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A
Look at The Toledo Black Agenda
A wide range of leaders in Toledo’s Black community have
joined forces to put together a report on the challenges
facing that community in six critical areas.
The report, The Toledo Black Agenda, a months-long project
in the making, examines historic obstacles and current
challenges in the areas of criminal justice, economic
development, education, health, housing, workforce
development.
The community leaders and experts were assembled by Lisa
McDuffie, CEO of YWCA of Northwest Ohio and Robin Reese, CEO
of Lucas County Children Services.
Now Toledo’s Black Agenda will be made available to local
government agencies, along with a host of private and public
companies and entities in order to gather community-wide
support for the demands and suggestions proposed in the
report.
We are printing excerpts from the report over the next few
weeks. The following is an excerpt from the fourth pillar –
the Health Care Equity & Justice Pillar. We will print the
recommendations of the Health Care Task Force next week.
The entire report, with citations, can be read online at
thetruthtoledo.com
PART IV: HEALTH CARE EQUITY & JUSTICE PILLAR
INTRODUCTION AND PURPOSE
The issue of equity in healthcare is a complicated one. To
improve health for everyone, hard, unflinching questions
must be asked, and reasonable, innovative and well-formed
solutions designed to directly address the needs of those
disenfranchised in our communities must be provided. There
can be no fear of confronting history and its fostering of
the intentional development of public policies that
“ghettoized” neighborhoods making them unhealthy places for
families to live. We must ask why housing stock is allowed
to remain infested with lead, well known to impair the
cognitive ability of our children. We must challenge our
elected officials to answer the question why, in the most
progressive and technologically advanced time in our
history, in the richest country in the world, issues of food
insecurity, educational process that fail many children in
our urban centers and environmental issues that deprive our
communities of life sustaining basics like water, still
exist? Employment and associated advancements are still
unevenly available and the inability or unwillingness to
provide equal access to health care, especially specialty
care, remains of great concern. Tough questions with no easy
solutions, but all necessary inquiries in the movement
toward healthcare equity.
What Is Health Equity?
A basic principle of public health is that all people have a
right to health care[1].
When access to care is denied, significant negative
differences in the health status between groups occur.
These differences most often affect those who are
marginalized because of socioeconomic status,
race/ethnicity, sexual orientation, gender, disability
status, geographic location, or some combination thereof.
People in these groups not only experience worse health but
also tend to have less access to those resources which
typically form the foundation of healthy communities.
Suitable housing, sound education nutritional food and safe
neighborhoods are all examples of what are now called the
Social Determinants of Health (SDOH) and are considered
essential resources in the pursuit of Health Equity.[2]
The actual definition of Health Equity is complicated by the
influences of those elements related to SDOH and its
similarity to its counterparts, Health Disparities and
Inclusion Health. The World Health
Organization defines health equity as the
“absence of avoidable, unfair or remediable differences
among groups of people, whether those groups are defined
socially, economically, demographically, geographically or
by other means of stratification” in the pursuit of optimal
health status.[3]
It is, as defined within the Veterans Health
Administration’s Health Equity Plan, “the understanding of
how people’s social characteristics and environments affect
health...” [4]
These are the definitions of health equity to be used within
this document. Health inequities are not naturally made.
They arise from racial and class inequities; from decisions
that this society has made. The single strongest predictor
of our health is our position on the class pyramid.
The issue of Health Equity is both massive in scope and
complex when considering a pathway toward its attainment.
And while there are a significant number of health issues
that should be addressed by this community, this document
will identify those health issues in our community that
require immediate consideration. One thing is without
question; the
data and research evidence are clear that racism is a
systemic and ongoing public health crisis with serious
consequences for the health of Black Ohioans. It is also
clear that racism has a profound and pervasive impact
across all the factors that shape our health. This includes
our healthcare delivery systems, education, housing, food,
economic, environmental, criminal justice and political
systems, among others.[5]
Health disparities
on the other hand, are the health-related outcomes present
in marginalized communities, which are
directly attributable to the systematic and unjust
distribution of those critical resources mentioned
above. Equally important is the somewhat derivative
definition of Inclusion Health. This term
is used to define a number
of groups of people who are not usually well provided for by
healthcare systems, have poorer, access to healthcare ,
experiences and health outcomes than even the most
vulnerable of our population.[6]
This definition covers people who are homeless, vulnerable
migrants (refugees, those undocumented, asylum seekers) and
sex workers to name a few. The conceptual differences
between these terms are subtle but significant. It is
important however, that they and their differences be
understood as each is important in this discussion.
