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Social Determinants of Health
With Dr. Marion Henry & Dr. Erika Newman & Dr. Victor Garcia · hosted by Dr. Todd Ponsky
Chapter 1 of 6 · Fundamentals
Bias vs racism
Introduction and the Question of Bias versus Racism
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What the experts said
Bias affects medical decision-making including who gets referred for procedures and who receives surgery.
Biases are not hard-wired and can be replaced with new associations.
An African-American woman, even a healthy woman with excellent prenatal care and college education, has a greater likelihood of giving birth to a premature baby.
A Black mother with a college education has a higher risk of giving birth to a premature baby than a white woman who has not graduated from high school.
African-American children and minorities who are poor have lower cognitive abilities as evidenced by educational achievement and economic attainment.
Both Black children and adults have higher incidence of cardiovascular disease, strokes, and high blood pressure.
Black children in certain neighborhoods have higher incidences of high blood pressure.
There are differences in life expectancy and health disparities between Mexicans who come to Chicago versus Puerto Ricans and Dominicans who come to New York City, with the latter groups experiencing worse outcomes due to African admixture and discrimination based on darker complexion.
In Greater Cincinnati, depending on what neighborhood you live in, there is a 20-year difference in life expectancy between affluent and poor neighborhoods.
In the 45229 zip code area, despite $68 million per year being spent by nonprofits, economic distress indicators have not changed significantly.
Chronic school absenteeism at Rockdale Academic Elementary School in the 45229 zip code is 39%.
There are not many low-poverty neighborhoods that will be welcoming to Black people moving in because of inherent biases.
Every neighborhood is different and there are no two ghettos that are alike, requiring neighborhood-specific solutions.
A recent article in Pediatrics showed that Black children are more likely than white peers to die or have complications after surgery, even when controlling for baseline health (ASA 1-2 patients undergoing inpatient procedures).
African-American children are more likely to die after congenital heart surgery, neurological procedures, experience delays getting onto kidney transplant lists, and are less likely to receive those transplants.
African-American children are more likely to have complications from appendicitis, solid tumors, extremity sarcomas, and gastroschisis.
Data from the Implicit Association Test shows that all healthcare providers have bias that favors whites.
Children and adolescents experience bias not only in healthcare but also in education and the criminal justice system.
The Institute of Medicine found disparities in all specialties with regard to race and ethnicity, with people of African descent receiving unequal treatment in America.
The worst urban context in which whites reside is considerably better than the average context of Black communities, according to Rob Sampson's research.
Your zip code is more of a predictor of your life span and quality of life than your genetic makeup.
Concentrated poverty by neighborhood impacts every organ system, including the prefrontal cortex (attention), hippocampus (memory), and amygdala (fight-or-flight response).
The incidence of chronic inflammation for parents and children in high-poverty neighborhoods is significantly higher, which helps explain why African-American women have higher prevalence of lupus and autoimmune diseases.
95% of Black children grow up in concentrated environments that are not only materially deprived but toxic, with exposure to air pollution from traffic and lead poisoning.
According to Raj Chetty's study of 20 million individuals, if a child born in Cincinnati does not move out of a high-poverty environment before age 10, there is a steady decline in the likelihood of improving adult outcomes.
It is estimated that 350 million jobs globally will disappear with automation and AI, creating urgency to address economic disparities.
In Sweden, which has universal healthcare, similar neighborhood-based health disparities exist, demonstrating that access to care alone does not eliminate disparities.
According to W.E.B. Du Bois in 1899, the issues affecting minority infants and families are due to their economic plight as a consequence of slavery and ongoing racism and discrimination, particularly affecting African-American males' work opportunities.