From left: David Williams, Zinzi Bailey, Chandra Jackson, Robert Blendon, Lisa Coleman

From left: David Williams, Zinzi Bailey, Chandra Jackson, Robert Blendon, Lisa Coleman

Progress, but challenges in reducing racial disparities

September 19, 2013 — Disparities between blacks and whites in the U.S. remain pronounced—and health is no exception. A panel of experts at Harvard School of Public Health (HSPH) discussed these disparities—what they are, why they persist, and what to do about them—at a September 12, 2013 event titled “Dialogue on Race, Justice, and Public Health.”

The event was held in Kresge G-1 and featured panelists Lisa Coleman, Harvard University’s chief diversity officer; David Williams, Florence Sprague Norman and Laura Smart Norman Professor of Public Health in the HSPH Department of Social and Behavioral Sciences; Chandra Jackson, Yerby Postdoctoral Research Fellow in the HSPH Department of Nutrition; and Zinzi Bailey, a fifth-year doctoral student in the HSPH Department of Social and Behavioral Sciences. Robert Blendon, Richard L. Menschel Professor of Public Health and Professor of Health Policy and Political Analysis at HSPH, moderated the discussion.

Gains, but pains

Health care disparities are troubling, Coleman said. One study found that doctors recommended coronary revascularization—bypass surgery that replaces blocked blood vessels with new ones—among white patients with heart disease 50% of the time, but just 23% of the time for blacks. Black women are less likely to be given a bone marrow density test than white women, even when it’s known they’ve had prior fractures. And the black infant mortality rate is 2.3 times higher than that of non-Hispanic whites.

Each speaker acknowledged that racial minorities have made significant gains over the past half-century, but said there is much more work still to do. They cited statistics providing stark evidence of continuing disparities in health, wealth, education, income, arrest and incarceration rates, foreclosure rates, and poverty. Coleman called the data “disconcerting; in some cases, alarming.”

Schools are desegregated, she said, but not integrated; median income is $50,000 per year for whites but $31,000 a year for blacks and $37,000 a year for Hispanics; since the 1960s, the unemployment rate among blacks has been two to two-and-a-half times higher than for whites; and one in three black men can expect to spend time in prison during their lifetimes.

Blendon shared results from surveys that accentuate sharp differences of opinion about how well blacks are faring in the U.S. For instance, in a survey that asked participants if they thought that the lives of black Americans had changed dramatically over the past 50 years, 54% of whites said yes but only 29% of blacks did. Another survey asked whether or not people approved of the verdict in the George Zimmerman trial; 51% of whites approved but only 9% of blacks did.

Reducing disparities through research, education

Jackson talked about growing up in a segregated neighborhood in Atlanta and attending a school with 99% black students and inadequate resources. She became the first in her family to attend college. Now, through her research, she hopes to expose and reduce racial health disparities. In a recent study in the American Journal of Epidemiology, Jackson and colleagues reported that blacks—particularly black professionals—get less sleep than whites, which can have potentially negative impacts on health.

Bailey discussed what’s known as the “school-to-prison pipeline”—a trajectory in which black teens do poorly in school, get held back a grade, drop out, commit a crime, then end up in jail. On the flip side, she said, there are “diversity pipelines” to recruit minority students into higher education. “Often these programs target students who have already avoided the school-to-prison pipeline,” Bailey said, noting that she would like to see higher education institutions connect with black students at earlier ages to steer them toward positive choices.

Williams said continuing disparities between whites and minorities are by-products of lingering racial prejudice that is deeply embedded in American society. He cited a study of popular U.S. television shows that found many black actors on the shows—something to celebrate—but also much more negative nonverbal behavior directed toward black actors than white ones. Another study, analyzing common pairings of words in American culture, found the words most frequently paired with the word “black” included “poor,” “violent,” “lazy,” and “dangerous.” Other research has uncovered widely pervasive “aversive racism,” in which people who have sympathy for the injustices blacks have experienced in the past nevertheless, as “normal” Americans, hold negative implicit biases against them.

Near the end of the event, Jackson stressed the importance of getting people to understand why they should care about inequities. “By 2040, this country will be a majority of minorities,” she said. “And, even if you don’t care from a moral standpoint, if we [as a country] take on the health profile of minorities in this country, we’re in trouble economically.”

Karen Feldscher

photo: Aubrey Calo

Listen to David Williams discuss how race can impact health care (NPR’s Marketplace)