Systemic Discrimination and Health Disparities in U.S.

Recently many voices have joined the conversation about systemic discrimination in the US. One aspect is how minorities and disadvantaged groups in the U.S. have poorer access to healthcare and behavioral healthcare services and poorer health overall. A recent blog post pointed out the connection between systemic discrimination, chronic stress, and hypertension in Black Americans. It also noted that employers have more than a corporate citizenship responsibility. They have a real and growing business and financial stake in such matters. This is because in our American system – in these uncertain times – private employers largely bear the burden of the high and growing costs of providing decent healthcare insurance for employees. Not to mention the smaller and intentional investments they make in their Employee Assistance Programs (EAPs), health coaching programs, and other lifestyle management services aimed at prevention and early intervention.

It’s widely known now that COVID-19 pandemic in the U.S. has been disproportionally impacting Black and Hispanic communities. These groups have highly disproportionate rates of COVID-19 infections compared to their percentage of the population. While there may be multiple reasons for this, one is the underlying health disparities.

Here are a few more facts that speak to health disparities related to systemic discrimination. Most have been recognized by scholars and researchers for many years, yet they persist.

  • About 14% of Black Americans report having fair or poor health compared to 8% of Whites.
  • 42% of Black Americans over age 20 have hypertension compared to 29% of Whites.

Disparities extend to behavioral healthcare as well.

  • Only 9% of Blacks received mental health services in a recent year compared to 19% of Whites. Yet mental health conditions affect everyone and have no racial preferences.

Disparities are not limited to Black Americans by any means. Similar facts abound for other minorities that regularly encounter discrimination. Asian Americans, Native Americans, Native Hawaiian and Pacific Islander Americans, and Hispanic Americans all have many health status indicators that are worse than Whites in America. For instance, suicide is highly associated with feeling of extreme hopelessness and is the second leading cause of death in young people. In 2017 the number of suicide attempts by adolescent Hispanic females was 40% higher than that of Non-Hispanic White females. Why might that be? Many of these groups have higher rates of obesity, diabetes, smoking, alcohol consumption, coronary disease, hypertension, cervical cancer, and other conditions than to Whites in America. Most also have poorer access to decent health insurance than do Whites, creating an enormous barrier to care. Poor cultural sensitivity by healthcare providers often creates another barrier when patients get to the moment of service.

I hope more employers join this conversation about systemic discrimination, social injustice, and resulting health disparities – and do more than talk or publish statements on their websites. Employers are made up of people. People can be advocates, and advocacy begins with action. Employers can advocate with insurers for patient-centric systems of care that provide and give access to optimum care delivered by culturally competent providers. They can advocate and lobby in the public realm for laws and policies that acknowledge systemic discrimination in American life, work to eliminate it, and diminish health disparities. Finally, employers can examine how minorities in their own workforces are accessing and being served by their EAPs and their other prevention and early intervention programs.

 

About the Author

Norman Winegar, LCSW, CEAP, is the Chief Clinical Officer for Espyr. Norman has worked in the mental health field for over 30 years and is frequently called on for presentations and as a panelist to share his expertise and experience as a mental health clinician.

 

Sources

Health and Racial Disparities

Center for American Progress

https://www.americanprogress.org/issues/race/reports/2020/05/07/484742/health-disparities-race-ethnicity/

 

Overcoming Racial Disparities in U.S. Healthcare

HealthAffairs

https://www.healthaffairs.org/doi/full/10.1377/hlthaff.24.2.445

 

Health Equity Considerations and Racial and Ethnic Minority Groups

U.S. Centers for Disease Control and Prevention

https://www.cdc.gov/coronavirus/2019-ncov/community/health-equity/race-ethnicity.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fcoronavirus%2F2019-ncov%2Fneed-extra-precautions%2Fracial-ethnic-minorities.html

 

CDC data: COVID-19 hit Hispanics, Blacks and those with underlying conditions harder

CNN

https://www.cnn.com/2020/06/20/politics/cdc-covid-charts-black-hispanic-underlying-conditions/index.html

 

About Espyr

For over 30 years Espyr, has provided innovative mental health solutions to organizations operating under some of the most challenging conditions. Espyr’s portfolio of customized coaching solutions help employers reduce healthcare costs by identifying and addressing employee mental health issues before they require more expensive, long term care. For more information on how Espyr can help your organization, call Espyr at 888-570-3479 or click here.

