That’s a loaded question, but one that Brown University President Christina Paxson tried to unpack at a lecture Monday night.
In addition to presiding over an Ivy League institution, Paxson is also a scholar of economic development and health. It may seem strange to be talking about racial disparities in health at a time when race is the topic of charged discussions on college campuses across the nation, including at Brown. But I think it’s perfectly relevant: if you want to level the playing field for everyone, start by addressing the startling differences in health (and wealth) between blacks and whites.
Here are a few takeaways from her data-driven talk that enlightened me:
- Paxson outlined the relationship between health and wealth: the lower your socioeconomic status, the worse your health. Pretty much across the board. And if you look at the difference in total household wealth (cash in the bank, income, equity in a home you own) between blacks and whites on average, you can begin to understand just how uneven the playing field is. On average, white households have nearly $200K in total wealth; on average, blacks have about $11K.
- Education leads to higher wealth, which should, in theory, lead to better health (because you have access to quality health care, food, insurance, etc.). But even among educated blacks, disparities in health persist. We can’t “educate our way” out of health disparities, Paxson said. This is institutional, structural, deep-seated, complex.
- Poor health means you’re not always able to work or be as productive as you might otherwise be. That leads to lower socioeconomic status. Which leads to poorer health, and the cycle continues.
- There’s strong evidence that more stressors in early life, environmental factors like poor quality housing, and a lack of access to quality health care (perhaps because of bias within the medical system) account in part for the fact that blacks often start off in worse shape than whites. Blacks have much higher infant mortality rates than whites, much higher rates of low birth weight.
- The disparities – in terms of how sick you are, how early in life you suffer the burdens of a chronic disease, or how much earlier you die – start from birth and only get bigger as you get older. That’s true for most of the major chronic diseases, especially diabetes, high blood pressure, etc. What this means, Paxson pointed out, is that by the time blacks reach their early 40s, they are much more likely to begin experiencing the effects of poor health than whites. That’s much earlier than whites. And that poor health affects a person’s earning potential.
- So, if the disparities begin from birth, accumulate over time, and can’t be addressed by wealth, education, or even by better insurance coverage alone, what’s to be done? Paxson suggests better maternal and infant health care, addressing chronic conditions before they get out of control, and leveling the economic and educational playing fields. All of them, tall orders.
- Some efforts are underway in Rhode Island to level this playing field. There’s a growing maternal and home visiting program to help improve life in early childhood. Community health centers continue to expand their reach with primary care and chronic disease management programs. Rhode Island is throwing tons of resources at improving access to primary care, in fact, which is supposed to help catch chronic disease earlier so that it can be managed more effectively, and more cheaply. Rhode Island also has very high rates of health insurance coverage for kids, which is great, but not enough to erase disparities on its own. So disparities may not be as stark in Rhode Island as in other places in the country, but they’re pretty much unacceptable at any level, anywhere, in my opinion.