CPSolvers: Anti-Racism in Medicine Series
Episode 11: Racism, Redlining, and the Path Towards Reconciliation
Show Notes by Sud Krishnamurthy, Michelle Ogunwole, Chioma Onuoha
October 12th, 2021
Summary: This episode is part of a 3-part series on Race, Place, and Health. In this episode, we invite Mr. Richard Rothstein, distinguished Fellow of the Economic Policy Institute and acclaimed author of the book, The Color of Law: A Forgotten History of How Our Government Segregated America, and Professor Fernando De Maio, PhD director of research and data use at the AMA’s Center for Health Equity, professor of sociology at DePaul University, and co-editor of the recently published book, Unequal Cities: Structural Racism and the Death Gap in America’s Largest Cities, to share their expertise on structural racism, neighborhood segregation, and health inequities.
Episode Learning Objectives:
After listening to this episode learners will be able to…
Credits
Time Stamps
00:00 Introduction
02:29 De Jure and De Facto Segregation: The Color of Law
06:45 Health Inequities and Segregation: Unequal Cities
12:07 Defining Structural Racism
18:05 Federal Policy and Suburbanization
24:50 The Racial Wealth Gap and its Consequences
30:27 The Role of Health Equity Promoting Policy
32:00 Potential Remedies for Past Harms
39:45 Segregation of Medical Care
41:20 What Can Listeners Do Going Forward?
Episode Takeaways:
1. Terminology and Definitions of de jure and de facto segregation: The myth that segregation in modern societies has to do with private activities (e.g individual bias or bigotry that leads to a failure to sell a home to a person of color) and personal choices ( e.g. Black people prefer to live among other Black people) is referred to as de facto segregation. Adopting this worldview removes any obligation to remedy the consequences of segregation. In contrast, de jure segregation refers to the involvement of federal, state, and local governments in creating, structuring, designing, reinforcing, and perpetuating segregation. This reality of de jure segregation helps us understand that we have an obligation to remedy this constitutional violation.
2. Segregation relates to crucial public health outcomes that ultimately have an effect on life expectancy: The average life expectancy across the United States is 78.6 years; however, there exists a 10 year gap in life expectancy among the 30 largest cities in the US, from 72.9 years in Baltimore to 82.9 years in San Francisco and San Jose. Across the country, we see a 4 year gap in life expectancy between Black and White Americans; and this gap between and Black and White individuals ranges from 12 years in Washington DC, more than 8 years in Chicago, to no gap in El Paso. These gaps are not a product of lifestyle choices, biology or individual behaviors. They are a product of deep-rooted man-made policies that extend to many sectors (healthcare, education, criminal justice etc). These policies have systematically disadvantaged some groups, and have advantaged others. These policies are woven deeply into the fabric of the United States, and are intimately related to residential segregation, life expectancy, and mortality.
3. Unconstitutional housing policy in the mid-20th century led to the present day wealth gap and has implications for disparities: Discriminatory policies prohibited African Americans from being homeowners, while allowing White Americans to purchase homes and accumulate generational wealth. These policies established the wealth gap between Black and White Americans that persists today. Nationally, African Americans’ income is 60% of that of White Americans. Although one would think this leads to a 60% wealth gap as well, household wealth of African Americans is 5% (95% wealth gap) of that of White Americans. This extreme disparity between the 60% income ratio and the 5% wealth ratio is attributable to consequences of federal housing policy practiced in the mid-20th century. You can draw a line from these discriminatory housing policies, to the wealth gap, to disparities in education, health, and police brutality.
Pearls
On the importance of considering place based inequities
Variability of health inequities between communities in a single city or across different cities is critical to consider when discussing health inequity.
“We tend to think of health inequities as big, monolithic, deeply entrenched patterns, and they are, but their variability is really important. It gives us a sense of how different things can be.”-Professor Fernando De Maio
On language and the use of the term ‘structural racism’
Structural racism is a word that is used often, however many people do not know what it really means. Professor DeMaio notes that confusion around terminology is not a reason to shy away from discussions around it. He declares that one of our greatest challenges, and also one of our obligations, is to address structural racism head on.
“It’s our collective responsibility to explain it, to define it, to communicate it in effective ways to physicians, to healthcare systems, to the public at large and in detail, with data and with narratives, all the ways through which racism impacts our health.” -Professor Fernando De Maio
On Remedies to segregation
Mr. Rothstein shares two examples of potential remedies to segregation. The first would specifically address the constitutional violation that prohibited African Americans from becoming homeowners. The remedy would be for the government to buy up homes at market value in neighborhoods where African Americans were not allowed to buy homes, and sell them back to qualified African American buyers at deeply discounted rates.
The second remedy would correct a policy– the low-income housing tax credit– that reinforces segregation. Currently, low-income housing tax credit is a federal program distributed to housing developers who build housing for low-income families. However, this program reinforces segregation as developers are more inclined to build low-income housing in low-income neighborhoods. This can be reversed by placing a priority on use of these tax credits in higher-opportunity communities and prohibiting the use of this credit for creating more segregated communities.
Mr. Rothstein notes that the challenge is not in thinking of ideas or potential remedies…
“ We know what the policies are to create equality, a more equal society and a non-segregated society. What’s missing is not policy ideas. What’s missing is a new civil rights movement that’s going to create the political environment where those policies have to be implemented.”-Mr. Richard Rothstein
On being a citizen and the collective effort needed to change the status quo
Mr. Rothstein leaves us with these wise words to consider as we head back into our professional roles in medicine.
“In addition to being a physician, you’re a citizen. And I think the most important thing you can do is align yourself with other citizens in whatever profession they are, because this is going to take a community effort” -Mr. Richard Rothstein
References
Disclosures
The hosts and guests report no relevant financial disclosures.
Citation
De Maio F, Rothstein R, Khazanchi R, Tsai J, Krishnamurthy S, Ogunwole M, Fields NF, Nolen L, Onuoha C, Watkins A, Williams J, Paul D, Essien UR. “Episode 11: Racism, Redlining, and the Path Towards Reconciliation.” The Clinical Problem Solvers Podcast. https://clinicalproblemsolving.com/episodes. October 12, 2021.
Show Transcript