In 1966, Dr. Martin Luther King, Jr. gave a speech, covered by the Associated Press, before the annual meeting of the American Medical Association convention. As the AP reported, he said: “Of all the forms of inequality, injustice in health is the most shocking and inhumane”.
Dr. King pointed out that hospitals in receipt of federal funds and bound by the recently passed Civil Rights Act still covertly or overtly discriminated against Blacks, particularly in the South. Officials at the Department of Health, Education and Welfare (HEW) threatened to cut off aid to hospitals found guilty of practicing discrimination. A government survey of health and welfare services desegregation in the South had revealed wide-spread non-compliance with the law in federally supported programs. A survey sponsored by the U.S. Commission on Civil Rights found that almost all Southern state hospitals remained segregated, with the exception of mental hospitals.
Over fifty years later, health care disparities by race continue. The Health Equity Tracker defines “health equity” as a status when all people, regardless of race, sex, sexual orientation, disability, socio-economic status, geographic location, or other society constructs have fair and just access, opportunity, and resources to achieve their highest potential for health”.
The Equal Justice Initiative reports that enormous racial disparities in our criminal justice system, education, health and employment reflect continuing problems that cannot be fully understood without a closer examination of the civil rights era. The Equal Justice Initiative has published three reports in a series on American’s history of racial injustice: Slavery in America, Lynching in American: Confronting the Legacy of Racial Terror and recently Segregation in America.
In a report by The Commonwealth Fund in 2021, racial and ethnic disparities in health and well-being remain the norm. Black people live fewer years on average than white people; are more likely to die from treatable conditions; more likely to die during or after pregnancy; more likely to suffer from serious pregnancy- related complications and more likely to lose children in infancy. The COVID-19 pandemic has only made average life expectancies worse.
Racial health inequities are driven by a number of factors: higher poverty rates, work in low-paying industries, residing in high risk environments; cost barriers to care and also medical discrimination leading to sub-optimal care. Decades of structural economic suppression, unequal education access and residential segregation have all contributed to worse health outcomes for people of color.
The Georgia Department of Public Health reports deaths each year by a number of factors, including race. The number of deaths of African-American adults exceeds that of whites in every age category up to age 70. Black adults died at much higher rates from COVID-19 than whites across all age groups – sometimes by rates as high as three or four times higher.
Georgia has the highest maternal mortality rate of 46.2 maternal deaths per 100,000 for all women and 66.6 deaths per 100,000 live births for African American women. The national average for maternal mortality rate is 29.6 per 100,000 live births.
A 2022 study on Medicaid expansion determined that one of the greatest barriers to care are states that did not expand Medicaid coverage under the Affordable Care Act. These are the states that still refuse to expand Medicaid coverage: Alabama, Florida, Georgia, Kansas, Mississippi, North Carolina, South Carolina, South Dakota, Tennessee, Texas, Wisconsin and Wyoming. The majority of these states are concentrated in the South. The groups with the largest concentration of uninsured rates are Blacks, young adults and women of a reproductive age.
Health care inequality equates with income inequality. The higher your income, the better your health. The United States is the only developed country that does not have universal healthcare for all citizens. Low income adults have more than three times the chronic illnesses of higher earners.
Southern states have poorer healthcare outsomes than northern states. Even with the passage of the Affordable Care Act, 30 million people remain uninsured. Half of those 30 million are people of color. According to the Brookings Institute, the states that have refused to expand Medicaid are some of the states with the largest population of Black Americans. More than 90 percent of the people who do not have insurance live in a state that did not expand Medicaid.
The Equal Justice Initiative reports that in 2016, the rate of African American unemployment (8.4 percent) was nearly double the rate for white Americans (4.3 percent). A 2017 study concluded that “discrimination against Black job applicants hasn’t changed since the 1990s.” In part due to high rates of joblessness, 22 percent of African Americans live in poverty, compared to 9 percent of white Americans. The racial wealth gap nearly tripled between 1984 and 2009, and today, for every $100 of wealth held by a white family, a Black family has just $5.04.
The Equal Justice Initiative concluded its report on Segregation in America with this: “Perhaps I was too optimistic,” Dr. King wrote in his Letter from a Birmingham Jail, five years before he was assassinated on a Memphis hotel balcony. “Perhaps I expected too much. I suppose I should have realized that few members of the oppressor race can understand the deep groans and passionate yearnings of the oppressed race, and still fewer have the vision to see that injustice must be rooted out by strong, persistent and determined action.”