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9 Conversation Tips on Race & Health Equity

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Seeing friends or extended family by video? You can have a huge impact by talking to them about issues that are important to you. Take the opportunity to discuss health care access for communities of color. 

Here are 9 tips for leading the conversation. Remember: Talking with your friends and family about the issues you care about can have a real influence that extends even beyond your circle.

Tip #1: Open the dialogue in a way that’s welcoming.

Share how the last couple of years have affected your views on health and health insurance. Say something like, “I’ve been [concerned/angry] about COVID-19’s disproportionate impact on [Black and Brown communities/our community].”

ASK: “Could we talk about how racist our country’s health care system is? I have some ideas about what can be done, and I’d love to hear your take.” 

Tip #2: Get everyone on the same page by defining common terms. 

Racism

  • Racism in America is the outgrowth of white supremacist policies and ideas that assume white people are superior to other racial groups. 
  • Racist policies are written and unwritten laws and customs that cause racial inequity, putting racial groups on unequal footing.

Public Health

  • Public health is built on the principle of protecting and improving the health of people and their communities.
  • A public health crisis happens when something threatens the lives and health of an entire community or multiple groups of people.

ASK: Have you [seen/experienced] racism in health care?

Tip #3: Define some terms about race that are less common.

Anti-Blackness refers to a worldwide ideology that devalues being Black.

  • Anti-Black policies and institutions in white supremacist systems dehumanize and marginalize Black people around the world.
  • Anti-Black racism covertly disregards and overtly attacks anti-racist policies, Black people, and Black institutions.

Structural racism is a system in which policies, practices, and other norms perpetuate racial inequity. It’s the root cause for the health inequities we see today.

  • Racial inequity in America blocks Black and Brown people from living freely and safely — while putting white people in power, giving them more resources, and chipping away at their humanity.
  • Racist health care policies cause health inequities for racial groups, fortifying long-standing barriers and creating new barriers to health care access for Black and Brown communities.

Tip #4: Define some terms about health and fairness that are less common.

Equality vs. Equity

  • Equality gives everyone the same exact things, but ignores differences. Equal access to COVID-19 testing means everyone could theoretically get a test. But for many people, testing is too expensive and far away, or only open at times where they are unable to take off work or get childcare. 
  • Equity gives everyone what they need, tailored to their individual situation. Equitable access to COVID-19 testing would be affordable, nearby, and have flexible hours for everyone.

Health Inequities vs. Health Equity

  • Health inequities are systemic, avoidable, and unjust differences in the health of a group of people compared to other groups. 
  • Health disparities are any kind of differences in health outcomes for a group compared to other groups. Disparities don’t refer to social or structural causes like inequities do. 
  • Health equity happens when everyone has a fair and just opportunity to be as healthy as possible. This requires removing obstacles to health such as: poverty, discrimination, powerlessness, limited education, unstable housing, unsafe environments, and lack of health insurance.

Tip #5: Provide examples of racial and health inequities. 

Racism is embedded in the structure of the U.S. health care system. The people in charge of that system — including politicians and insurers — have carried out discriminatory practices throughout its history.

Institutionalized discrimination in the U.S. health care system has thrown up roadblocks to insurance, testing, treatment, and care for communities of color. That includes the system’s reliance on employer-sponsored insurance. Because of historic economic barriers, Black and Brown people are less likely to be working in jobs that offer this benefit.

Racial bias among medical researchers and health care providers — such as the erroneous belief that Black people feel less physical pain — have withheld needed care and pain management from Black patients.

Being Black in America takes a toll on the health of Black people. 

  • Racism, microaggressions, and discrimination cause chronic stress.
  • Researchers have shown that racism stresses and prematurely ages human cells. 
  • All that stress causes physical and psychological harm over time.
  • The result: increased rates of illness and death among Black people.

Tip #6: Share how health care inequities have led to dramatic disparities in health conditions for Black and Brown communities.

Racial and health inequities help explain why — regardless of income or education — Black and Brown patients have disproportionately fared worse compared to their white counterparts across many health outcomes.

