Last Monday, January 15th, we recognized Dr. Martin Luther King, Jr.’s incredible life and enduring legacy as we celebrated MLK day. This MLK day marked what would have been the 95th birthday of one of American history’s most galvanizing and celebrated figures – a man who mobilized millions in the fight for racial equity in the United States, even with a life tragically cut short shy of his fortieth birthday.
Among the many issues Dr. King brought to light in the civil-rights era discourse on racial equity is health equity, a sometimes overlooked but critically important topic that must be given due credence in the broader conversation on race in the United States. A powerful quote attributed to Dr. King in 1966 summarizes his position well: “Of all the forms of inequality, injustice in health is the most shocking and inhuman.”
In spite of the immeasurable progress Dr. King helped to drive for people of color in the United States, inequity in healthcare persists almost sixty years after his pointed words.
In my recent article on the social determinants of health, I covered a few drivers of health disparities that tend to be underappreciated yet have a marked influence on the differences in health outcomes for communities of color. Building on those points, it is important to consider the ways inequity continues to pervade our healthcare landscape.
Maternal mortality is among the most jarring examples of race-based health disparity in the United States. Kevin McNair’s July article points out New Jersey’s alarming statistics on maternal health, indicating that Black women are almost 8 times more likely to die of pregnancy-related complications than white women.
Zooming out to the national level, the incongruity remains – Black mothers die of issues related to pregnancy at three times the rate of white women, according to the CDC.
Much of the onus to address this disturbing reality falls squarely on providers. While part of the root cause of the problem certainly may relate to competency in knowledge and procedure, another core element is even simpler – listening. A 2019 study that found that rates of mistreatment are higher for women of color in maternal contexts noted poor listening, including provider ignorance or outright refusal for requested care, as a critical factor.
Treatment of Pain
Highly germane to the maternal mortality issue is the continued inequity in the treatment of pain for people of color. Accounting for the intersectionality between the experience of being a woman and a person of color highlights the gravity of the issue – for example, Vidya Rao notes in her 2020 article that Black women are prone to being judged as both less susceptible to pain and more dramatic about it.
While this problem is often most pronounced for women of color, it extends to all people of color. A 2020 study in the Journal of Pain Research summarizes several notable studies, which consistently find impediments to pain evaluation and mitigation in emergency departments, lower rates of appropriate pain management prescriptions, and incorrect diagnoses stemming from slipshod and biased pain assessments for people of color.
As a practicing cardiologist and a Black man, I am particularly keen on trends in cardiovascular health for people of color. Heart disease, the leading cause of death in the United States, disproportionately impacts communities of color – in 2019, Black Americans died of heart disease at a rate more than 25% higher than white Americans.
The Black community in New Jersey fares only marginally better, with both Black men and women dying at more than 15% higher rates than white New Jerseyans in 2020.
The expansive influences on heart health that should be considered in light of these statistics extend deep into the complex social determinants of health web. The social factors like poverty, education, community safety, and food access paint a broad but incomplete picture. A CJC Open study from 2021 details the physiological toll of discrimination, anticipation of bias, and constant prejudice, underscoring that racism-based psychological stressors influence health in the same way that more concrete environmental factors do.
This finding calls to mind a saddening discovery made during the autopsy of Dr. Martin Luther King, Jr. Although he was killed at age 39, his heart bore resemblance to that of a 60-year-old – a phenomenon that Arline T. Geronimus has dubbed “weathering” and which reflects the physical implications of the constant barrage of stress evoked by unrelenting prejudice and racism.
Initiatives like Healthy People 2030 are taking aim at reducing inequity in healthcare, and states like New Jersey are prioritizing the reduction of health disparities as they continue to spearhead data-driven, people-focused efforts to make real progress. To capitalize on these efforts, we must continue to spread awareness of racial inequity in healthcare and take focused action to build the future Dr. King envisioned.