Health disparities are preventable differences in health outcomes between groups in society

by James Crawford, Chatham County Commissioner, District 4

The following statement was adopted by the Chatham County Board of Health at its August 24, 2020 meeting:

 “As members of the North Carolina, Chatham County Board of Health, it is our stated purpose to identify factors that adversely affect health outcomes, formulate plans to address these factors, and to ultimately negate their effect on the health of Chatham County residents. As such, we are formally declaring structural racism as an ongoing public health crisis, and pledging the Board’s commitment and expertise in mitigating the associated health disparities.”

“It is an irrefutable fact that race and socio-economic status have innumerable influences on health outcomes. This is evident in a multitude of statistics in Chatham County, and throughout the State, including, but not limited to, the disproportionally high COVID-19 case percentage of Chatham County Latino community members, the decreased life expectancy of African American men, and the suboptimal birth outcomes of African American women.”

Chatham County has cradle to grave disparities, documented by several surveys, ongoing data collection, and targeted studies:

  • Maternity/Births: Chatham’s infant mortality rate is above the state’s 7.1 per 1,000 versus 10.7. Disaggregate the data: white 5.2; black 18.7 deaths per 1000.
  • Low weight babies: White, 9.3%; Hispanic, 11.6%; and black 11.6%. 
  • Women’s preventative care: Older women have disparate rates of mammogram screening, according to our data. White, 46%; black, 45%; and Hispanic, 32%. 
  • Flu shots: 62% of whites using our medicare service get vaccinated; 45% of African-Americans, 33% of Hispanics.

All of the above impact morbidity and mortality: Black women are more likely to die from heart disease than white women; 114 v. 81 per 100,000. Black men have a rate of 208 v. 126 for white men, per 100,000. Poor cancer treatment kills at black men at a rate 235 per 100,000 versus 172 for white men. For women the corresponding numbers are 133 versus 99. Overall black folk in Chatham have seven fewer years of life expectancy than whites.

Half of Chatham’s Covid-19 victims are Hispanic, although they are about 12% of the population.

The Health Board is also concerned with community mental wellness: attempted suicides are seven points higher among Latina high school students, four points higher for Hispanic boys. There is a higher reporting of symptoms of depression too. 

Each of these indicators (and others) is the outgrowth of marginalization in a society shaped by white supremacy as a legal, cultural, and political value with damaging social, economic and psychological consequences.

In turn, the public must acknowledge the socio-economic determinants of health: Poverty, lack of medical insurance, lack of screenings, preventative measures, diagnosis and treatment. Bad health outcomes are tied to the marginalization of our neighbors. Whereas 14% of white children in the county are living in poverty, 24% of black and 30% of Hispanic/latinx children live in poverty. White median income is $85K, African-American is 45K and Hispanic/Latino is 47K. 

This is the local context in which the state legislature’s rejection of Medicaid expansion must be reckoned. To be clear, North Carolina’s leaders choose to deny preventative care, diagnosis opportunities and treatment to the poor and working poor. To the extent that it falls more heavily upon people of color, it is a form of structural racism dating not to 1915 or 1815, but 2015. 

We must commit ourselves to doing better. When? Now. The BOH statement continues: “It is not enough to simply declare structural racism a public health crisis, measures must be taken to address the root causes and secondary influences if we hope to succeed.“ The first step to doing better is to have a thorough diagnosis, to reckon the metes and bounds of the problem of disparities, inequalities and iniquities.

It is an iniquity to obfuscate, deny or obstruct discussion of the issue. This willful blindness is not new; just wrong.

Dr. James G. Crawford is a Chatham County Commissioner in District 4, holds a PhD in History from UNC-Chapel Hill, and a former professor at UNCG, Elon, and N.C. A&T.