  • Racism’s chronic stress is linked to higher risk of depression, diabetes, and high blood pressure.
  • Black people disproportionately experience police-inflicted harassment, violence, injuries, and murder. Living in fear of state-sanctioned brutality causes a host of underlying health problems. 
  • Because of racist policies like redlining, Black and Brown people are more likely to live near toxic sites and amid high pollution, as well as in neighborhoods that lack healthy food options and places to exercise. These environments are linked to higher rates of asthma, respiratory illnesses, and cardiovascular disease.
  • Long-standing, systemic health and social inequities in the United States and discrimination in doctors’ offices and hospitals all have resulted in a high maternal mortality rate among Black women — three times the rate for white women.
  • Structural racism, public health failures and economic inequalities — including that the location of Black and Brown workers’ jobs are more likely to put them at risk of catching COVID-19 — have all translated to exponentially higher COVID-19 infection and death rates in Black, Indigenous, and Latino communities.

Tip #7: Discuss why racism is a public health crisis.

The American Medical Association, the American Public Health Association, several states, and other U.S. institutions declared that racism is a public health crisis and called for urgent action from policymakers and institutions.

Discrimination creates barriers to health, both inside and outside the doctor’s office. Your health depends on whether you can access health care, employment, good wages, food security, clean air and water, and stable housing — all of which are hurt by racism.

SCROLL UP: Refer to the definition of “public health crisis” and share how you feel about it.

ASK: “How do you feel about racism being declared a public health crisis?”

Tip #8: Share what federal policies you support to address racial inequity. 

For example, you may want them to support policies that:

  • Aim to eliminate the inequities and biases woven into the fabric of this nation’s institutions, particularly the racial inequities in maternal health. 
  • Provide additional COVID-19 relief that helps Black, Indigenous, and Latino communities — which have been disproportionately ravaged due to ongoing systemic racism and oppressive policies.
  • Defund the police. Instead of investing in police forces that brutalize Black people, prioritize a public-health approach that strengthens Black communities, promotes community support, and connects people to services.
  • Support Black organizations and leaders who are at the forefront of the fight to fix the public health crisis that racism presents and the systems that exploit people of color.

Tip #9: Express gratitude for everyone in the conversation.

Thank your friends and family for connecting with you on this issue, and let them know that you’re open to speaking with them again. 

Show them some warmth — and give them the time and space to sit with the discussion. 

Racism is a Public Health Crisis Experienced in Personal Tragedies

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I was 12 when my 17-year-old brother died. He was not shot by police or targeted by white supremacists, but racism killed him.

Richard had bipolar disorder, and our family relied on Medicaid for health care. After a brief stay in one of very few mental health facilities that accepted Medicaid in Chicago, he became extremely ill with a high fever and trouble breathing. We took him to the hospital, where he was not tested or x-rayed. Instead, he was given an inhaler and told to take ibuprofen. When his condition worsened, we went back to the ER, where staff diagnosed him with pneumonia in both lungs. He was admitted to the ICU and put on a ventilator. Five days later, as my mother and I finally took a break from living in the ICU to shower and change clothes at home, Richard died.

It is not a question to me whether Richard would have received better care if he wasn’t Black. There is a straight line from his Blackness to the health care options available to him to his treatment to his death.

Racism is a public health crisis. It manifests in dramatic inequities in health outcomes across the board — including three times as many COVID-19 infections among Black people and nearly twice as many deaths than white people. It manifests in the daily grind of discrimination and stress on Black bodies. It manifests in where we live, the health care available to us, and how we are treated. It manifests in which mothers must mourn sons who died too early, which sisters grow up without brothers.

Because of the long legacy of redlining and an economic system built on racism, Black Americans are disproportionately relegated to living in poverty-stricken areas. And since most health outcomes are determined by things like poverty, income inequality, wealth inequality, food insecurity, and the lack of safe, affordable housing — the social determinants of health — in all of these areas, Black people have to overcome 400 years of the deck being stacked against us.

If we do manage to get care, we often receive a poorer version in comparison to white people. In 2016, half of white medical students and residents surveyed held false beliefs about biological differences between Black people and white people — beliefs with deep roots in slavery, when physical violence was seen as acceptable because people believed enslaved Black people had “thicker” skin than white people. The medical students and residents with these false beliefs rated Black patients’ pain lower and made less accurate treatment recommendations.

Black women are doubly dehumanized. For centuries, we have been denied the rights and resources to make our own decisions about our bodies. Our desires are dismissed, our pain is ignored, and our needs go unmet. And it kills us. It’s why Black women are more than three times as likely to die of pregnancy and childbirth-related causes.

