Racial Justice: Why we need to be talking about race

Are we living in a post-racial society? That question has been bandied about frequently since the election of President Barack Obama, the assumption being that electing an African-American to our highest office was proof enough that America’s complicated, and often ugly, past was long behind it. But for people of color and the activists and community groups that work to achieve racial equity in health, education, employment, housing, and everything else the answer is simple: no.

Confronting race to achieve health equity was the theme of a racial justice training that Bronx Health REACH and staff from REACH communities around the country received earlier this week in Washington, DC. Presented by the Applied Research Center, a racial justice think tank, the group learned how to frame issues with a racial equity lens and to recognize the different ways that racism can appear (internal, interpersonal, institutional, structural). The major takeaway was that we need to be explicit in addressing race as a key component in our work. If we shy away because we are afraid of being accused of playing the “race card”, we may unintentionally derail the policies necessary to address structural and systemic racism.

In an earlier blog post, we wrote about a recent study that found that race and ethnicity was the primary barrier to proper follow-up after an abnormal breast cancer screening. Another study, published in May in the Journal for the Poor and Underserved, looked at Emergency Room wait times based on race. The researchers found that African-Americans coming to the ER with chest pains were 1.42 times more likely to wait longer than 60 minutes than whites. Similar trends occurred with Hispanic patients. Race, whether intentionally or not, is a factor in this decision-making and it needs to be addressed head-on.

Taylor Branch, Dr. Martin Luther King’s biographer, said that King saw race as part of everything, but not all of anything. In Bronx Health REACH’s work to achieve health equity in communities of color, we know this is true. Race is a major factor in our work, but it’s not all of it. Like everything else, health equity requires a multi-faceted approach and, as the ARC trainers taught, we should be race explicit, but not race exclusive. Though bringing up race can be uncomfortable and often unwelcome, these are necessary conversations. If we don’t keep having them, study after study will continue to show the blatant disparity in access to health care between whites and people of color and the people we work with will continue to experience unfair treatment. Advancing the premise of America being a colorblind society benefits no one and doesn’t move our country any further along in realizing the equity for all that we so need.

Race/ethnicity, not health insurance, as primary barrier to quality care

As a community-based organization committed to the elimination of health disparities, Bronx Health REACH works closely on access to health care issues in underserved communities. One of our signature issues is advocating against the segregated health care system in New York City, which separates patients into two systems based on their health insurance status. This two-tiered system discriminates on the basis of health insurance, steering patients on Medicaid or with no insurance toward the clinic system while those with private insurance are seen in faculty practices. We have found that public insurance or no insurance can be a barrier to accessing quality care due to the poor follow-up, lack of continuity of care, and long wait times that plague the clinic system. However, a recent study published in the journal Cancer, found that lack of health insurance may not be the primary barrier to proper diagnostic care for minority women.

The objective of the study was to determine the impact of race, ethnicity, and health insurance on follow-ups from breast cancer screenings in Washington, D.C., an area that has high mortality rates from breast cancer compared with national rates. The researchers’ hypothesis when they began the study was that patients with health insurance would have a shorter diagnostic time (defined as the number of days from a suspicious finding from a breast cancer screening to a definitive diagnosis for the patient) than patients without health insurance. However, after analyzing the diagnostic times of over 1500 women, the researchers found that health insurance was not the main determinant in longer wait times. On average, the diagnostic wait times for white, black, and Hispanic women were half a month, 1 month, and 2 months respectively. For white women on government insurance the average diagnostic time was 12 days; however for black women with the same insurance it was 39 days and for Hispanic women it was 70 days. Similar trends occurred when comparing women with private insurance from the three different racial/ethnic groups (16 days for whites; 27 days for black; and 51 days for Hispanics). The huge difference in diagnostic time between the different racial/ethnic groups suggests that health insurance status may not be the primary barrier to care.

This research highlights the alarming disparity in quality health care between minority groups and whites. While having health insurance does mediate this issue somewhat, the fact that women on the same insurance but of a different racial/ethnic background would have such varied waiting times shows that the system does discriminate against minority groups. In this particular case, the women were waiting to hear whether a breast abnormality identified by a clinician was benign or malignant. Depending on the stage of the cancer, a difference in diagnostic time between 12 and 70 days could be a serious impediment to proper treatment and halting the spread of the cancer. Other studies have shown similar disparity in treatment between white and minority patients. One well-known study by Dr. Kevin Schulman looked at the effect that race and gender had on physicians’ recommendations for cardiac catheterization and concluded that African-Americans and women were less likely to receive a referral than whites and men, with black women being the least likely group to get a referral.  Another study conducted by the Department of Veterans Affairs found disparities in health care between black and white veterans across all clinical areas. The study also suggested that disparities in health care delivery between the two groups are contributing to disparities in health outcomes.

This research all points to the conclusion that racial and ethnic disparities in health care access and delivery are a critical problem in our health care system. Through community outreach and education efforts, such as the health disparities education conducted by Bronx Health REACH, community members are becoming more aware of their patient rights and learning how to advocate for proper care. However, policy and system change must take place both in the training of physicians and in how care is delivered in order to affect lasting change.  

Take Action and Protect Healthier School Lunches!

Over 31 million children receive lunch through the National School Lunch Program. In New York City alone, public school kitchens serve 860,000 meals each day and service 1.1 million kids. School food is a critical piece in keeping children fed and alert throughout the school day, but it also provides a key opportunity to get children eating healthy. The federal government’s Healthy Hunger-Free Kids Act of 2010 authorizes funding and sets policy for the U.S. Department of Agriculture’s core child nutrition program. Under this legislation, the USDA has proposed nutrition guidelines to improve school lunches and breakfasts by including more fruits, vegetables, whole grains, and low-fat milk, as well as cooking with less salt and fat. Despite support from tens of thousands of parents and organizations, some members of Congress are trying to stop these guidelines from being finalized. 

According to the most recent estimates by the U.S. Census Bureau, over 20 percent of America’s children live in poverty. In New York City, the number of children living in poverty ranges from 25 to 33 percent depending on age group. Overall, 76% of elementary and middle school children in NYC receive free lunch and in some neighborhoods that number is much higher. (In the South Bronx, almost 95% of elementary and middle school children receive free lunch). For many of these children, school meals provide one of the few available opportunities for a nutritious meal. The food deserts in which many of these children live only compound the problem by providing few options to access healthy, affordable food. By insuring that school food follows common-sense nutrition guidelines, these children can eat healthy twice a day, which will lower risk factors associated with childhood obesity. Other national efforts to fight childhood obesity, including the Partnership for a Healthier America’s recent initiative to bring healthy, affordable food to 10 million people over the next five years, are crucial. However, the USDA guidelines are a critical weapon in the fight to combat childhood obesity in high need, vulnerable communities and they must be protected.

The House of Representatives has already included a rider on its agriculture spending bill to urge USDA to start over and propose a new set of school meal standards. The Senate will vote on its own agriculture appropriations bill on September 7^th. To keep healthy school lunches, please send an email to both of your Senators asking them to support USDA’s efforts to improve school meals. Go to https://secure2.convio.net/cspi/site/Advocacy?cmd=display&page=UserAction&id=1251 and take action!