By the Editors of the Southern Poverty Law Center
Racism affects every aspect of American life – none more so than our medical system.
Numerous studies over the years have laid bare the gap in health outcomes between minority groups and white Americans.
African Americans have a lower life expectancy than white people. They are more likely to suffer and die from chronic conditions like kidney, cardiovascular, and lung disease.
Black children are more likely to endure asthma and have more severe symptoms than white children. The infant mortality rate is more than twice as high for black children than for white children – a disparity that’s wider today than it was in 1850, when the majority of African Americans were enslaved, and one that is not related to the economic or educational status of the mother.
These persistent disparities in health outcomes are not due to genetic or biological differences between the races but to entrenched racism in American society.
Discrimination in American health care is well documented. African Americans, in fact, have been subjected to racist understandings of biology and cruel medical experimentation since the Middle Passage. In the mid-1800s, for example, the physician J. Marion Sims performed torturous experiments on enslaved women without anesthesia. In the infamous Tuskegee syphilis experiment of the 1930s, doctors collaborating with the U.S. Public Health Service studied the deadly symptoms of syphilis on hundreds of black men without treating them or even telling them they were infected.
African-American women, in particular, have been subjected to unspeakable horrors, including bearing the brunt of a eugenics movement in the 20th century that sought to control black population growth. Not only were oral contraceptives deliberately pushed in black communities but African-American, as well as Native women have been subjected to forced sterilizations.
In 1973, the SPLC represented the Relf sisters, who were 12 and 14 and lived in public housing with their mother when doctors working for the U.S. government surgically sterilized them without consent. Their mother, who was illiterate, signed an “X” on a document after being told her daughters, who both had mental disabilities, would be receiving birth control shots. The SPLC’s legal action exposed a program under which tens of thousands of black women had been coerced into undergoing sterilization.
The legacy of these injustices is still with us. Perhaps no other group of people in America experiences worse health outcomes than black women.
Black women have higher death rates for nearly all cancers than white women and are twice as likely to experience infertility problems. These health disparities manifest most severely, however, in maternal death rates – the rates at which women die during pregnancy or up to after a year after childbirth.
This phenomenon has puzzled researchers for decades. A recent study released by the Centers for Disease Control and Prevention confirmed that maternal death rates among black women are 3.3 times higher than for whites. In a separate national study examining the five major conditions linked to maternal death, researchers found that black women did not have a significantly higher prevalence of these conditions but were two to three times more likely to die from them.
Ever since researchers confirmed this stark disparity, they've been trying to understand its causes. One could partly attribute it to the structural barriers black women experience when trying to access health care due to generations of discrimination and segregation. In fact, many of the health disparities between black and white Americans can be directly linked to federal housing discrimination, redlining, and neighborhood segregation.
Black women in America are more likely to live in poverty and to live in neighborhoods where it is difficult to get quality health care. They’re also more likely to have limited access to transportation, to work in jobs with inflexible hours or inadequate benefits with little sick leave, and to be uninsured.
Despite the barrage of evidence that these barriers necessarily affect health outcomes, researchers cannot rule out the role that racism – implicit or explicit bias – plays in interpersonal interactions between health care professionals and women of color.
Even when all other factors are equal – economic status, educational background, and access to health care – maternal death rates for black women are still higher compared to white women. Public health researcher Arline Geronimus has posited that black women’s health is affected by a process she calls “weathering.” Under this hypothesis, the cumulative experience of racism throughout one's life can induce the kind of chronic stress that makes African-American women particularly susceptible to chronic health conditions that lead to otherwise preventable deaths.
Even the wealthiest black women in America aren’t immune from these problems. Tennis star Serena Williams, worth an estimated $180 million, nearly died from post-birth complications in 2011. This week, she announced that she has invested in a start-up company that’s working to end the maternal mortality crisis among black women.
At the SPLC, we’re fighting against both structural and explicit racism that contributes to this extraordinary health disparity.
We’re working to defend access to health care by combating the misguided work requirements some states are adopting as a way to strip low-income people of their coverage under Medicaid. These requirements particularly threaten low-income women of color who rely on Medicaid before their pregnancies as well as during and after them. Many, of course, live in states that have refused to expand Medicaid eligibility under the Affordable Care Act.
We’re also fighting racism by providing free anti-bias resources and social justice teaching resources to our nation's schools so that all children may have access to safe and non-stressful learning environments where they can thrive. And, we’re working to dismantle the racist criminal justice systems that keep women of color impoverished from generation to generation.
The evidence is glaringly clear: Racism is lethal, and we cannot hope to achieve racial equity without acknowledging that this underlying factor causes an untold number of premature deaths among black Americans.