Black Americans suffer significantly worse health outcomes than their white counterparts–from higher rates of chronic disease to lower life expectancy. During the coronavirus pandemic, these disparities have only been amplified, with Black patients dying at more than three times the rate of white Americans.
Despite decades of research and community efforts, the United States’ racial health gap–rooted in centuries of discriminatory laws and practices–persists today. To address these inequities, healthcare providers across the country are taking new approaches to care.
On this episode of the podcast, we speak with two providers in Minnesota, Minneapolis, about what they are doing to ensure their patients receive equitable access to care.
Direct Relief has sent personal protective gear and emergency medical supplies to 45 health facilities in communities engaged in racial justice protests, including Southside Community Health Services and the Hennepin County Homeless Program.
From chronic disease to maternal morbidity, Black Americans have worse health outcomes than their white counterparts.
The pandemic has only magnified these disparities. According to the Brookings Institution, Black patients in the United States are dying at more than 3 times the rate of white patients.
“I am an African American woman. I am Black. I have lived with this reality my entire life. And I think that that is the case for many of my patients.”
Naomi Windham is a healthcare provider for the Hennepin County Homeless Program, which serves homeless individuals in Minneapolis, Minnesota.
The majority of her patients are African American, though they make up about one-fifth of the city’s population.
“I think that there was, there is a large amount of sadness that George Floyd was killed in the way that he was. But the reality of that for Black Americans is that this has been happening for 400 plus years. So it is a trauma that continues.”
She says the trauma the Black community has endured is a major contributor to the chronic health conditions she treats every day.
“Experiences of trauma and stress when they are generational. Um, especially for Black people. I am, I am Black myself, but especially for Black people rooting back to times of slavery that when you have a population that has chronic stress. Chronic health issues kind of come with that.
The link between trauma and chronic disease is not a new finding.
According to a landmark study conducted in the late 90s, adverse childhood experiences, such as abuse, contribute to chronic health problems later on in life.
That’s because early trauma alters the body’s ability to cope with stress, triggering a flight or fight response.
For Black Americans, this trauma isn’t necessarily tied to one event. It’s rooted in a history of oppression and survived today by a host of discriminatory practices, from being denied home loans at higher rates than white buyers to serving longer prison sentences for the same crime.
This treatment–and the trauma it inflicts–has a name.
“You ready for this? Racism. Racism gets under your skin.”
That’s Dr. Stephen Thomas. He’s a professor of public health at the University of Maryland and Director of the Maryland Center for Health Equity.
“For African Americans that fight-flight mechanism never shuts down, it’s constantly revving until it becomes normal. And you’re walking around with high stress as if it’s normal.”
When a person experiences consistently high levels of stress, the body wears down faster and develops disease sooner.
In addition, these toxic stress levels can lead to poor coping behaviors, like substance use or eating disorders, which are linked to obesity, diabetes, and heart disease.
For Windham’s patients, poverty compounds the effects of this trauma and makes it even more difficult to take care of their health.
“It is not uncommon for us to have someone come into clinic who has pretty severely uncontrolled diabetes, who is able to easily say, ‘My mother also had uncontrolled diabetes’ or ‘My mother died of diabetes.’
I think, especially with a population like ours who are in shelters and have little to no income, the ability to prioritize your physical health, it’s very difficult for that to be the top priority because you’re wondering where your next meal is coming from, or where you are going to sleep that night.”
To help patients better manage their chronic condition, Windham individualizes her approach.
“I think the key to making any change is trust and knowing that I may potentially have one opportunity to make a trusting relationship with an individual.”
She makes recommendations that are realistic and within her patients’ means.
Most are living in a shelter where meals are served, so they don’t have control over what they eat.
Instead of telling them to eat more produce, Windham encourages them to make healthy choices with what they’re given, like eating all of the veggies on their plate and skipping desert. Or swapping water for juice.
Because many of her patients don’t have a car, refilling their medication on time is a struggle.
To ensure they can get to their appointments, the clinic gives out bus tokens and works with a local cab company to pick up and drop off patients as needed.
“The best victories I’ve had in this job, and in jobs that I’ve held previously, has been to listen well to my patients.”
She says many of her patients have had negative experiences with providers making them reluctant to trust medical professionals.
“Many of the people that I see on a daily basis feel unheard by their medical providers.”
This is a trend well documented within the medical community.
Researchers call it implicit bias and it has been proven to impact the quality of care Black Americans receive.
“I have a doctorate in nursing, so I’m an advanced practice nurse.” Sheila Kennedy is a provider at Southside Community Health Services, in Minneapolis, Minnesota near the site of the recent protests.
“We serve mostly uninsured or under-insured patients, majority people of color.”
She says at previous health facilities where she’s worked, implicit bias was noticeable.
“Somebody will come in in-labor and it might be a person of color and they will do a drug screen on them where it wouldn’t be routine if the same 25-year-old white girl were to come in in-labor.
Or, the patient is a no-show, or, doesn’t come in for a few visits in a row and, if implicit bias plays a role, maybe it’s person of color, they write them off or assume they don’t care or are irresponsible, something like that. They might be labeled in more negative terms where maybe, again, the 25-year-old white girl, ‘She’s working so hard’ or ‘She’s in school.’ They’ll make up more excuses as to why she’s not coming to her appointments.”
To combat this bias and ensure patients receive equitable care, Kennedy–like Windham–takes a personalized approach.
“The number one thing that I do on a personal level is just to create a relationship with my patients individually.”
She takes extra time during appointments to get to know her patients and follows up with them during her off time.
“So that’s more of just a personal level, making sure that they know that there is somebody here, that’s there for them.”
At Southside Community Health Services, patients have access to a multitude of services that, in effect, help bridge the health gap.
The health center works with community organizations to connect patients with educational resources and nutritional support.
Patients can get help with scholarships, attend prenatal classes, and improve their diets through cooking classes.
“As a clinic, I guess you could say we ‘walk the walk.’ We say we’re going to take care of our patients as a community and we do.”
Across the nation, providers like Windham and Kennedy are working to address the root cause of these inequities.
And, measurable successes have been made.
Since 2014, preventative screenings for colon cancer have increased by 4% for Black patients in Minnesota. Nationwide, similar gains have been made. Since the Affordable Care Act was passed, Black patients have experienced improved access to preventative care services and received diagnoses earlier.
But health disparities persist, at a time when calls for racial justice are shaking the nation.
“The death of Mr. Floyd was a spark in the dry grass of racism in the United States.”
Despite these tensions, Dr. Thomas appears hopeful.
“I think people of good hearts are taking positions and they’re saying, ‘What kind of country are we? What kind of country do we want to be?’”
We can’t go back to normal, he says, because for people of color normal is: ‘I live sicker and I die younger.’