High infant mortality among Black infants is not an indication of biological differences between Black and white people, but is an “index of social conditions.” This was a conclusion W.E.B Du Bois drew after analyzing the morbidity and mortality rates of Black and White people, as part of The Health and Physique of the Negro American, a report he presented in 1906 at the 11th Conference for the Study of the Negro Problem. He concludes that “with improved sanitary conditions, improved education, and better economic opportunities, the mortality of the race may and probably will steadily decrease until it becomes normal.”
Du Bois meticulously studied extensive medical data which allowed him to make his conclusions more than 100 years ago. Fast forward to today, with much more information at our disposal and increased capacities by which to analyze data; yet, social conditions (what we now call the “the social determinants of health”) continue to impact the health of communities of color. These non-medical factors that affect health particularly impact Black and Hispanic communities, resulting in disproportionate health outcomes. The current COVID-19 pandemic shows, in real time no less, how stark these outcomes truly are.
According to a recent Episcopal Health Foundation report, Economic Health Disparities in Texas 2020: AN Update in the Time of COVID-19, Black mortality rates due to the pandemic are four times higher than white mortality rates; Hispanic mortality rates are seven times higher. Factors such as higher uninsured rates, higher rates of delaying medical care due to cost, high rates of service-related jobs, and underlying health issues have been associated with the disparities we are seeing with COVID-19 outcomes. It must be noted that these underlying health issues themselves are often associated with poor social conditions.
Clearly, as Du Bois reminds us, using data to make the case to address health inequities is not novel: Neither is linking social inequities with health disparities. And yet, far too often we focus on addressing health disparities while disregarding the social conditions that provide fertile ground for poor health outcomes. As poor social conditions beget poor health outcomes, poor health outcomes beget worsening social conditions. In the same EHF report, it is estimated that if Black and Hispanic communities experienced COVID-19 hospitalization rates equal to white communities in Texas, the reduced impact could have resulted in 24,000 fewer hospitalizations and a financial burden that would be $558 million dollars lower. Further, the report concludes that if age-adjusted COVID-19 related death rates for Black and Hispanic populations were equal to white populations, there would have been 5,000 fewer deaths in Texas alone. In addition to the emotional toll, premature deaths will have significant economic impacts on families for years to come. These high death rates for working-aged Black and Latino populations means deepening financial hardships for families that are already struggling.
However, by focusing on root cause issues such as supporting the development of policies and strategies, and aligning resources to address the educational, housing, employment, and transportation needs of low-income communities of color, as Du Bois continues to remind us a hundred years later, health disparities can be remedied. Further, resources and efforts to address these issues should be de-siloed because that’s not how people live life, nor is it how people deal with hardships. In his essay, Financial Health is Public Health, Dr. Jason Q. Purnell quotes a gentleman he encountered in his research as saying, “If you want to lower my blood pressure, help me pay my electricity bill.”
This message reminds us that challenges in one aspect of life can result in challenges in all aspects of life, and health is no exception. This message also reminds us to listen to people, to hear what challenges they are experiencing, and to truly understand the conditions affecting not just their health, but their lives.
To explore this topic and how you can apply these lessons to your grantmaking, dive into our Drive Equity resources.
Photo: Courtesy of Episcopal Health Foundation