Racism is a public health crisis

By Asif Dhar, M.D., US Life Sciences & Health Care leader, and Kulleni Gebreyes, M.D., principal, Deloitte Consulting LLP

“Of all the forms of inequality, injustice in health is the most shocking and the most inhuman"—Dr. Martin Luther King Jr., Chicago, 1966

We are in the midst a two-fold public health emergency: One is from the biological agent that causes COVID-19 and the other is the multigenerational social disease of racism. In 2019, the American Academy of Pediatrics explained that “the evidence to support the continued negative impact of racism on health and well-being through implicit and explicit biases, institutional structures, and interpersonal relationships is clear.”¹

COVID-19 is disproportionately affecting Blacks, Latinos, and indigenous people.² While racism and profound health disparities commonly affect minority communities, this particular blog looks specifically at the impact on Black people. While COVID-19 emerged less than a year ago, racism in the US is older than the country itself. It stretches back hundreds of years to a time when human beings were enslaved to generate economic prosperity for a selected few.³

We are passionate about working to address the disease of racism in collaboration with our clients and broader communities, and we want to open a dialog about effective, impactful strategies to prevent or treat it. Disruptive technologies—combined with orchestrated ecosystems—hold promise both for raising awareness and improving the health and well-being of Black lives. 

Racism has an exponential impact on health and well-being

Boston Mayor Marty Walsh (D) recently declared racism as an emergency and public health crisis.⁴ Kentucky Governor Andy Beshear (D) outlined a strategy to address racial disparities in health care.⁵ Dozens of other mayors and at least three governors are making similar moves. Within health care, a growing number of professional associations and health care organizations have used social media and their public platforms to decry the impact of racism on health status. The American Medical Association announced that it “recognizes that racism in its systemic, structural, institutional, and interpersonal forms is an urgent threat to public health,” and the American College of Physicians said it “reaffirms and commits to expanding on its previous policies to confront racial and ethnic disparities, discrimination and racism in health.” ^6,7

Recognizing racism as a public health crisis is one step in collectively moving to address this fundamental source of health inequity. We can also learn from past lessons and develop empathy through today’s disruptive technologies—for example, respectfully sharing experiences on social media platforms. Such tools are helping people develop collective empathy and an elevated level of social consciousness to take a stand against the structural, institutional, environmental, and individual constructs that cause harm and perpetuate injustice toward Black Americans and other minorities.

Racism, not race, is often a root cause of poverty, homelessness, unemployment, poor nutrition, violence, and mental-health concerns for Black people. Racism was not dismantled with the end of slavery. Laws and systems put into place after the Civil War frequently made it difficult for Black Americans to own property and accumulate wealth.⁸ State and local statutes denied Black Americans many opportunities—including the right to vote. While the Civil Rights movement of the 1950s and 1960s achieved equal rights for Black Americans under law, disparities and racism continued in several forms. 

Unequal access to quality medical care has led to poor health outcomes for many Black Americans.⁹ However, limited access to quality education, jobs with good pay, healthy food, and safe housing can have an even more profound impact. Some studies estimate that these non-medical drivers of health (also known as social determinants of health) can account for 80% of a person’s health.¹⁰ In addition to the issues of physical safety and security caused by racism, research indicates that racism itself might increase chronic inflammation and the risk of chronic illness.¹¹ Recent data from the American Heart Association, for example, shows that people who experience racism, even after adjusting for age, gender, and hypertensive risk factors, have higher blood pressure.¹² A comprehensive meta-analysis of data from more than 300 articles demonstrates a strong link between racism and poorer mental and physical health outcomes. It shows that racism can have its own negative impact, separate from that of age, gender, birthplace, and education.¹³

Racism and the COVID-19 pandemic

The COVID-19 pandemic is magnifying the profound impact racism has on the health and well-being of individuals and their communities. “The disparities in the data reflect longstanding challenges facing minority communities and low-income older adults, many of whom face structural challenges to their health,” US Centers for Medicare and Medicaid Services (CMS) Administrator Seema Verma said in a prepared statement. “Among racial/ethnic groups, Blacks had the highest hospitalization rate, with 465 per 100,000,” which is nearly four times the rate of white Americans (123/100,000).¹⁴   

Data also shows COVID-19’s impact on structural and institutional constructs of racism. Black residents of a community are three times as likely as their white neighbors to become infected by COVID-19 and are more than twice as likely to die from it.¹⁵ Black Americans are more likely to be employed in frontline, essential jobs—and are more likely burdened with chronic disease—because of the drivers of health. If infected, the mortality rate from COVID-19 is higher for Black people because of delays in or limited access to testing and treatment.¹⁶  

In testimony before the House Energy and Commerce Committee, Anthony Fauci, M.D., the nation’s top infection disease expert, noted that racism likely contributed to higher rates of COVID-19 infections among Black Americans. “Would I consider institutional racism as contributing? The African American community has suffered from racism for a very, very long period of time and I cannot imagine that that has not contributed to the conditions that they find themselves in economically and otherwise,” he told the committee.

Digital technology and social media can drive change

Throughout history, social activists have relied on the technology disruptors of their time to help others understand the injustice of their situation and experience. During the Salt March in 1930, Mohandas Gandhi led an act of civil disobedience to protest British rule in India. He took advantage of live radio and encouraged photographers and journalists to march with him and document their experiences. Dr. Martin Luther King, Jr. used television, the technology of his day, to expose the injustice of racism in the US to the public around the world. Both movements clearly understood the important role disruptive technologies could play in helping the public feel their struggle, their challenges, and their injustices.

Many of today’s activists rely on the highly coordinated use of social platforms, smartphone cameras, widespread bandwidth, and inexpensive computing. Anyone can share their experiences with the world, often in real time, with the press of a button. Smartphone-based cameras wielded by the public are allowing us to see what others have been experiencing for generations.

