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Racism in US health, two reminders

Summary: Racism in US health manifests in multiple guises and scales. Today we report on two diverse country-wide phenomena most severely harming Blacks: thousands of deaths due to police violence, and millions burdened by social stresses and substandard insurance for the poor.

Fatal police violence by race and state in the USA, 1980–2019: a network meta-regression
Lancet
October 2, 2021
By GBD 2019 Police Violence US Subnational Collaborators

From the abstract:
We compared data from the USA National Vital Statistics System (NVSS) to three non-governmental, open-source databases on police violence: Fatal Encounters, Mapping Police Violence, and The Counted.

Across all races and states in the USA, we estimate 30 800 deaths from police violence between 1980 and 2018; this represents 17 100 more deaths than reported by the NVSS. Over this time period, the age-standardised mortality rate due to police violence was highest in non-Hispanic Black people (0·69 per 100 000), followed by Hispanic people of any race (0·35), non-Hispanic White people (0·20), and non-Hispanic people of other races (0·15). This variation is further affected by the decedent’s sex and shows large discrepancies between states. Between 1980 and 2018, the NVSS did not report 55·5% of all deaths attributable to police violence. When aggregating all races, the age-standardised mortality rate due to police violence was 0·25 per 100 000 in the 1980s and 0·34 per 100 000 in the 2010s, an increase of 38·4% …

Racism, Chronic Disease and Mental Health: Time to Change Our Racialized System of Second‐Class Care
Healthcare
September 27, 2021
By Judith Albert et al.

The “weathering hypothesis” was first proposed by Arline Geronimus in 1992: “Namely, that the health of African American women may begin to deteriorate in early adulthood as a physical consequence of cumulative socioeconomic disadvantage.” Now, nearly 30 years later, a large body of literature has expanded upon this hypothesis. There is accumulating evidence that structural as well as interpersonal racism contribute to the significant increases in Black maternal and infant morbidity and mortality compared to that of whites.

Blacks use about half the outpatient care and fewer psychiatric medications as white adults, yet are hospitalized at twice the rate as their white counterparts for mental illness

From the abstract:
Medicaid … while passed alongside Medicare during the Civil Rights era, was Congress’s concession to Southern states unwilling to [permit] federal oversight and funds to the provision of equal healthcare for poor and Black people. Medicaid, which covers 33% of all Blacks in the US and suffers from chronic underfunding and state efforts to weaken it through demonstration waivers, is a second‐class system of healthcare with eligibility criteria that vary by state and year.

Comment by: Jim Kahn

Racism in US health is structural, pervasive, and multi-faceted. Two articles published this week together convey this devastating point.

The article in Lancet is an impressive national comparison of databases of more than 30,000 deaths from police violence with government vital statistics. The official statistics 50% under-report violent deaths by police. These deaths are 3.5 times more common for Blacks than for Non-Hispanic Whites. It’s not healthcare, but it certainly is health-related. And these vast racial differences constitute highly suggestive evidence of systemic racism in attitude and approach.

The article in Healthcare reviews social and health burdens disproportionally faced by millions in Black populations. These include social stressors, poor access to mental health care, and the Medicaid insurance for impoverished populations – under-funded and manipulated to impede access to care. Our health insurance system is profoundly structurally inequitable.

And what for? We know that the simplest, most equitable insurance systems – covering everyone with the same insurance — are also the most efficient and effective.

Single payer would not only eliminate insurance and care inequities, it would foster social cohesion, and thus help reduce policing bias.

Who’s gaining with our current bloated, lopsided system? Mainly the rich, so they can stash more money overseas (that’s another story this week!).

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