make up 31%.
However, out this 31% about 15% are current medical school applicants,
12% become medical school graduates, while only 6% become practicing
physicians, and it unclear what happened to the other 6%.
Increasing minority representation in medicine
Students
interested in pursuing a career in medicine need to be reminded that a
career in medicine takes time and a substantial financial investment
where the revenue will be returned later down the line. More early
exposure programs targeted to underrepresented groups in high school
would help, since early exposure has been linked to an increase of
applications to medical school. In these programs, students build their
resumes while also establishing professional connections. Finally,
admissions policies should be revised to create more diverse medical
school classes rather than relying exclusively on academic achievements.
As a result of this, helps to increase cultural competence within
healthcare where providers have the opportunity to learn from colleagues
of different ethnic and cultural backgrounds in order to care for
patients from different backgrounds.
Criticisms
Some
scholars have argued for a genetic understanding of racial health
disparities in the United States, suggesting that certain genes
predispose individuals to specific diseases.
However, the U.S. Census Bureau's recognition of race as a social and
not biological category necessitates a social understanding of the
causes of health disparities. Additionally, the restricted options for
"race" and "ethnicity" in Census Bureau data complicates the results of
their findings.
This issue is illustrated with the example of those who identify
themselves as Hispanic/Latino, typically a mix of White, American Indian
and African ancestry. Although some studies include this as a "race",
many such as the U.S. Census do not, forcing members of this group to
choose between identifying themselves as one of the listed racial
categories, even if they do not personally identify with it.
Additionally, individuals who identify as biracial or multiracial must
choose one category to identify with, limiting the ability of many
Americans to select a census category that they actually identify with.
The inability of many individuals to fully identify with one census
category indicates the necessity of cultural, historical, and
socio-economic explanations of health disparities rather than a
biological one.
Census groupings have also been criticized for their broadness.
"Race" and "ethnicity" are used in many different ways in the United
States, and the lack of subgroups in Census categories fails to account
for the diversity of people identifying with each group. Every group on
the Census includes people who identify with a number of unrepresented
racial and ethnic sub-categories, but the Hispanic/Latino ethnicity
group and Asian racial group have been particularly criticized for this
lack of specificity.
