Racism and health

OSU study finds COVID vaccine hesitancy falling faster among Black Americans

While the COVID vaccination rate for Black Americans still lags white Americans, a new study found that hesitancy among Black individuals is falling at a faster rate (Source: “COVID Vaccine Hesitancy Falling Faster Among Black Americans Than Whites,” HealthDay News via U.S. News, Jan. 24).

According to the study by Ohio State University researchers published in JAMA Network Open, In December 2020, about 38% of Black participants and 28% of white participants expressed hesitancy about the vaccines. By June 2021, those responses had shifted so they were almost even, with 26% of Black participants hesitant compared to 27% of white participants.

Still, by May 2021, the percentage of white individuals who had received at least one dose of vaccine was about 1.5 times the percentage of Black individuals who had received a dose.

If, as the study showed, it's not that Black Americans are more hesitant than white individuals, but they remain less vaccinated, "then we really need to ask ourselves, is it access barriers that are affecting Black Americans more?" said Tasleem Padamsee, lead study author.

Though this study was not focused on the reasons for the lower vaccination rates, it pointed out that various obstacles might keep Black people from getting vaccinated. Potential obstacles could include concern about missing work to get the vaccine or missing it afterward due to side effects, not having transportation to the vaccine site or worrying that there may be a cost for vaccines.

Commonwealth Fund releases racial equity framework for assessing health policy

Earlier this month, the Commonwealth Fund released a brief laying out a racial equity framework for accessing health policy.

“Despite enduring racism and the need for greater racial equity, there is limited consensus among analysts, academics, and public officials on how to assess policy for its impact on racial equity,” according to the paper. “Without instructive conceptual frameworks, our ability to identify, examine, and eradicate racial inequity through health policy will be limited.”

The framework is a conceptual tool meant to provide researchers, policymakers, and others with guidance on how to assess the racial equity implications of policy. It can also benefit those who are collecting systematic data on health policies by providing a lens through which to methodically assess what those policies mean for racial equity and why.

Black, unmarried patients more likely to have negative descriptors in health records, study finds

The language clinicians use in their electronic health record (EHR) notes varies by patients' race, marital status and type of insurance, according to a new study (Source: “Patients who are Black, unmarried or on government insurance described more negatively in EHR, study shows,” Jan. 19).

The Health Affairs study found Black patients were 2.54 times more likely to have one or more negative descriptors in their EHR notes than white patients. It also found patients who are unmarried or enrolled in a government insurance program had higher likelihoods of negative descriptors than patients who were married or enrolled in private or employer-based insurance plans. 

The study's authors said their findings raise concerns about racial bias in healthcare and the possible transmission of stigma through the EHR. They said providers may need self-awareness and bias training to change their language.

Study links cardiovascular disease risk for African Americans with social determinants of health

A new study has found that social determinants such as age, sex, marital status, and education level were associated with risk of cardiovascular disease for American Africans (Source: “SDOH Drive Cardiovascular Mortality Disparities for African Americans,” Patient Engagement HIT, Jan. 6).

The study from Mayo Clinic Proceedings found a higher occurrence of cardiovascular disease and associated clinical and social determinant risk factors than past studies, suggesting these issues are worse than previously understood.

The study analyzed 644 African American individuals from Minnesota, using data gathered from May to December 2019 to examine the association between age- and sex-adjusted cardiovascular disease risk factors, sociodemographic characteristics and health beliefs. 

HPIO fact sheet outlines actions private sector can take to address racism


The Health Policy Institute of Ohio has released a new fact sheet as a companion to its Connections between Racism and Health brief.

The fact sheet, the second in a series of three, outlines actions private sector partners can take to support the health and well-being of Ohioans of color and move Ohio toward a more economically vibrant and healthy future. The first fact sheet provided action steps for state and local policymakers.

“Ohioans of color, in particular, continue to face barriers to good health and well-being that are rooted in racism and centuries of unjust practices,” the fact sheet states. “However, improvement is possible and there are many actions private sector organizations can take to support the health of every Ohioan.”

Last year HPIO released a data brief, "Connections between Racism and Health: Taking Action to Eliminate Racism and Advance Equity" and an accompanying resource page to support state and local efforts to eliminate racism.

Fewer people identify health disparities as a problem, new study finds

The number of people who think health disparities and inequities are a problem has waned since 2020, according to new research (Source: “Fewer People Recognize Health Disparities, Inequities as a Problem,” Patient Engagement HIT, Dec. 9).

Robert Wood Johnson Foundation and RAND Corporation researchers saw a significant decline in the number of people recognizing health disparities between July 2020 and September 2021. In July 2020, 61.1% of U.S. adults agreed that people of color faced a disproportionate health impact from the COVID-19 pandemic, and 57.5% agreed people of color faced more of a financial impact than their white peers.

By September 2021, however, those numbers had shrunk. Only 52.7% of adults agreed populations of color saw a stronger health impact from the pandemic, and 50.3% agreed populations of color saw a bigger financial impact.

