The Connecticut Health Divide: How Racism Contributes

Easton will hold its annual town meeting on Monday, April 26. As usual, the meeting will afford residents an opportunity to be heard on topics of keen local interest, foremost being the town’s proposed budget. But this year’s agenda will also tackle issues of broader concern that have roiled our nation, state, region and local communities, including Easton. Among them is the issue of racism and the link between racism and health.

The cumulative evidence on Connecticut’s racial and ethnic health divide is extensive and ever growing in the unfolding narrative of the COVID pandemic. A plethora of studies and reports have documented how Blacks and Latinos, and other minority groups have historically experienced higher rates of infectious and chronic disease, injury, premature death and disability, and acts of violence.

A recent Connecticut Health Foundation publication, https://www.cthealth.org, provides ready examples of the stark differences in health status among Connecticut residents by race and ethnicity:

  • The infant mortality rate for babies born to Black women in Connecticut exceeds the national rate. Babies born to Black women in Connecticut are nearly twice as likely to be underweight and over four times as likely to die before their first birthday.
  • Asthma, a chronic and controllable condition, is the leading cause of preventable hospitalizations for children of color in Connecticut. Black youth are 5.5 times more likely to wind up in an emergency department (ED) due to asthma and 4.5 times more likely to be hospitalized for asthma than white counterparts. Hispanic youth are 3.5 times more likely to require ED visits related to their asthma and 4.5 times more likely to be hospitalized due to asthma than Connecticut’s white youth.
  • Diabetes, another chronic and controllable condition, has had a devastating impact on Blacks and Hispanics in Connecticut. Blacks and Hispanics are more than twice as likely as whites to have diabetes and even more so to suffer severe complications including amputations.
  • The death rate for cancer in Black men is significantly higher than other groups in Connecticut, most notably for prostate cancer.
  • Residents of color in Connecticut have a lower life expectancy with Black residents dying at a faster rate than whites.

Disproportionately Bad Health Outcomes

And the list goes on if you endeavor to do the research. There is really no disputing that gross health disparities exist and continue to cause disproportionately bad health outcomes for people of color. But acknowledging these disparities falls short. We need to understand the causes and specifically, how racism contributes to disparate health outcomes for Black and Latino and other people of color in our state and local communities.

For it is more than socioeconomic factors that determine health. While higher income and education do correlate with better health outcomes generally, these factors fail to fully explain the profound disparities in health experience by race and ethnicity. Other factors related to discrimination have been identified through research and provide more insight. Prominent among these is the research documenting implicit bias in medical care that can result in differential treatment.

As one example, a study of racial disparities in cardiovascular care revealed that Black patients with heart problems received less beneficial interventions than white patients to a significant degree. The other major factor contributing to health disparities, supported by scientific research, is the toll of discrimination on the physical and mental health of those who routinely experience “everyday discrimination” and overt and subtle forms of racism. The stress of experiencing continuous discrimination has been associated with an array of adverse health outcomes including depression, anxiety, hypertension, breast cancer and premature birth or low birthweight babies.

Dr. David Williams is a research scientist and one of the most acclaimed scholars on the issue of racism and health. In a talk titled “How Racism Makes Us Sick” https://youtu.be/VzyjDR_AWzE he explains the concepts of stress and allostatic load. (Allostatic load is “the wear and tear on the body” which accumulates as an individual is exposed to repeated or chronic stress.). Williams also synthesizes the research on discriminatory practices in the health care system that can lead to unequal treatment for people of color.

Although race and ethnic health disparities have been a prominent concern of public health for decades, COVID has brought the issue to an unprecedented level of consciousness in our nation and state. The disproportionate impact of the pandemic on people of color in Connecticut, and particularly Black and Latino residents, underscores the entrenched nature of health inequities and reflects the reality that many people of color live in crowded housing, have low incomes, work in jobs that increase their exposure to COVID, and have pre-existing health conditions that increase their risk of severe illness and death from COVID.

A recent publication “Towards Health Equity in Connecticut: the role of social inequality and the impact of COVID-19” https://ctdatahaven.org/reports/ provides an in-depth profile of these issues based on statewide, regional and local data from urban, suburban and rural towns across the state including Fairfield County.

Taken together, these disturbing facts and trends are the reason why so many national, state and local leaders have coalesced around the issue of racism and health, declaring it a public health issue of crisis proportions. On April 8, the Centers for Disease Control and Prevention (CDC) announced a new initiative on racism and public health. Dr. Rochelle Walensky, director of the CDC, declared racism a serious public health threat and described CDC’s intensified efforts to address racism as a fundamental driver of racial and ethnic health inequities in the United States.

“What we know is this: racism is a serious public health threat that directly affects the well-being of millions of Americans. As a result, it affects the health of our entire nation. Racism is not just the discrimination against one group based on the color of their skin or their race or ethnicity, but the structural barriers that impact racial and ethnic groups differently to influence where a person lives, where they work, where their children play, and where they worship and gather in community. These social determinants of health have life-long negative effects on the mental and physical health of individuals in communities of color,” said Walensky, who also announced a new CDC website, “Racism and Health”.

There is action in Connecticut as well. The Connecticut General Assembly is considering proposals to “Declare Racism a Public Health Crisis” in our state and to establish a Commission on Racial Equity in Public Health (Senate Bill No. 1 and House Bill No. 6662). Proponents assert that by recognizing the significance of systemic racism on public health these bills represent an essential first step toward corrective action to assess and change the way our state government works, embed anti-racism principles in state level decision making processes, and facilitate anti-racist policy making at all levels.

The proposed Commission on Racial Equity in Public Health would review and analyze ethnic/racial health disparities in Connecticut, including the disproportionate impact of the COVID pandemic on people of color, facilitate the development of an executive level statewide strategic plan with broad community input and mandates to report on its findings to the Connecticut General Assembly, and support studies on health care workforce diversity, and trainings on implicit bias and cultural humility for students in health programs.

At the local level 20 towns/cities in Connecticut have made declarations and/or passed resolutions declaring racism a public health crisis or major concern since June 2020. Many of these municipalities are now actively engaged in efforts to address systemic racism through education and policy change.

Easton Resolution on Racism and Public Health

Easton was one of the first towns in Fairfield County to take action, followed by neighbors in Bridgeport and Westport. The resolution passed by the Board of Selectmen on August 20, 2020 titled “Easton Resolution on Racism and Public Health” states that “the Board of Selectmen of Easton acknowledges that racism is a growing public health concern affecting our town and all of Connecticut” and avows to support action at all levels, local, state and national, including promoting racial and health equity in policies and enhancing educational efforts about racism and its harmful effects.

On March 4, 2021, the Easton Board of Selectmen decided to withdraw the town resolution on racism and public health and put it out for public comment, providing opportunity for discussion with a broader representation of citizen input. Easton residents who want to participate may express their views on the resolution at the Annual Town Meeting on April 26 followed by a vote on the issue at the town referendum on May 4.

Easton may not be a community where the effects of racism are pronounced. But Easton is a community where issues of discrimination, diversity and inclusion are no less important. By upholding a resolution that acknowledges the impact of racism on our collective health, Easton could take an important step toward positive action at the local level while joining a growing movement in Connecticut and the nation to reckon with systemic racism.

Elaine O’Keefe has lived in Easton for 25 years. She is a former public health professional who worked in local health departments and at the Yale School of Public Health for nearly 40 years combined. She continues to serve on several health-focused boards and is a member of the Easton Diversity and Inclusion Task Force.

image_pdfimage_print