Access open? ADA is 30 years old.

Last week, I called attention to how society’s systemic discrimination against people of color creates a level of chronic stress that has been shown to be a cause of hypertension in black Americans.  Hypertension kills 1,300 Americans of all races and ethnicities every day. This should be a concern to employers given they bear the bulk of the costs to ensure American workers, and directly bear the costs of lost workdays, recruitment, and replacement. This week it’s hard to not notice another aspect of discrimination that is also very relevant to employers.

Civil rights icon, Rep. John Lewis of Atlanta who died recently, is being remembered and honored in Alabama, Washington, and here in Georgia. Leading a large group of peaceful civil rights demonstrators, Lewis’ bloody beating on national television by Alabama state troopers on the Edmund Pettis Bridge in Selma, Alabama on March 7, 1965 shocked the nation. Known as “Bloody Sunday,” it led to the passage of the Voting Rights Act later that year. Though that law has since been weakened by a 2013 Supreme Court decision, it was an important first step in the effort to end systematic suppression of black voters in the US.

I’m mindful that Rep. Lewis once said, “When you see something that is not right, not fair, not just, you have to speak up. You have to say something. You have to do something.” Twenty-five years after the passage of the Voter Rights Act, America did something about discrimination against another group of citizens – those with physical, cognitive, and learning challenges. Thirty years ago, on July 26, 1990 President George H.W. Bush signed into law the Americans with Disabilities Act of 1990 (ADA). It prohibited discrimination against less abled people in areas of Employment, Education, Healthcare, Transportation, Recreation, and Housing. Historically American society had viewed such disabilities as individual and personal issues. That attitude was effectively a “shelter-in-place order.” One that excluded millions of adults and children from participation in society and from achieving their potential.  Today, about 1 in 4 Americans have some type of disabling condition and over 9 million children have special needs. According to the Centers for Disease Control and Prevention (CDC), people with disabilities continue to face health disparities. Adults with disabilities are three times more likely to have heart disease, stroke, diabetes, or cancer than are other Americans.

The ADA created inclusion for millions of adults and children. Then came 2020 and the Coronavirus Pandemic. When unemployment skyrocketed, those employed through the opportunities created by the ADA suffered the most according to Bureau of Labor Statistics. They were often the “last hired, first fired” and this seems to be the case in the current recession. This is very concerning to this community and their advocates. However, there is a silver lining to this cloud. Employers have seen how effective working from home can be. They are learning that remote work can in many cases make their businesses more successful and their workforce even more engaged. Ironically, many of the aspects of working from home were the very same accommodations advocated for decades by the community of Americans with physical, cognitive, or learning challenges. While many obstacles remain for disabled Americans, employers can help by being intentional and thoughtful about lessons learned from the Coronavirus Pandemic as they pertain to opportunities for all workers.

 

About the Author

Norman Winegar, LCSW, CEAP, is the Chief Clinical Officer for Espyr. Norman has worked in the mental health field for over 30 years and is the author of four books on behavioral health topics. He is frequently called on for presentations and as a panelist to share his expertise and experience as a mental health professional.

 

Sources

U.S. Department of Health and Human Services.  https://www.hhs.gov/ash/oah/adolescent-development/physical-health-and-nutrition/chronic-conditions-and-disabilities/trends.html#:~:text=The%20National%20Survey%20of%20Children,16%2D20%20have%20a%20disability.

U.S. Centers for Disease Control and Prevention

https://www.cdc.gov/media/releases/2020/p0724-30th-anniversary-disabilities-act.html

https://www.cdc.gov/media/releases/2018/p0816-disability.html

U.S. Bureau of Labor Statistics

https://www.bls.gov/home.htm

Atlanta Journal Constitution

https://www.ajc.com/news/nation-world/disabled-americans-mark-milestone-as-crisis-deepens-job-woes/RIO26WROQBCLDAQCFI65CP6MXQ/

 

About Espyr

For over 30 years Espyr, has provided innovative mental health solutions to organizations operating under some of the most challenging conditions. Espyr’s portfolio of customized coaching solutions help employers reduce healthcare costs by identifying and addressing employee mental health issues before they require more expensive, long term care. For more information on how Espyr can help your organization, call Espyr at 888-570-3479 or click here.