The survey showed that fewer people recognize the link between systemic racism and health outcomes. For example, the researchers reported a 3% decline in the number of people who agree poor health outcomes are related to systemic racism; only about 40% of respondents in September 2021 said they agreed health outcomes could be linked to systemic racism.

Study: Racial disparities exist in every state in U.S.

Racial and ethnic health inequities are pervasive in every state in the U.S., according to a new analysis that found some of the widest disparities occur within states known for having high performing health care systems (Source: “States Have Large Racial Disparities in Health Care Equity, Study Finds,” U.S. News, Nov. 18).

A new report from the Commonwealth Fund assessed the performance of the health system in all 50 states and the District of Columbia on health care access, quality of care and health outcomes for racial and ethnic minority residents.

The report evaluated state health system performance for Black, white and American Indian/Alaskan Native residents, as well as for Asian American, Native Hawaiian, Pacific Islander and Latino populations.

Only six states had health systems that scored above the national average for all racial and ethnic groups studied – Oregon, Rhode Island,  Hawaii, Massachusetts, Connecticut and New York. Yet large disparities were also found in those states, where health system performance for white residents was scored the best of any group except in Massachusetts, where it was slightly higher among Asian American, Native Hawaiian and Pacific Islander residents.

The overall health of Black Ohioans ranked 22nd out of 38, Latino Ohioans ranked 16th out of 42, Asian Ohioans ranked 19th out of 23 and white Ohioans ranked 34th out of 51 states and D.C.

Answers sought for rise in suicide attempts among Black teens

Legislators and academics are pushing for better research to understand why self-reported suicide attempts have dramatically risen among Black adolescents over the past three decades (Source: “Why Are More Black Kids Suicidal? A Search for Answers.,” New York Times, Nov. 18).

A study published this summer in the Journal of the American Medical Association found that self-reported suicide attempts rose nearly 80% among Black adolescents from 1991 to 2019, while the prevalence of attempts did not change significantly among those of other races and ethnicities.

One study of high school students, published in September, found that the Black teenagers surveyed were more likely than the white teenagers to have attempted suicide without first having suicidal thoughts or plans. Because suicide screening questionnaires typically ask whether people are having suicidal thoughts or have made plans to hurt themselves, the authors speculated that the questionnaires might fail to identify some Black youths who are at risk of suicide, or that there could be additional factors that might indicate a need for intervention.

More research is needed, but a government study conducted last year suggested that Black children and adolescents who died by suicide were more likely than white youths to have experienced a crisis in the two weeks before they died. They were also more likely to have had a family relationship problem, argument or conflict, or a history of suicide attempts.

Federal grant aims to address social determinants of health in Black neighborhoods in Cleveland

The Case Western Reserve University School of Medicine and University Hospitals Harrington Heart & Vascular Institute have received an $18.2 million federal grant from the National Institutes of Health to lead a multi-organizational effort addressing cardiovascular health disparities (Source: “CWRU, UH receive $18.2 million federal grant to address social determinants of health in Black neighborhoods,” Cleveland.com, Oct. 12).

The initiative involves CWRU, UH and Wayne State University in Detroit. The institutions will work to address social drivers of health in Black communities in Cleveland and Detroit, according to a joint statement from CWRU and UH.

The initiative’s goal is to reduce cardiovascular complications and hospitalizations by improving blood pressure, lipids and glucose targets for Black patients who are at high risk for poor heart health, said Dr. Sanjay Rajagopalan, the principal investigator of the initiative.

Education, socio-economic status, geography and environmental factors contribute to the burden of cardiovascular disease in the United States, Rajagopalan said in the statement.

“There are seismic gaps that exist in health care for Black Americans that continue to result in disproportionate and disappointingly poor outcomes,” he said. “This transformative grant will help to address some of these health disparities.”

Study links historic redlining to current Black maternal health disparities

Despite coming to an end in the 1960s, institutionally racist policies like redlining still contribute to poor health outcomes and Black maternal health disparities, according to new research (Source: “Decades-Old Policy Fuel Black Maternal Health Disparities,” Patient Engagement HIT, Oct. 5).

A relic of the 1930s, redlining was a discriminatory practice in which the US Home Owners’ Loan Corporation designated thousands of areas as “unsafe” for issuing a homeowner’s loan. “Unsafe” usually meant there was a higher proportion of Black people living in a given neighborhood, creating a system of divestment that made it harder for Black people to own a home.

The study, which was published in the Journal of the American Medical Association, found that poor outcomes happening today were largely concentrated in areas that in the 1940s had been deemed “hazardous” for homeowner’s loans by the HOLC. In other words, the racist policymaking of the mid-20th century is still having negative health equity impacts today.

“This structure of disinvestment, which formally stretched forward into the 1960s, has far-reaching impacts,” the researchers explained. “The legacy of historic redline racial discrimination correlates with modern social and health inequities.”