Vernellia Randall, Inequality Is Killing Us! What President Obama Must Do to Save Black Lives, 18-DEC NBA National Bar Association Magazine 20 - 21 (August-December, 2011) (27 Footnotes Omitted)

Inequality is killing us! Blacks are sicker than white Americans; they are dying at a significantly higher percentage. These are undeniable facts. Black men live on average 6 years less than white men. Black men have shorter life spans than men in Chile, Barbados, Bahamas or Jamaica. Black women live on average years 4 less than white women.

Social determinants of health are the key factors in the health status disparity between blacks and whites. Social determinants of health are the social, economic and political forces under which people live that affect their health. Social determinants include wealth/income, education, physical environment, health care, housing, employment, stress and racism/discrimination. In fact, for blacks racism is a key factor. Even when economics is controlled, blacks have poorer health. That is, middle-class blacks have poorer health than middle-class whites. In fact, middle-class whites live 10 years longer than middle-class blacks. The stress of living in a racialized discriminatory society accounts for these racial health disparities.. Black women have shorter life spans than women in Barbados, Panama, Bosnia and the Bahamas. Infant mortality rates are 2 times higher for blacks than for whites. Pat Buchanan has voiced the view that African Americans should be grateful for living in the United States. Yet, Black Americans have more low birth weight infants than women in Rwanda, Ghana, and Uganda.

Racial inequality in health persists in the United States because racial discrimination persists despite laws against racial discrimination, in significant part because of the inadequacy of anti-discrimination law. In short, civil rights law only prohibits intentional discrimination and does not address reckless or negligent discrimination. Reckless discrimination occurs when a person knows that there is a high risk of discrimination and the individual proceeds with the behavior. Negligent discrimination occurs when the individual knew or should have known that their behavior would result in discrimination and fails to take appropriate action to prevent or reduce discrimination. Most discrimination of the 21st century is reckless or negligent discrimination rather than intentional. Eliminating racial discrimination is necessary to close the health gap in America.

For blacks, health inequalities are the cumulative result of both past and present discrimination throughout U.S. culture. Because of institutional and cultural discrimination, blacks have less education and fewer educational opportunities. Blacks are disproportionately homeless and have poorer housing options. Due to discrimination and poor educational opportunities, blacks disproportionately work in low pay, high health risk occupations (e.g., migrant farm workers, fast food workers, garment industry workers). Historic and present racism in land and planning policy also plays a key role in minority health status. Even when income is controlled, blacks are much more likely to contain toxic materials (and other unhealthy uses) sited in their communities than whites. For example, over-concentration of alcohol and tobacco outlets and the legal and illegal dumping of pollutants pose serious health risks to minorities. Another significant factor affecting many blacks is the lack of grocery stores with fresh foods but the ready availability of fast foods with high salt and fat content. Exposure to these risks is not a matter of individual control or even individual choice. Health status disparities are a direct result of policies, practices, and procedures (institutional discrimination) that protect white privilege at the expense of black health.

Compounding the racial discrimination experienced generally is the institutional discrimination in health care that affects access to health care and the quality of health care received. Racial discrimination in health care delivery, financing, and research continue to exist, and racial barriers to quality health care manifest themselves in many ways including:

• economic discrimination; rationing health care on the ability to pay;

• insufficient hospitals and health care institutions and clinics in the community;

• insufficient physicians and other providers in the community;

• racial discrimination in treatment and services; and

• culturally incompetent care.

The primary focus of the health care reform law is the assurance of economic access through the expansion of insurance. The recently passed health care insurance reform is not universal health insurance because it does not require everyone to have health care insurance. Nor does it assure health care because importantly, economic access to health care (that is the ability to pay) does not address issues of lack of physical access, such as the unavailability of providers and institution. Nor does it address the poor quality of care, such as the lack of culturally competent care or discrimination in care or services.

President Obama has placed health care and economic recovery at the top of his agenda. The federal government has spent billions of dollars to help America regain economic footing and to reform the health care system. Yet, there is little evidence that the money is being spent in a manner that will close the health and economic inequality between whites and black. Health care reform and economic recovery for communities of color are something that cannot be achieved unless it is specifically addressed. Given the institutional discrimination that currently exists in housing, financing, jobs, health, and economic development, unless it (institutional discrimination) is explicitly addressed it can be expected that communities of color will not reap the same benefit from his recovery plan. Thus, unless the federal government specifically addresses the economic and health care gap between communities of color and white communities and the institutional discrimination, communities of color will not benefit from his economic recovery plan as much as white communities.

Inequality will most certainly continue. The Obama administration must be encouraged to assure that racial disparities do not exist in the implementation of his jobs plan, economic recovery plan and the health care reform law by:

• enacting an Anti-Discrimination Act for the 21st century, which among other things recognizes reckless and negligent discrimination;

• directing the economic transition team and then his entire executive branch to engage actively in eliminating racial disparities in their area of responsibility by conducting racial impact assessments on all new policies, practices, procedures and programs;

• requiring the state, organizations and others who receive economic recovery monies and jobs monies to assure that those monies are proportionally available to blacks and people of color in contracting, in jobs and in closing the racial economic gap, and in revitalizing their neighborhoods;

• providing economic relief for individuals and families who lost housing due to subprime lending practices for at least the previous 10 years, including liberalizing the bankruptcy laws, developing a lending program for individuals who were foreclosed because of subprime lending practices with particular attention on black communities; and,

• assuring availability of health care providers and institutions in black communities.

100,000 African American deaths a year occur that would not occur if African Americans had the same death rate of White Americans. The efforts of the Obama administration to improve access to health care and the economic environment is not enough if those efforts don't include measures to assure the removal of racial inequalities. It is possible, to improve the health for everyone, while still allowing the racial gap to continue to exist. That outcome would be unacceptable.

Vernellia Randall, Professor at the School of Law at University of Dayton since 1 990.