The Surprising Impact Of Discrimination On Health

Last week, we called attention to the issues facing minorities and mental health, an appropriate topic since July is Minority Mental Health Awareness Month. Espyr joined its voice to the conversation about how minorities and disadvantaged groups in the US have poor access to mental health services and called for dialogue about an end to such disparities. This week, we examine a related issue. While it’s been long known that poorly managed stress can lead to costly and deadly heart related ailments, we have not understood the possible impact of chronic stress brought about by systemic discrimination on people’s health.   And specifically,  we haven”t fully grasped the role of discrimination – related chronic stress in creating higher risks for hypertension.

Discrimination and Hypertension

Hypertension or high blood pressure directly kills 1,300 American every day or about half a million annually. It puts sufferers at risk for other common causes of death such as heart disease and stroke. Over 30 million Americans have hypertension. The condition is very treatable with diet, exercise, and medication, especially when detected early. But despite medical advances, only about 1 in 4 with hypertension have their condition under control according to the US Centers for Disease Control and Prevention. Some of the highest rates of dangerous hypertension are in Southern states like Mississippi, Alabama, South Carolina, and Louisiana. These states all have large numbers of Black citizens. African Americans overall are known to have a higher risk of hypertension than do other racial or ethnic minorities. Is discrimination one reason for this racial disparity?

Hypertension and Black Americans

A recent study published in the journal Hypertension looked at this question and examined the relationship between discrimination and the incidence of hypertension. The researchers looked at whether everyday discrimination, lifetime or cumulative discrimination and the resultant stress associated with this were associated with hypertension. Their study involved 1,845 Black Americans aged 21 to 85. After adjusting for risk factors, socioeconomic status, gender and age, the researchers found that stress from discrimination, especially over a lifetime is associated with higher risks for hypertension.

The results of this study are not surprising. Researchers have been finding other disturbing patterns of racial disparities in health outcomes for many years. For instance, despite the marvels of 21st Century healthcare Native American and Black women in the US are three to four times more likely to die a pregnancy- related death than White women. Many factors may contribute to such disparities: poor healthcare insurance coverage, poor access to our unevenly distributed healthcare system in the US and other reasons. Could one reason be that the lack of cultural competency on the part of healthcare providers affects diagnostic interviews and inhibits early screening and treatment?

Looking To The Future

Healthcare costs are a concern for all of us- consumers, practitioners, businesses public policy makers and taxpayers. Will the Black Lives Matters movement help bring greater public and institutional attention to the role of disparity in health outcomes and create positive change – change that can improve people’s wellbeing and better manage healthcare resources?  We hope so.

About the Author

Norman Winegar, LCSW, CEAP, is the Chief Clinical Officer for Espyr. Norman has worked in the mental health field for over 30 years and is the author of four books on behavioral health topics. He is frequently called on for presentations and as a panelist to share his expertise and experience as a mental health professional.

Sources

Forde AT, Sims M, Muntner P, et al. Discrimination and Hypertension Risk Among African Americans in the Jackson Heart Study. Hypertension. 2020. doi:10.1161/HYPERTENSIONAHA.119.14492 https://www.ahajournals.org/doi/10.1161/HYPERTENSIONAHA.119.14492

US Centers for Disease Control and Prevention. Facts about Hypertension

https://www.cdc.gov/bloodpressure/facts.htm

Racial and Ethnic Disparities in Mental Health Care: Evidence and Policy Implications

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3928067/#R38

Petersen EE, Davis NL, Goodman D, et al. Racial/Ethnic Disparities in Pregnancy-Related Deaths — United States, 2007–2016. MMWR Morb Mortal Wkly Rep. 2019;68:762-765. doi:10.15585/mmwr.mm6835a3

Testing for Statistical Discrimination in Health Care

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1361135/

About Espyr

For over 30 years Espyr, has provided innovative mental health solutions to organizations operating  under some of the most challenging conditions. Espyr’s portfolio of customized coaching solutions help employers reduce healthcare costs by identifying and addressing employee mental health issues before they require more expensive, long term care. For more information on how Espyr can help your organization, call Espyr at 888-570-3479 or click here.

