Why racism is a public health crisis

The COVID-19 pandemic has disproportionately impacted Black Americans, spotlighting a problem that has persisted for decades: systemic healthcare inequality. In addition to infecting communities of color at higher rates, the pandemic has exacerbated disparities in every aspect of healthcare—from preventive medicine to hospital access and maternal health.

“Black women are three to four times more likely to die as a result of childbirth nationally than white women, and in our state of Illinois, black women are six times more likely to die,” Rep. Lauren Underwood said during a recent virtual event hosted by the University of Chicago. “These disparities have persisted my entire lifetime, and I’m 33. So I knew that when I got sworn in, this was something that I wanted to work on.”

Elected in 2018 to represent Illinois’ 14th district, Underwood is a registered nurse and the youngest Black woman ever sworn into Congress. On Sept. 10, she spoke as part of the UChicago Urban Network’s panel, “Racism as a Public Health Crisis for America’s Cities,” discussing how racism in healthcare manifests at the individual and societal level, as well as paths forward through improved practice and policy.

A co-founder of the Black Maternal Health Caucus, Underwood was joined by Brenda Battle, Vice President of the Urban Health Initiative and Chief Diversity, Inclusion and Equity Officer at UChicago Medicine; and Melissa Gilliam, the Ellen H. Block Professor of Health Justice and Vice Provost for Academic Leadership, Advancement and Diversity at UChicago.

Gilliam highlighted emergency care as an example of how bias in everyday decision-making can affect health outcomes.

“In cardiac care, if a person of color comes to an emergency room and says they have chest pain, they (might) need a balloon blown up in their coronary artery,” Gilliam said. “But the (response) timing is often slower than if it was a white person.”

But the panelists noted that individual actions do not fully explain racial health disparities. According to Battle, racism in the healthcare system can also be traced to a lack of providers who are people of color, as well as community-level disinvestment.

“There has been 72% more investment in healthcare (north of Roosevelt Road) than there has been on the South Side” of Chicago, Battle said. Patients of color may have better outcomes if their providers are also people of color, and those providers may be more likely to practice in underrepresented communities, highlighting the need for a diverse and culturally competent workforce.

Policy can also make a big difference, Underwood said. She is currently working with colleagues in Washington such as Sens. Kamala Harris and Elizabeth Warren on a package of nine bills that target maternal health and mortality. The omnibus legislation seeks to address acute examples of inequality in maternal health outcomes, focusing on issues from maternal mental health to food security during and after pregnancy.

How insurance coverage is administered after pregnancy is also important, Gilliam noted, because such policies can affect a provider’s decisions in providing care. For example, a provider might not prescribe longer-term drugs if they know coverage will end shortly after delivery.

On the whole, Gilliam says, big picture solutions are needed that engage communities and address the way cities are structured, from facilitating healthy lifestyles to improving access to quality care.