PUB 540 Consider the following statement: “Race is not a risk factor and should not be used in public health data collection.”

PUB 540 Consider the following statement: “Race is not a risk factor and should not be used in public health data collection.”

PUB 540 Consider the following statement: “Race is not a risk factor and should not be used in public health data collection.”

In research that I have done regarding maternal mortality and specifically the incidence hypertensive disorders in pregnancy, mainly preeclampsia, being African American was described as a risk factor. Due to social economic disparities, culture, and other factors such a history of hypertension lead to African Americans having a higher risk factor.  Study after study suggests this, but certainly not as a descriptor. 

But that is not to say that racism does not exist in healthcare. As discussed by Williams et al. (2019) that structural racism determines differential access to health and resources that drive disparities in care. Studies have shown that segregation does not equate in better health. communities separated by race still tend to fare worse when it comes to diseases such as heart disease. Policies have been made based on difference, where separate is not equal. Racial discrimination or perceived discrimination affects the outcome of health due to trust issues or perceived notions regarding the individual being treated. 

Williams & Cooper (2019) suggest that we use what we know to decrease health care institutional racism by creating communities of opportunity. But to do this, societal systems that create inequities such as education, housing, work, and other areas that address early education, childhood poverty, enhanced economic opportunities, and better housing. There are many strategies but building political will to address these things has to be addressed for the public to have better health outcomes. It is the Christian thing to do. We must find a way to increase public empathy, not just for moments but sustainably overtime. 

References

 Williams, D., R., Lawrence, J., A., Davis, B., A. (2019). Racism and health:  Evidence and needed research.  Annual Review of Public Health ,40(1), 105-125. https://doi.org/10.1146/annurev-publhealth-040218-043750 

Williams, D. R., & Cooper, L. A. (2019). Reducing Racial Inequities in Health: Using what we already know to take action. International journal of environmental research and public health, 16(4), 606. https://doi.org/10.3390/ijerph16040606 

Race is a strong hold of our society in which we live. Race and genetic make-up often determine how we view situations, and it creates a point for a sense of bias to become present (Silverman-Lloyd and Bishop, 2021). Racism exists in our society in various forms such as beliefs (spiritual rituals), discrimination (belief that all are not created equal) and prejudice (exemplified by those who cannot be racist). Studies have shown that race plays a vital component in economic development, and access to care.  Removing race as a risk factor in public health data collection would be detrimental to the communities that certain health conditions are more prevalent. This will create a greater gap of between disparities (William and Rucker, 2000). Not considering race as a risk factor would be unethical and immoral to the communities, and the people in which we.  Removing race as a risk factor would infringe on the seven principles of public health ethics:  maleficence, beneficence, health maximization efficiency, respect for autonomy justice and proportionality.  

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Within the social structure of the society in which we live it has been proven through scientific studies that minorities, and economically disadvantage are not offered the same level or quality of healthcare. Structural and institutional racism determines how we live, what resources, and directly impacts the health of the nation. 

The Belmont Report elaborates on the ethical principles. It speaks on the key terms “Do no harm” which correlates with the seven principles of public health.  Policies related to healthcare initiatives advocate for human rights and non-racial distributions of resources. 

References:

Office for Human Research Protections (OHRP). “The Belmont Report.” HHS.gov. June 16, 2021. Accessed June 14, 2022. https://www.hhs.gov/ohrp/regulations-and-policy/belmont-report/index.html.

Silverman-Lloyd, L. G., Bishop, N. S., & Cerdeña, J. P. (2021). Race is not a risk factor: Reframing discourse on racial health inequities in CVD prevention. American journal of preventive cardiology, 6, 100185. https://doi.org/10.1016/j.ajpc.2021.100185

Williams, D. R., & Rucker, T. D. (2000). Understanding and addressing racial disparities in health care. Health care financing review, 21(4), 75–90.

Unfortunately, race was one of the concepts created when United States were founded. I appreciate the opportunities and my ancestors before me that made a drastic difference in public health such as John Snow and Edward Jenner. Race itself is not a risk factor but due to institutional racism, it created a large gap of health disparities of people. For example, African-American schools get less funding than other schools. Certain areas that are mainly populated by blacks are considered low in property value. When the Tuskegee experiment happened in Alabama back in the 1932 to 1972, the goal was to study how syphilis reacted in the poor African-American male population. The government agency that funded the study wanted to compared the results to that of the Caucasian population. Hardeman et al. (2018) research study mentions that institutionalized racism play an important role of the various barriers of health equity. There is a lack of how institutionalized racism play a huge role in health outcomes of minority races. Truthfully, there will not be any policies that will dismantled racism because racism will never go away. Our society will gauge one another using race and socioeconomic status and class.

According to the Belmont report, there are three basic ethical principles: respect for persons, beneficence, and justice. Our American society has failed to uphold these three ethical principles due to the Tuskegee experiment. Overall institutionalized racism does not care about ethical principles.