Awareness Of Disparities In Minority Mental Health

July is Minority Mental Health Awareness Month. Why is this important? Because people of all races, ethnicities, sexual orientations, ages and religions experience mental health concerns. Some are transitory while others are chronic.   Some affect our quality of life, happiness, and wellbeing. Others can exacerbate existing medical conditions increasing suffering and costs to employers, taxpayers, and patients. Severe conditions can be disabling and even result in premature death and suicide.

Across the country, especially during periods of exceptional stress and anxiety as we are going through now, Americans are becoming increasingly aware of the importance of good mental health.  However, awareness of disparities in mental health issues among minority populations is not as well recognized.

Espyr is joining the conversation with many other voices across the country during Minority Mental Health Awareness Month. We are calling attention to the issues disadvantaged minority groups in America regularly experience in accessing mental health services and we are joining our voice with those advocating for the end to such disparities.

Minority Mental Health Issues 

The Agency for Healthcare Research and Quality is a branch of the US Department of Health and Human Services. It reports that marginalized communities in the United States are less likely to have access to mental health services, less likely to use community mental health services, more likely to receive poorer mental health care and more likely to use expensive Emergency Department services for treatment. These facts, which are supported by a wealth of research, lead to a disproportionate number of minority group members having poorer mental health. Poorer mental health is also associated with poorer medical treatment outcomes, given mental health conditions such as depressive or anxiety disorders interfere with or complicate medical interventions. Let’s take a moment to look at this issue on both a personal or micro level and on a societal or macro level.

Micro Level Issues

On a micro level, one way that minorities can experience barriers is through their interactions and communications with clinicians. Treatment professionals interview and assess clients or patients. Based on their assessment, clinicians make a diagnosis and develop a treatment plan to address the diagnostic condition that suits that unique client. Studies have shown that many clinicians have a greater challenge of discerning noise from signals in interactions with minority group clients because of miscommunication and lack of cultural awareness on the part of the clinician. This dynamic can result in misdiagnosis, inadequate treatment plans, less engagement with the client, and ultimately poorer care for the consumer.

Related to this minority mental health issue, Espyr is providing a continuing professional development workshop for its staff and its network clinicians on Aug 28 about racial and cultural diversity and culturally informed interventions in counseling. Our workshop will help providers of care consider the implications of race, culture, systemic racism, privilege and oppression in their work with clients and patients. Other leaders in the medical and behavioral health fields will hopefully take similar steps to educate practitioners.

Macro Level Issues

On a macro level, minority groups are often among 38 million Americans living in poverty according to the pre-Covid pandemic, pre-recession data from the U.S. Census Bureau in 2018. Living in poverty is associated with a host of negative consequences for children, adults and families including poorer access to healthcare and to mental health services. The Trump administration’s proposal to severely cut or “de-fund” Medicaid over the next decade (Medicaid provides healthcare for poor children and adults) also threatens to make a bad public health situation much worse.

Thanks for learning about this issue and please join in the conversation. Take the time to learn more about minority mental health and public policy issues and what you can do to contribute to awareness and positive change. If you haven’t given this issue much attention, then the resources below are a good starting point for further thought and dialogue.

Resources

Minority Mental Health Awareness Month, Office of Minority Health, US Department of Health and Human Services

https://www.minorityhealth.hhs.gov/omh/content.aspx?ID=9447

NAMI’s Statement on Recent Racist Incidents… National Alliance for Mental Illness

https://nami.org/About-NAMI/NAMI-News/2020/NAMI-s-Statement-On-Recent-Racist-Incidents-and-Mental-Health-Resources-for-African-Americans?gclid=EAIaIQobChMI-87yn9e46gIV7wiICR3BNgxQEAAYASAAEgINB_D_BwE

AFSP’s Statement on Minority Mental Health…American Foundation for Suicide Prevention (A service partner of Espyr)

https://afsp.org/minoritymentalhealth

About Espyr

Espyr’s innovative mental health solutions, coaching and assistance programs have been helping employees and organizations achieve their full potential for over 30 years. For more information on how Espyr can help your organization, call Espyr at 888-570-3479 or click here.