The Cumulative Impact of Healthcare Inequity
Racism and the inequities it creates are well documented as
drivers of health disparities and overall poor health in the
Black community. While these are avoidable differences in
health outcomes among groups, the ongoing trauma of systemic
or institutional racism, results
in an unequal allocation of social resources that
shape health status. Resulting imbalances can be seen in
conditions that shape and define Social Determinants of
Health.
[7]
But beyond
these things, evidence suggests that the stress of the
experience of racism may have its own physical impact. “It's
about access and unequal treatment, but it's also about much
more than that’ states April Thames, PhD, Associate
Professor of Psychology and Director of the Social
Neuroscience in Health Psychology lab at the University of
Southern California.
The fact that individuals live with these stressors their
entire lives produces adverse health consequences.
Discrimination has a directly toxic impact on health in
general and neurologic health in particular. Several studies
have shown clear biological links for poor health outcomes
associated with racism, even after controlling for other
factors that might serve as a proxy, such as access to care.
In fact,
the persistent stress of these environmental influencers
causes changes to the neurological, endocrine and immune
systems. These changes contribute to a great number of
health maladies including high rates of infant mortality and
co-morbidities such as hypertension and heart disease.
Comorbidities render Black people more vulnerable to
illnesses like COVID-19, shortens lifespans and increases
medical complications and death from otherwise survivable
diseases.
There are also real differences in how people are treated
when they obtain care. The examples are many and range from
providing significant misinformation (telling a patient with
suspected Multiple Sclerosis that “Black people don’t get
MS”) to disparities in the way illnesses are managed. For
example, Black patients experiencing a stroke are one
quarter less likely to be given thrombolysis, the treatment
which is known to be most effective, than White patients. In
her book CASTE, Isabelle Wilkerson discusses that empirical
studies show physicians often disregard the reports of pain
from Black patients, wrongly believing that Blacks in
particular have higher pain thresholds. This, according to
Wilkerson, has led physicians to undertreat or deny pain
medication to Black patients-even those with metastatic
cancer-while readily prescribing medication to White
patients reporting equivalent levels of pain. The disparity
is so severe that Blacks as a group receive pain medication
at levels beneath the threshold established by the World
Health Organization.
California Surgeon General Dr. Nadine Burke Harris is a
pediatrician who has studied the profound health effects of
childhood trauma and stress. In pointing out the higher
COVID-19 rates among Black and Brown people, she identified
their long term environmental and racially tinged
experiences to be “severely flawed and systematically
different than others, resulting in negative health
outcomes. We (this country) have created these differences—
and they are literally leading Black and Brown people to die
in far greater numbers, than others” she said.
Ohio by The Numbers
When it comes to developing a health system rooted in the
principles of health equity and justice, the numbers below
will show that Ohio and Lucas county face significant
challenges.
-
Ohio consistently ranks among the bottom half of
states on measures of health and wellbeing. For
example, Ohio ranks 38 out of 50 states on America’s
Health Rankings 2019 report.
-
In the Health Policy Institute of Ohio’s 2019
Health Value Dashboard,
Ohio ranks 46 out of 50 states and D.C. on health
value, a composite measure of population health and
healthcare spending, This means that Ohioans are
less healthy and spend more on health care than people
in most other states.
-
Ohio is in the bottom quartile (42 out of 50 states) for
Black child wellbeing based on the Annie
E. Casey Foundation 2017 Race for Results Report,
indicating that Black children in Ohio do not
have adequate supports to achieve optimal health.
-
Ohioans of color face large gaps in outcomes across
socio-economic factors, community conditions and health
care. This, in turn, drives poorer health outcomes among
Ohioans of color, such as higher rates of infant
mortality and premature death.