References:

Hardeman, R. R., Murphy, K. A., Karbeah, J., & Kozhimannil, K. B. (2018). Naming Institutionalized Racism in the Public Health Literature: A Systematic Literature Review. Public health reports (Washington, D.C. : 1974), 133(3), 240–249. https://doi.org/10.1177/0033354918760574

Eliminating race from the parameters of public health will be in breach of the ethical morals and duties that are to be upheld by officials and providers.  I agree that predominately black schools such as HBCU have received lesser funding for higher learning then predominately white institutions. In the State of Alabama, which is known as the birthplace of the Civil Rights Movement and the home of my Alma Mater.  In the court case Knight vs. Alabama was a federal court case that lasted approximately 30 years.  This case challenged the policies and procedures of the states’ colleges and universities, including funding on the grounds that they were racially discriminatory.  Moreover, the Tuskegee experiment was unethical and unjust. Today, the African American race is skeptical about trusting the opinions of medical providers.  The Tuskegee experiment infringed on the basic rates of Americans and dismantled the trust within the systems of government. 

Refences: 

Alsan, M., & Wanamaker, M. (2018). TUSKEGEE AND THE HEALTH OF BLACK MEN. The quarterly journal of economics, 133(1), 407–455. https://doi.org/10.1093/qje/qjx029

The most important predictor of health is socioeconomic status (SES), a concept that includes inequalities of resources, whether that is income, education, housing or health. Groups with the lowest SES have the highest mortality rates from both preventable and other causes and morbidity. The reasons for the relationship between social class and health includes things such as health risks in low paid, unsafe jobs and stress caused by having low status and lack of power, as well as changes in behaviors and risk factors that affect health outcomes, such as smoking, lack of physical activity, and poor dietary habits (Schneider, 2006; Schneiderman et al., 2001). People with higher SES are healthier and it seems to be related to the fact people with more education behave in healthier ways. Socioeconomic status can improve or decrease people’s life chances and has an impact on the whole of society (Becker & Newsom, 2003; Schneider, 2006).

Variations in access to medical care is an added factor that has been blamed for some of the socioeconomic differences in health. In today’s society, health is an important issue; good health practices improve ones quality of life, but on the other hand poor health practices decreases ones life expectancy. In every country access to healthcare is one of the primary indicators of health (Schneider, 2006). Low- socioeconomic groups tend to have low- income jobs that rarely provide full health insurance or are uninsured and many must depend on assistance to afford medications and it also limit opportunities to seek medical attention. High-income persons on the other hand, are able to afford medications or have good employer health insurance. SES is among the most significant factor because it dictates the sector of the health care system in which people receive care (Becker & Newsom, 2003).

References

Becker, G., Newsom, E. (2003). Socioeconomic Status and Dissatisfaction with Health Care among Chronically Ill African Americans. American Journal of Public Health, (93)5, 742-748

Schneider, J.M. (2006). Introduction to Public Health (2nd Edition). Sudbury, Massachusetts: Jones and Bartlett

Schneiderman, N., Speers, M. A., Silva, J. M., Tomes, H., & Gentry, J. H. (Eds.). (2001). Integrating behavioral and social sciences with public health. Washington, DC: American Psychological Association

Racial and ethnic disparities in health have been largely documented and the causes are both numerous and diverse. Unfortunately, disparities in health care have been shown to play a substantial role. According to Jones (2010). The moral problem of health disparities exists along lines of race/ethnicity and socioeconomic class in US society” He argued that we should work to phase out these health disparities because their continuation is a morally wrong and should be addressed. Jones suggested “Making progress toward the goal of eliminating disparities will require widespread, reliable, and consistent data about the racial and ethnic characteristics of the U.S. population. This information is needed to identify the nature and extent of disparities, to target quality improvement efforts, and to monitor progress. Tracking the racial and ethnic composition and changing health care needs of different populations is vital if our health care system, which includes both public health and the delivery of personal health care services, is to fulfill its essential functions. Measurement, reporting, and benchmarking are critical to improving care.” Perhaps, some structural and institutional factors such as poverty and lifestyle behaviors, social environments and limited access to clinical preventative screenings and services have contributed to racial health disparities. Nevertheless, increasing awareness of racial and ethnic disparities in health care within the community (National Research Council, 2004).

References

National Research Council (2004). Panel on DHHS Collection of Race and Ethnic Data; Ver Ploeg M, Perrin E, editors. Eliminating Health Disparities: Measurement and Data Needs.The Role of Racial and Ethnic Data Collection in Eliminating Disparities in Health Care. Retrieved from: https://www.ncbi.nlm.nih.gov/books/NBK215740/

Jones, C (2010). The moral problem of health disparities. Am J Public Health. Retrieved from: S47-S51. doi:10.2105/AJPH.2009.171181