Undoing the Racial Patterning of Health - 2022 Alexander D. Langmuir Lecture Mary T. Bassett, MD, MPH - New York State Department ...
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Undoing the Racial Patterning of Health 2022 Alexander D. Langmuir Lecture Mary T. Bassett, MD, MPH NYS Health Commissioner
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CDC COVID-19 County Levels
As of April 21 As of April 28
4 Source: Johns Hopkins University Center for Systems Science and Engineering
5 The centrality of race in the US
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10 US Census 1860
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Inclusive Public Health
1. Data
2. Narratives
3. Interventions12
13 Alexander Langmuir
14 Leona Baumgartner
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16 1956/Daily News, L.P. (New York)
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18 Jane Addams
19 W. E. B. Du Bois
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“Particularly with regard to consumption it must
be remembered that the Negroes are not the first
people who have been claimed as its peculiar W.E.B. DuBois
The Philadelphia Negro
victims; the Irish were once thought to be
doomed by that disease—but that was when the
Irishmen were unpopular.”24
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28 Illustration by W. E. B. Du Bois / Courtesy Library of Congress
29 Mondrian Kandinsky Klee
30 Private Collection/AF Fotografie/Alamy
31 Turning to COVID-19
32 Private Collection/AF Fotografie/Alamy
33 Cities and States with Predominate Black and Latino deaths • Milwaukee • Louisiana • Chicago • Illinois • Minneapolis • Massachusetts • New Orleans • Connecticut
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NYC Race Specific Data
Crude Death Rate Age-adjusted Death
Race/Ethnicity Per 100,000 Rate Per 100,000
Population Population
All Hispanic 21.3 22.8
NH-Black, African
American 23.1 19.8
NH-White 15.7 10.2
All data are preliminary and subject to change. Data are derived from the Bureau of Communicable Disease Surveillance System as of April 6, 2020.35 Cumulative incidence and diagnosis of COVID infection in NY
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“But there is nothing we can do Dr. Anthony Fauci,
about it right now… except give White House Coronavirus
them the best possible care.” Task Force
April 7, 202037
“We need you to understand —
especially in communities U.S. Surgeon General
of color, we need you to step up Jerome Adams
April 10, 2020
and help stop the spread so that
we can protect those who are most
vulnerable.”38
After adjusting for age, Blacks are 3.6 times more likely than
Whites to die of COVID-19
Racial/ethnic disparities in COVID-19 age-adjusted mortality
(Feb-May)
Black Latino AI/AN Asian/PI
Rate Ratios
3.6 2.6 1.2 1.7
(Compared to Whites)39
Among adults ages 35-44, Blacks are 9 times more likely
than Whites to die of COVID-19
Racial/ethnic disparities in COVID-19 mortality by age
(Feb-May)
Black Latino AI/AN Asian/PI
Ages 25-34 7.3 5.5 7.3 2.4
Ages 35-44 9.0 7.9 8.2 2.4
Ages 45-54 6.9 5.8 3.5 2.8
Ages 55-64 5.7 4.1 2.1 2.740 Unequal Exposure
41 Unequal Exposure
42 Unequal rates of health coverage
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May 5, 2022 44
Delta and Omicron:
Black New Yorkers saw rates of hospital admission twice as high as white New Yorkers45 Let’s talk about racism
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48 Inter nalized Inter personal Institutional
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LAW, POLICY, AND STRUCTURAL RACISM
STRUCTURAL RACISM involves interconnected institutions,
whose linkages are historically rooted and culturally reinforced
Structural racism refers to the totality of ways in which
societies foster racial discrimination, through mutually
reinforcing inequitable systems that in turn reinforce
discriminatory beliefs, values, and distribution of resources,
which together affect the risk of adverse health outcomesMay 5, 2022 50
“Redlining” as an
Example of
Structural Racism51
May 5, 2022 52
Hospitals that primarily serve Black and Hispanic communities have lower
capital assets, and offer fewer capital-intensive services, than other
hospitals.
These hospitals were also less likely to offer 19 of 27 specific capital-intensive services
Source: Himmelstein, G., & Himmelstein, K. E. W. (2020). Inequality Set in Concrete: Physical Resources Available for Care at Hospitals Serving People of Color and
Other U.S. Hospitals. International Journal of Health Services, 50(4), 363–370. https://doi.org/10.1177/0020731420937632May 5, 2022 53
NYC’s Sickest
Neighborhoods54 NYC health department takes on racism
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57 Source: New York City Department of Health and Mental Hygiene
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Making Waves
Source: New York City Department of Health and Mental Hygiene/Facebook59
Disparities in Zika Testing, NYC, Jan-Feb 2016
0
0 - 191 1 - 10
192 - 532 11 - 19
533 - 1,166 20 - 417
1,167 - 8,128
Number of Residents with Zika Virus Testing Rate per
Birthplace 10,000 Among 15–44 Year-
In Area with Active Zika Old Women Residents
Transmission, ACS 2010-1460
Undoing the Racial Patterning of Health
• Undoing social patterning is everyone's job
• Invest in education and training
• Start with data
• Change the narrative
• Target programming
• Support engagement with communities61
Undoing the Racial Patterning of Health
• The proposition: All humans (as a group)
are equal
• The question: What explains racial
patterning of risk factors and disease?
• Is it the people?
The Aspen Institute
If the problem in the people, interrogate it as a racist idea
• Is it the context?62 There is no single action that undoes racism
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64 Conclusion: What’s next?
65 Angela Davis Quote at Barclays Center. Norman Oder/Bklyner
66 Thank You
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Economic injustice and social deprivation
Environmental and occupational health inequities
Psychosocial trauma
Targeted marketing of health-harming substances
Structural racism is not a miasma
Inadequate healthcare State-sanctioned violence
Maladaptive coping behaviors
Political exclusion
Stereotype threatsYou can also read