People around the world didn’t hear, didn’t see, but experienced George Floyd’s final eight minutes and 46 seconds of life. The video record of his death, which inspired millions to protest and raised our collective social consciousness, spread globally over social media.

Social media continues to expose racism in the US.¹⁷ This can, in turn, increase empathy by letting an individual walk in another person’s shoes for a moment. Social consciousness and awareness of racism can grow through digital technology. Because smartphones and other technologies have grown significantly, they can support exponential growth in empathy. Communities can take advantage of these technologies to generate greater empathy, virtual convening, virtual organizing, and virtual education to make meaningful changes. But these tools can also be misused to increase racism.  

Our commitment to building a culture of anti-racism

As advisors to some to the nation’s largest and most influential health care and life sciences companies, Deloitte adds our voice to the voices of public health officials, advocacy groups, and business leaders who are going to help end systemic racism and are calling out its devastating impact on Black people. We are joining the communities we serve and our professional societies in taking actions against racism and social injustice. We are inviting dialogue and input in developing an agenda that we can work on together. We firmly believe that action needs to be collective and aligned across the ecosystems in which we work and live. Working together, collectively aware of the extent of the problem, we intend to make gains against racism that we cannot make on our own.

Deloitte’s life sciences and health care industry framework for action

Our culture: Diversity, equity, and inclusion are incorporated into our strategies, policies, practices, and operations. We want a work environment that rejects racist behaviors. We try to ensure that our employees are aware of subconscious biases, and we promote the well-being of all of our practitioners. We have created conscious and subconscious tools and resources to help professionals engage in open conversations within safe spaces that foster empathy and awareness.

Our communities: We believe that we can make meaningful progress in addressing the two-fold public health crisis of COVID-19 and racism by working with our communities. Given our breath and scale, we are pooling our time, talent, and resources to promote social justice in the communities in which we live and work. We are providing financial and pro-bono support focused on health equity and access to care. We are collaborating with other organizations that have a proven track record of addressing systemic and institutionalized racism. By listening to the voices of our people and our communities, we are taking immediate steps toward long-lasting change.

Our offerings for clients: Disruptive technologies can usher in great industry transformation. While these tools can help move us closer to an era of equity, without careful consideration, they could also exacerbate disparities. We are transforming our thinking and are exploring ways to potentially change our products, services, and solutions to address racism, drivers of health, and the systemic barriers to health equity. We are also tapping into data analytics, artificial intelligence (AI), and machine learning to help uncover and address the institutional and structural constructs that perpetuate racism within the health care industry.

Health care and life sciences organizations can be transformed by both incumbent and new stakeholders as innovation and disruptive technology changes some of what we know about health.

Our goal: Combine the power of ecosystems with disruptive technologies

Ecosystems have advanced civil rights. Progress has come from the combined actions of advocates, voters, lawmakers, the courts, and many institutions and individuals. In the CMS statement referenced above, the agency notes that “given the complexity of these disparities, any solution requires a multi-sectoral approach that includes federal, state, and local governments, community based organizations, and private industry.” We believe these ecosystems—combined with disruptive technologies—will allow society to make non-linear gains in progress, whether it be in awareness of racism or in developing strategies to address it. Combining ecosystems with disruptive technologies will, we believe, result in real change. 

While we do not have all of the answers, we are skilled at bringing together disruptive technologies and ecosystems. Even as we are listening to our people, we also want to hear from our communities and clients. If we combine our efforts, use the power of disruptive technologies, are open to outside help from non-traditional life sciences and health care stakeholders, we can develop initiatives that have profound impacts. We would be honored to be a part of your dialogues and welcome your insights into ours.    

Together, we aim to grow wiser and stronger and work to address the public health crisis of racism.

Listen In!

Delve into the ways industry leaders can work to address issues of racism and to help improve health outcomes in Race, racism, and public health, an on-demand DBrief. 

Endnotes

1. Dismantle racism at every level: AAP president, The American Academy of Pediatrics, AAP News, June 1, 2020

2. COVID-19 hospitalization and death by race/ethnicity, CDC, August 18, 2020; Health equity considerations and racial and ethnic minority groups, CDC, July 24, 2020 

3. How slavery became the economic engine of the South, History.com, March 6, 2018

4. Marty Walsh declared racism a public health issue, here’s why, Boston magazine, June 15, 2020

5. Governor promises to provide free health care for all Black Kentuckians who need it, National Public Radio, June 9, 2020

6. AMA Board of Trustees pledges action against racism, June 7, 2020

7. Racism and health in the United States, the American College of Physicians, June 19, 2020

8. Jim Crow laws, History.com, June 23, 2020

9. Racism and discrimination in health care, Harvard Health Publishing, Harvard Medical School, January 16, 2017

10. Social determinants of health 101 for health care, National Academy of Medicine, October 9, 2017

11. Study links racism to chronic inflammation and disease risk among African Americans, USCDornsife, University of Southern California, May 30, 2019

12. Discrimination and hypertension risk among African Americans in the Jackson Heart Study, American Hospital Association, July 1, 2020

13. Racism as a determinant of health: A systematic review and meta-analysis, National Center for Biotechnology Information, September 23, 2015

14. Trump Administration issues call to action based on new data detailing COVID-19 impacts on Medicare beneficiaries, CMS, June 22, 2020

15. The fullest look yet at the racial inequity of coronavirus, New York Times, July 5, 2020

16. The coronavirus doesn't discriminate, but U.S. health care showing familiar biases, NPR, April 2, 2020

17. Social media pages exposing racist behavior becoming more popular, NBC News, 7 San Diego, June 18, 2020

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