By MEAGAN RICO
MSN, RN, Health Educator at the Saline Co. Health Department
Special thank you to Sheila Kjellberg, at the KWU Community Resiliency Hub
Black History Month, celebrated every February, is a time to recognize the Black community's contributions, resiliency, and rich history. This month also affords a very important opportunity to discuss ongoing health differences and how to promote racial fairness in public health. For the Saline County Health Department and our community, this month calls for action in bridging the gaps in healthcare access and outcomes while it celebrates diversity.
Health Inequality within the Kansas Black Community
Significant health disparities persist within the Black community because of systemic inequality. Health disparities are preventable differences in health outcomes or healthcare access that negatively affect specific groups of people who have historically faced greater social, economic, or environmental obstacles. According to the Centers for Disease Control and Prevention, chronic diseases, such as hypertension, diabetes, and heart disease, take an especially disproportionate toll among African Americans. This includes the following:
19% of Black adults in Kansas are uninsured, compared to only 9% of white Kansans [4].
The mortality rate for Black Kansans from treatable causes before age 75 is twice as high as for white Kansans [4].
In 2020, Black infant mortality in Kansas surged by 58%, resulting in 17 out of every 1,000 Black babies dying before their first birthday [7].
Between the years of 2016 and 2020, 105 Kansas women died while pregnant or within a year of being pregnant. Of that count, two-thirds of those deaths were women of color [8].
Healthcare performance for Black Kansans ranks 30th out of 39 states with available data (not all states chose to participate) [4].. Stroke: Black adults with diabetes are 1.5 to 2.5 times more likely to have complications such as stroke [3].
Diabetes: Black adults in Kansas are 73% more likely to have diabetes.
These disparities are not just biological but are deeply influenced by social determinants of health. Social determinants of health (SDOH) are the non-medical factors and conditions in the environments where people are born, grow, live, work, and age that influence health outcomes, risks, and quality of life. These factors include economic stability, education access and quality, healthcare access and quality, neighborhood and built environment, and social and community context [2]. These factors create barriers that make cycles of poor health outcomes self-perpetuating.
Historical Context: Racism and Public Health
The practice of public health in the United States is steeped in legacies of racism. Segregated healthcare facilities, exclusion from medical research, and discriminatory policies like redlining, which allowed for limited quality healthcare in specific neighborhoods, have given Black communities profound scars. In this setting, even today, racial biases continue to result in lower-quality treatment for Black patients than for others of similar socioeconomic or insurance status [2]. These are inequities that require action regarding their historic underpinnings and systemic changes.
A stark historical example illustrating the legacy of racism in U.S. public health is the Hospital Survey and Construction Act of 1946, commonly known as the Hill-Burton Act. This federal legislation, while seemingly aimed at improving healthcare access, explicitly allowed states to construct racially segregated healthcare facilities [5]. Despite mandating that health services be available to all without racial discrimination, the Act permitted the creation of "separate but equal" facilities, effectively authorizing and continuing systemic racism in healthcare infrastructure [5].
This policy had far-reaching consequences:
- It established racial segregation in healthcare, creating a two-tiered system of medical care.
- It reinforced health disparities by providing unequal access to medical services for racial minorities.
- It contributed to the persistence of racial health inequities, which continue to impact health outcomes today.
The Hill-Burton Act exemplifies how structural racism was embedded in U.S. health policy, shaping the development of the healthcare system and contributing to long-standing racial disparities in health access and outcomes [5][6].
Mental Health Stigma and Access
Another area where disparities exist is in mental health. Stigma within some parts of the Black community creates a barrier to mental health care. The Central Kansas Mental Health Center defines stigma as a set of negative and often unfair beliefs that a society or group of people have about something. Mental Health and stigma are intertwined because stigma prevents people from seeking out the help that they need. Many people feel ashamed or isolated.
This, combined with a lack of culturally competent providers and systemic barriers such as poverty, leads to a state of underutilization of mental health services [1][2].
Normalization of discussions around mental health and access to culturally sensitive care become very important. Breaking stigma entails having open conversations, educating others, and promoting understanding so that mental health is treated with the same importance as physical health.
Saline County Call to Action
Local organizations working to improve the lives and health of the Black community include the Salina Chapter of the National Association for the Advancement of Colored People (NAACP), led by Reverend Dr. Allen D. Smith. Other state organizations working for such causes need our support, including the Kansas Black Health Initiative.
The Kansas Black Leadership Council leads this initiative and receives help from the African American Affairs Commission and Community Voice Organization. Their work is currently focusing on addressing the gap in vaccination rate among African Americans in Shawnee, Wyandotte, Sedgwick, and Johnson counties.
Furthermore, Wyandotte County is leading the charge in health equity by forming WyCo Health Equity Task Force in 2020. What started as a mission to bring community members together to provide advice, input and guidance on the COVID-19 public health response, the task force has grown to support initiatives like the Health Outcomes Assembly. This assembly aims to answer the following questions: Does everyone in Kansas have the same access to health care? And if not, how can these health disparities be eliminated so that people living in Kansas can have healthier lives [9]?
This Black History Month in Saline County, let's pledge to be brave and honest about inequity as we create a healthier future for all. Equal access to high-quality and affordable health care is the right of all individuals, regardless of race, age, ethnicity, gender identity, disability, socioeconomic status, sexual orientation, sex characteristics, or geographical location. The Saline County Health Department invites area residents to participate in the educational events around you, volunteer with any local organization making strides against disparity, and contact your policymakers on behalf of equitable legislation.
Let us build a community where everybody gets a chance to blossom because public health is not just about treating illness but about creating wellness for all.
References:
[1] https://community-alliance.org/black-history-month-a-time-to-celebrate-diversity-and-culture-and-to-promote-health-and-wellness/
[2] https://communitycommons.org/collections/Black-History-of-Public-Health
[3] https://www.heart.org/en/about-us/office-of-health-equity/black-history-month
[5] https://www.healthaffairs.org/doi/10.1377/hlthaff.2021.01466
[6] https://communitycommons.org/collections/Black-History-of-Public-Health
[7] https://www.npr.org/2022/11/14/1136423443/birth-workers-in-kansas-are-addressing-the-states-high-rate-of-infant-mortality
[9] https://www.kumc.edu/about/news/news-archive/health-outcomes-assesmbly-2022.html