The racism in the U.S. health care system is borne out in these numbers, and in stories like my brother’s … and mine.

In 2018, I made the decision to get an abortion. I went to a local clinic in Brooklyn. I did not feel ashamed about having an abortion, but I was treated as if I should be. I was forced to have two visits with two ultrasounds before the procedure, and was ordered to go from room to room without being given any information about what was going on or what would happen next. I was seen by several doctors who didn’t even attempt a decent bedside manner and couldn’t pronounce my name.

The first doctor simply told me, “You can’t smoke cigarettes or drink alcohol,” without giving me any information on my options or asking me if I’d like to continue the pregnancy. I had to ask several times for information on abortion. I was then reluctantly, coldly told that medication abortion was “out of the picture” because insurance wouldn’t cover it. I felt like I had no control over my body.

If this was my experience in Brooklyn, in a state with liberal abortion laws, I can only imagine what people in states where access to abortion is even more restricted must be experiencing.

Trust me when I tell you: Black people feel pain. And we thrive in spite of it. For decades, Black people — Black women in particular — have been at the forefront of the movements to hold this country accountable to its promise of equality and justice — the Civil Rights movement, women’s suffrage, the LGBTQ+ movement, and reproductive justice. Black women started Black Lives Matter, now recognized as among the largest protest movements in U.S. history.

It isn’t enough to tear down statues of Confederate generals (as much as they should be). As American white supremacy meets this moment of reckoning, Black people still suffer from health inequities because of racism and a for-profit health care system.  We will only see change when we start to break down and rebuild the longstanding institutions that have historically been used as tools of oppression. We need to tackle the racial inequities in health care head on. Racism as a public health issue needs to be widely understood, especially by all who enter the medical field.

The health care system is killing us, as surely as police are. No more Black people should die from racist violence, or from illnesses that could be treated with just a little more care. No more Black women should experience the dehumanization I felt while getting care that is my right to have.

Racism is a public health issue, and all lives will matter when Black lives do.

-Leanna at PPFA

Leanna Burton is a media assistant in the Communications & Culture division at Planned Parenthood Federation of America. She was born and raised in Chicago, IL and studied journalism at City University of New York - Brooklyn College. She is also a musician and freelance writer whose main focus is lifting the voices of people in underserved and undervalued communities.

Why Racism is a Public Health Issue

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As health care experts, we know racism is a public health crisis. Public health is built on the principle of protecting and improving the health of people and their communities. Police violence against communities of color is antithetical to that mission.

Multiple Public Health Crises

As our nation confronts the COVID-19 pandemic, the public health crisis of racism must also be addressed. COVID-19 is disproportionately ravaging the health and economic stability of the Black community. 

  • The country’s underinvestment in Black and Latinx communities has led to less access to health care and dramatic health care disparities. 
  • The effects of these disparities can be heard loud and clear amid the pandemic: Economic inequality, structural racism, and public health failures have translated to dramatically higher COVID-19 infection and death rates in the Black and Latinx communities.
  • Discrimination creates a barrier to health, both inside and outside the doctor’s office. The stresses of anti-Black racism, microaggressions, and discrimination take a toll on the health of Black people.

Systemic inequities that block Black people’s access to basic health care are, in turn, intensified by violence inflicted under the badge of government authority.

Standing Up for Bodily Autonomy and Reproductive Freedom

Planned Parenthood fiercely values bodily autonomy. Full bodily autonomy is the ability to live without the threat of over-policing and without the fear of state-sanctioned violence or murder — and it’s the freedom to make personal decisions about your body without judgment or persecution.

Systemic Racism in Public Policies and Institutions

The policing of Black bodies in the United States extends beyond the police to all of the country’s public institutions — including not only the health care system, but also laws that restrict access to sexual and reproductive health care. 

The same politicians who use racial oppression as a tool of control against Black people also push policies that take away Black people’s reproductive rights. For example, many of the states with abortion bans have higher-than-average-sized Black populations. These states also have higher rates of voter suppression, gerrymandering, stand-your-ground laws, and anti-immigration legislation. 

Bodily Autonomy for Black People

Black women have long been denied control over their own bodies — whether being raped during slavery, not having access to affordable health services, or being punished for terminating a pregnancy or making other reproductive care decisions. 