-
Women of color and low-income mothers, are several
times more likely to
suffer from postpartum mental illness but less
likely to receive treatment than
other mothers, according to recent studies.
-
According to the study, “Suicide attempts rising among
Black teens.” Reuters, Oct 16, 2019, while the overall
proportion of teens reporting suicidal thoughts or plans
declined for all racial and ethnic groups during the
study period, the proportion of Black teens
attempting suicide surged by 73%.
-
A Centers for Disease Control and Prevention report
found that Black women are about three times more likely
to die from causes related to pregnancy, compared to
White women in the United States. (Source: “Huge
Racial Disparities Found in Deaths Linked to Pregnancy,” New
York Times, May 7, 2019)
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In Cleveland, Ohio Black babies are dying at a rate of 7
times that of White babies. Generally, in Ohio, Black
infants die at a rate of 2-3 times that of White infants
-
Black children are almost three and a half times more
likely to die within 30 days after surgery than White
children, according to a new study published in the
journal Pediatrics
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Twenty percent of Ohio children live in poverty
(Spotlight on Poverty and Opportunity 2019)
-
Blacks have the highest mortality rate for all cancers
combined compared with any other racial and ethnic
group.
-
The likelihood of having two or more significant
conditions is 60% by the age of 75-79 years, and more
than 75% by 85-89 years causing most Seniors to suffer
complications from comorbidities.
-
Food insecurity in Ohio has nearly doubled from 13.9% to
23%
-
In Ohio, more than one-in-six older adults (17.6
percent) face the threat of hunger. Ohio is among the 10
worst states in the nation for food insecurity among
older adults, with over 457,000 Ohioans over age 60 who
are either “marginally food insecure” or “food
insecure,” according to a recent report by Community
Solutions, “Fighting Food Insecurity Among Older Adults”
(2017)
Suicide attempts for Black teens rose 73% in 2019 while they
fell for every other group.
Lucas County by the Numbers
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19.3% of Lucas County residents live in poverty, higher
than the national average of 13%.
-
Those poorest are women 18-34 years of age
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38.2% of Toledo children live in poverty, compared to
28.1% in Lucas county (Toledo and Lucas County Poverty
Study 2019).
-
In Lucas County, white babies died at a rate of 4.7 per
1,000 live births, while the rate for Black babies was
13.7.
-
In Lucas County, Ohio and the United States in
2012-2016, Blacks had higher cancer mortality rates than
Whites.
-
In Lucas County, one in nine (11%) Lucas County Black
adults were diagnosed with cancer at some point in their
lives, increasing to 25% of those over the age of 65
based on the 2017 Health Assessment.
-
In Lucas County, Blacks have a higher rate of
co-morbidities than Whites
-
36% of those over 65 in Lucas County rated their health
as fair or poor
-
Four percent (4%) of Black adults reported they had
heart disease, increasing to 13% of those with incomes
less than $25,000 and 14% of those over the age of 65
according to Healthy Lucas County’s 2018 Community
Health Assessment.
-
According to the same report, 22% of Lucas County
African American adults had been diagnosed with
diabetes, increasing to 45% of those over the age of 65.
-
By
2030, older adults will make up 25% of the population in
Lucas County.
-
28% of Lucas County residents and 1 in 4 children
experience food insecurity
Health Statistics for Black American Men
Black men in the United States suffer worse health than any
other racial group in America. As a group, Black men have
the lowest life expectancy and the highest death rate from
specific causes when compared to both men and women of other
racial and ethnic groups.
Statistically speaking, Black men live 7 years less than men
of other racial groups. They have a higher death than Black
women for all leading causes of death. Black men suffer more
from preventable oral diseases that are treatable, have a
higher incidence of diabetes and prostate cancer. In Lucas
County, Black men have a 38% obesity rate and 44% are
considered overweight. Suicide is the third leading cause of
death in 15-24-year-old Black men. In 2017, homicide was the
number one cause of death for young Black men between the
ages of 15 and 44.
Ed. Note: The Task Force’s recommendations will be published
next week.
HEALTH CARE EQUITY & JUSTICE PILLAR
THE EDUCATION PILLAR
THE ECONOMIC JUSTICE PILLAR
The Toledo Black Agenda Report
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