Editor’s Note: This National Health Law Program blog series authored by Executive Director Elizabeth G. Taylor delves into the achievements and challenges the organization continues to face in its 50-year fight to make health care a reality for low-income people and underserved communities. The second post in this 3-part series centers on how a legacy of racism and increasing income inequality exacerbate the challenges faced by health care reformers. Part three will be published tomorrow. Read Part one here.
Our legacy of racism
We continue to suffer from the consequences of our history of slavery, racism, and discrimination. In 1966, the head of the Medical Committee for Human Rights (MCHR) said, “There is scarcely a hospital North or South that does not overtly or covertly discriminate against Negroes.” Addressing the MCHR’s annual meeting, Dr. Martin Luther King declared, “Of all the forms of inequality, injustice in health is the most shocking and the most inhuman because it often results in physical death.” It was not just discrimination against patients but also discrimination against doctors and other health care professionals of color seeking admission to medical societies and the privileges to practice. This discrimination robbed communities of color of generations of culturally competent physicians and nurses, and left us poorer as a nation, never knowing what breakthroughs and cures might have been discovered by generations of bright, young people denied access to the field of medicine.
Since 1969, the National Health Law Program has fought against discrimination in the provision of health care services, both overt and implicit. An early executive director of the National Health Law Program was passionate about fighting discrimination in access to health care from experiences representing people of color who were refused admission to southern hospitals, one of whom died from his gunshot wound. We sued to enforce the Hill Burton Act, which requires that hospitals receiving certain federal funds must provide free or below cost services to low-income people, regardless of race.
We have also pushed for the tools and data needed to understand health disparities and better address them. For years, federal agencies only collected data on “white,” “black,” or “other.” We’ve fought to guarantee that federal agencies collect data that represent the reality of race in the U.S. We continue these fights today as without having accurate and comprehensive data, we can’t identify and address disparities. We also fight to ensure that medical forms, other important health care documents, and oral communications can be accessed by anyone, regardless of English proficiency.
We work on behalf of people with disabilities, to battle discrimination and ensure that they have the support they need to live in the most integrated setting possible.
We fight against laws and practices that coerce low-income women, most often immigrants and other women of color, into agreeing to sterilization immediately after delivery of a baby as a “public health” measure.
Many of us fervently hoped that as a nation we had at least moved beyond overt discrimination on the basis of race, but the past few years are opening our eyes to that delusion. Take for example the administration’s recently proposed “public charge” regulation, which would severely punish lawfully present immigrants who use the health care they are legally entitled to under Medicaid and CHIP. The proposed changes do not further public health or well-being; the goal is to intimidate minority and immigrant communities. (The National Health Law Program and our partners are fighting back on this too). Additionally, new and proposed regulations allow, and even encourage, discrimination against LGBTQ individuals and women in health care settings. The health and well-being of these groups have been historically sacrificed for political gain, and the deadly impacts are felt most keenly by women of color and queer people of color.
Racism also takes its toll in less obvious but no less certain ways. People of color have poorer health outcomes than white people in our country. Some of that stems from the economic vestiges of racism – people of color on the whole make less money, are more likely to be imprisoned, and live in segregated neighborhoods where, for many years they were unable to build equity in homes they owned or benefit from tax breaks related to home ownership – but racial disparities in health cross economic lines. Even high-income people of color with access to great health care, have poorer health outcomes. There is no medical reason why people of different racial backgrounds should have different health outcomes, but for years the medical community blamed race for health disparities. We are at last naming a significant culprit – racism, not race is the cause of poor health outcomes. Mounting evidence reveals that people of color in our country live with the constant stress of racism and that stress causes a plethora of negative health outcomes.
Finally, the stark and vast income inequality we created, and perpetuate through economic policy decisions, like the 2017 tax cuts for wealthy corporations, is also making us sick. We all know now that the health individuals can expect to enjoy is directly impacted by where they live, how much money they make, where they work, and where they go to school, in addition to whether they have access to good health care services. People in poverty have greater health challenges than people with high incomes.
Children born into low-income families start off with a weight that drags them down when they start school: their brain development is impacted by the multiple traumas associated with growing up in low-income families and dangerous neighborhoods. In addition, parents who are battling depression, substance abuse, economic pressures, trying to keep their children safe in dangerous communities, have fewer resources left to provide stimulation to their young children.
The likelihood that someone born into a low-income family will break out of the cycle of poverty is akin to that family winning the lottery. We know that and we do very little about it. Instead, we do the same thing – continue economic policy that favors the rich and expects the poor to dig themselves out – and we don’t really expect a different outcome.