Black people deserve to live lives free of violence; and Black women can and should be able to make their own decisions about their health. State control of Black bodies makes the promise of reproductive freedom unattainable for Black people. 

Intersecting Identities

It’s also important to note that structural discrimination also targets people who are immigrants, LGBTQ+, and part of other marginalized groups — and especially those whose identities intersect. Planned Parenthood will not rest until all those who are disproportionately affected by restrictions on health care get the access they deserve.

Lawmakers: Prioritize Public Health Approaches Over Further Investment in Policing

It’s unacceptable that Black people disproportionately suffer from state violence and killings. That’s why Planned Parenthood is committed to advocating for policies that will dismantle the system of white supremacy and oppression of communities of color — including policies to defund the police and end police violence. 

  • Specifically, we’re calling on public officials at all levels of government to work together to adopt four key proposals: holding police officers and departments accountable, divesting from police budgets, investing in community-based solutions, and ensuring peaceful neighborhoods.
  • We support calls from Movement for Black Lives and other social justice partners to defund the police. Here’s what that means: Instead of investing in police forces that brutalize Black communities, we demand that elected officials prioritize public-health approaches that strengthen Black communities. Excessive and discriminatory policing must be replaced with a model that promotes community support, connects individuals to available services, and actually creates safe and sustainable environments. 

In determining exactly how to defund the police, there is no one-size-fits-all approach. Thankfully, examples of successful efforts to defund the police demonstrate what’s worked. And one thing is certain: True reform requires community participation.

Get Involved

We are working with organizations and communities to build a future where Black people have the right to live their daily lives without the fear of violence; make choices about their bodies without fear of persecution; and access sexual and reproductive health care without entrenched barriers.

Join us in calling for justice and freedom. 

Get involved in defunding the police, creating safer communities and defending Black lives. 

GO TO: M4BL.ORG

COVID-19: No, We’re Not All in This Together

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The pandemic, the protests, and why racism endures as a public health crisis

By: Ylonda Gault

My daddy used to say: When America gets the sniffles, Black people catch pneumonia. My dad didn’t invent the saying but he used it to explain everything from the war on drugs to the 1990s national recession. Even as a child I knew what he meant. In other words, the country’s history of institutional racism and unjust policies make every part of Black life — including economic growth, fair housing, health care access and more — exponentially harder than it is for others. Today, as worldwide protests against police brutality continue and COVID-19 ravages the Black community, we see clearly that old sayings are so often repeated because they bear truth.  

The pandemic, a danger for all, is lethal for Black people, who’ve died at a rate of  61.6 per 100,000 people, compared with 26.2 for whites. Yet, this peril is not new. We’ve been brutalized for generations. The murders of Breonna Taylor, Tony McDade and George Floyd, to name but a few, are only an extension of plantation overseer violence and Klan lynchings that have been hallmarks of our 400-year existence in America. In recent weeks, the streets have erupted because structural racism is — and has long been —the public health crisis that no masks, sanitizer, or social distancing can remedy. 

With widespread mandated sheltering and business shutdowns, the serious and potentially deadly infection — caused by a virus for which there is no known cure, vaccine or treatment  — has meant lost income or job loss for some and, for others, a huge inconvenience. But research shows that Black people are much more likely not only to get infected with COVID-19 — but to die from the disease because racism undergirds our health care systems, workplace policies, and the environment.  — Indigenous and Latino communities are also more vulnerable. 

That’s not because we are, as a race, doing something to cause infection. We’re not to blame. Nor is it because we’re unhealthy as a group, or because of something in our biology.

Why are Black communities hit hardest? 

Institutional racism is the pre-existing condition that has left Black communities far more vulnerable to COVID-19 than others. While many think the racist barriers to Black people’s rights and freedom came to a close with the end to enslavement, they have not only persisted — but grown more entrenched. From Jim Crow segregation, voting and housing discrimination, to heavy-handed policing, generation after generation of targeted bigotry has led to a lack of equity in health care, housing, education, and opportunity. For example, for Black people who work in the service sector; their jobs put them at greater risk of getting COVID-19 — as does the environment. These circumstances are not the result of bad luck or poor choices; they’re created by a long legacy of racist policies that have put Black people in harm’s way and made our communities more at risk from the virus that causes COVID-19 than white people 

Of course, chief among the risk factors is the barrier to health care access. Black people who work in low-wage jobs usually lack insurance, leading to delayed or bypassed essential health care services — because of the cost. We’re also more likely to live farther away from medical care and face language barriers. And Black people and other folks of color are distrustful of health care professionals because of historical mistreatment. The U.S medical establishment has a history of exploiting Black folks, Latinos, and Indigenous people by performing medical experiments on them without consent, and even stealing their dead bodies from the grave for research and profit.  

