SDOH Roundup: Racism as a Driver of Health

By Kate Raphael

We’ve talked about racism as a driver of health in previous posts; indeed, the toll of racism on BIPOC (Black, Indigenous, People of Color) bodies has gained increasing national attention in recent weeks, especially in light of the coronavirus, which exacts disproportionate economic and health tolls on racial minorities and immigrants, and police killings of Black people. Here are some recent  publications that caught our eye and highlight the connections between racism and other social determinants and health.

Racism In My Medical Education

Michelle Ko, Health Affairs, June 2020

Moving between Drew and UCLA taught me that there is no way that our health care systems will care about black, brown, or other marginalized minority lives until we change who enters the profession and ascends to its leadership. Lack of racial and ethnic diversity throughout all institutions is why the Black Lives Matter movement in 2013 was so necessary; why, until the past few years, almost no one discussed the glaring tragedy of black maternal mortality; and why, most recently, our policies and systems have collectively and catastrophically traumatized black communities communities during the COVID-19 epidemic. Even though California expanded eligibility for Medicaid under the Affordable Care Act in 2014, and the Martin Luther King, Jr. Community Hospital opened near the site of the former King/Drew Medical Center in 2015, no one expects these changes to produce an influx of majority physicians into south Los Angeles. The persistent segregation of communities by race, combined with our lack of diversity in medicine, will continue to result in chronically underserved minority populations.

Trends in Racial/Ethnic Representation Among US Medical Students

Lett et al, JAMA Network Open, September 2019

RESULTS: The number of medical school applicants increased 53%, from 33 625 to 51 658, and the number of matriculants increased 29.3%, from 16 488 to 21 326, between 2002 and 2017. During that time, proportions of black, Hispanic, Asian, and Native Hawaiian or Other Pacific Islander male and female individuals aged 20 to 34 years in the United States increased, while proportions of white male and female individuals decreased and proportions of AIAN male and female individuals were stable. From 2002 to 2017, black, Hispanic, and AIAN applicants and matriculants of both sexes were underrepresented, with a significant trend toward decreased representation for black female applicants from 2002 to 2012 (representation quotient slope, −0.011; 95% CI, −0.015 to −0.007; P < .001).
CONCLUSIONS AND RELEVANCE: Black, Hispanic, and AIAN students remain underrepresented among medical school matriculants compared with the US population. This underrepresentation has not changed significantly since the institution of the Liaison Committee of Medical Education diversity accreditation guidelines in 2009. This study’s findings suggest a need for both the development and the evaluation of more robust policies and programs to create a physician workforce that is demographically representative of the US population.

The Effects of Gentrification on the Well-Being and Opportunity of Original Resident Adults and Children

Quentin Brummet and David Reed, Federal Reserve Bank of Philadelphia, July 2019

Overall, we find that gentrification creates some important benefits for original resident adults and children and few observable harms. It reduces the average original resident adult’s exposure to neighborhood poverty by 3 percentage points, with larger (7 percentage points) reductions for those endogenously choosing to stay and no changes for those endogenously choosing to move. Gentrification also increases the average original resident homeowner’s house value, an important component of household wealth, with effects again stronger for stayers. Importantly, less-educated renters and less-educated homeowners each make up close to 25 percent of the population in gentrifiable neighborhoods, and 30 percent and 60 percent, respectively, stay even in gentrifying neighborhoods. Thus, the benefits experienced by these groups are quantitatively large.

Social determinants of health and survival in humans and other animals

Snyder-Mackler et al., Science Magazine, May 2020

The available evidence indicates that social impacts on life span are a shared phenomenon across humans and other social mammals and that the health-related outcomes of social adversity in nonhuman animals parallel socially patterned pathologies in humans. To some degree, the mechanisms that underlie these observations are also similar across species.

These findings suggest a shared biology underlying the influence of social gradients and a coherent evolutionary logic for when these gradients tend to be shallower versus steeper—arguments that have been made in various forms over the years.

A shared biology in turn suggests that integrating human and nonhuman animal studies can help address longstanding questions about the social determinants of health. Research at this interface should open several new opportunities.