Barriers to preventive health care — again, a primary outcome of structural racism in the U.S. — mean Black and Latinx communities also have higher rates of health issues like diabetes, heart disease, and lung disease. People with chronic health conditions such as heart disease and diabetes were hospitalized six times more often than otherwise healthy individuals infected with the coronavirus during the first four months of the pandemic, and they died 12 times more often, according to a new report published by the Centers for Disease Control and Prevention.

The public health disaster facing Black communities is the result of hundreds of years of U.S. policies that bolster white supremacy and marginalize Black people. But the pandemic is just a single symptom of the nation’s public health disaster. What is being played out over the past few weeks, as people take to the streets to protest a national pattern of violent over-policing, is another. 

Why protest during a pandemic?

Just as structural racism created fertile ground for COVID-19 to take root in the Black community, it has also helped plant the groundswell of pro-Black organizing across the country in the wake of George Floyd’s murder May 25. Black people, for whom racial profiling and stop-and-frisk policies are a way of life, don’t need a viral video to prove their realities; police have killed roughly 1,000 people a year since 2015, according to The Washington Post’s real time police shooting data base. While many outside the Black community see the recent spate of killings at the hands of police as random and unrelated — “a few bad apples,” so to speak — the pandemic and police brutality are two crises inextricably linked. Both are killing us. And both seem to be unrelenting.

It’s Shakespearean that as he lay dying — a white police officer nonchalantly kneeling on his throat, Floyd can be heard in a plaintive whisper: “I can’t breathe.”

Black America has long been suffocated by racist and dehumanizing policies. Certainly protests have erupted in the past, in response to the brutal murders of Black people by the police — notably, the 2014 murders of Eric Garner in New York City and Michael Brown in St. Louis. But none have gripped the national and global attention of what is happening now. The volume and breadth of outrage is magnified — at least, in part — because the added dimension of COVID-19 deaths has created a perfect storm. 

Unlike Ferguson demonstrations, for example, when protesters of late carry placards that read “Stop Killing Us,” the statement has implications far broader than police violence. And the simple phrase, Black Lives Matter, hits different now, too. There will always be detractors and deniers who reflexively counter that “all lives matter.” But there’s a new resonance to the BLM phrase, and wider acceptance among white Americans of what it means to “matter” — and with it, a deeper awareness of the unjust conditions that disproportionately keep the rest of the world from understanding all the ways that Black lives matter.

Meet the Civil Rights Leaders Who Served on Planned Parenthood’s 1942 Advisory Council

The National Negro Advisory Council of Planned Parenthood Federation of America formed in 1942 to lead educational and outreach efforts in Black communities. Dorothy Celeste Boulding Ferebee, Mabel Keaton Staupers, and Dr. Paul B. Cornely were just three of more than 100 Black leaders and health care providers who joined the initiative, along with W.E.B. Dubois and Mary McLeod Bethune. This Black History Month, we honor Black leaders of the past who fought for the lives, dignity, and future of black communities in the US.

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U.S. National Library of Medicine

Dr. Dorothy Celeste Boulding Ferebee (1898-1980) was an obstetrician and civil rights activist who was the first medical director of the Mississippi Health Project, working to administer health care to thousands of Black Mississippians during Jim Crow. Later, she became president of Alpha Kappa Alpha sorority, president of the National Council of Negro Women, and a vice president of Girl Scouts of the United States of America.

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U.S. National Library of Medicine

Dr. Paul B. Cornely (1906-2002) was a physician and civil rights leader who fought for desegregation in hospitals and became first Black president of the American Public Health Association (APHA) in 1969.

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Moorland Spingarn Research Center, Howard University

Mabel Keaton Staupers (1890-1989) (center) was a nurse who helped establish the Booker T. Washington Sanitarium, a Harlem-based health care facility that was the first to treat Black tuberculosis patients. Later, she fought against quotas that limited the number of black nurses allowed in the military during World War II.