Ohio Minority Health Strike Force issues final report, recommendations

DeWine announces plan of action to "advance equity"

By Susan Tebben

Ohio’s Minority Health Strike Force released its final report last week, laying out both how disproportionate the health care and economic lives of people of color are across the state, and ways to deal with it. 

The strike force was empaneled to collect information on COVID-19’s effect on African Americans and other minority populations, along with the racism and trauma that leads to worse health outcomes for those communities.

According to state numbers, African Americans represent 14% of Ohio’s population, but represent 24% of positive COVID-19 cases, 32% of hospitalizations and 19% percent of deaths from the disease.

The group’s report notes the most important framework needed to advance equity are the categories that make up social determinants of health, those things that make up the overall health of a person and community.

In order to advance equity, “racism must be dismantled,” the Strike Force members said, and that must include action in three categories: health care and public health, the social and economic environment and the physical environment.

The first recommendation from the group is a statewide, government-wide and community-wide acknowledgment of racism as a public health crisis.

Ohio’s legislature already has a resolution in both the House and Senate declaring racism a public health crisis, but neither have successfully passed through committee. The House version didn’t see a hearing before the body went on summer break.

Ohio Gov. Mike DeWine made several statements during his Aug. 13 press conference about the report, including stating outright that he believes racism is a matter of public health.

“There are racial disparities in Ohio … certainly in health, education, housing, and we could go on and on,” DeWine said.

The sponsors of the Senate’s proposed resolution said the governor’s comments further underscore the need for the measure.

OH Sen. Hearcel Craig

“We have a duty to protect the lives and freedoms of all Ohioans, and that starts with addressing the glaring inequities in our health care, housing, education and justice systems,” said state Sen. Hearcel Craig, D-Columbus, in a statement. “Governor DeWine was right when he said that history will judge us for how we choose to respond to these disparities.”

House Minority Leader Emilia Sykes, D-Akron, was a part of the Minority Health Strike Force, but criticized the lateness of the final report, and the lack of action by the governor.

OH House Minority Leader
Emilia Sykes, D-Akron

“For thousands of Black workers and Black families, it’s too little, too late — the damage is done,” Sykes said in a statement. “The governor and his team moved quickly to address some issues but not the ones that dealt with Black and Brown lives.”

Several of the strike force’s recommendations focused on creating cultural competency and health literacy, along with urging equitable representation in government and the private sector and a health equity lens for policy.

“The state of Ohio should support the recruitment and retention of an equitable representation of Ohioans of color in health care and public health professions in all established workforce development programs,” the report stated.

Through better representation, the strike force hopes to target those social determinants that cause increased mortality rates and comorbidities in people of color.

Comorbidities are health problems such as hypertension and heart disease that exacerbate or expand into bigger diseases. Racism and discrimination of all kinds can lead to trauma and stress, and social determinants like poverty can impact immune systems, and overall health, the strike force said.

“Comorbidities render communities of color more vulnerable to COVID-19 complications and death,” the report reads. “While protective factors, such as supportive family and caregiver relationships, social connections, and economic security can mitigate these risks, the impact of trauma and toxic stress often persists.”

Health disparities were a problem for people of color long before COVID-19 began ravaging the state and country. “Preexisting disparities” like diabetes, hypertension and heart disease were already prevalent in Black and other minority communities, and were only made worse by new traumas, the report said

With that in mind, the strike force also recommended new policies and services to address safe and affordable housing, broadband funding, access to public transportation, and criminal justice reform.

“State government leadership should formalize a partnership to identify policy reforms to reduce community violence, police brutality, and bias in policing, sentencing and other aspects of the criminal justice system,” the report stated.

In response to the strike force report, DeWine enlisted his cabinet in a “plan of action to advance equity,” which proposes an entirely new study group, the Governor’s Equity Advisory Board to “assist the state’s efforts to dismantle racism and promote health equity.”

In addition to Sykes, task force members from northeast Ohio included physicians Lolita McDavid, M.D. MPA [Rainbow Babies and Children's Hospital] and Charles Modlin M.D., MBA, FACS [Cleveland Clinic]; business owner Andrew Jackson [Elson International, Inc.]; agency executive June Taylor [Western Reserve Area Agency on Aging]; Cleveland State Professor Ronnie Dunn, Ph.D.; and public officials Jamael Tito Brown [Youngstown mayor] and Alisha Nelson [director, RecoveryOhio], who served as co-chair. 

A full list of task force members can be found here.

This story is provided by Ohio Capital Journal, a part of States Newsroom, a national 501 (c)(3) nonprofit. See the original story here.

Additional reporting contributed by R. T. Andrews.

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Racism in U.S. health care

How racism in US health system hinders care and costs lives of African Americans

By Tamika C.B. Zapolski and Ukamaka M. Oruche

Photo by Joe Raedle/Getty Images.

As the COVID-19 pandemic swept across the U.S., the virus hit African Americans disproportionately hard. African Americans are still contracting the illness – and dying from it – at rates twice as high as would be expected based on their share of the population.

In Michigan, African Americans are only 14% of the population, but account for one-third of the state’s COVID-19 cases and 40% of its deaths.

In some states the disparities are even more stark. Wisconsin and Missouri have infection and mortality rates three or more times greater than expected based on their share of the population.

Speculation has suggested these disproportions are due to several factors: African Americans are more likely to live in poor neighborhoods, work at riskier occupations, and have more underlying health conditions and limited access to health care. But similar inequities exist in African American communities with above-average wealth and health care access. Staggering rates of COVID-19 occurred in Prince George’s County, Maryland – the nation’s wealthiest African American enclave. Comparable white communities were relatively unaffected.

As experts in clinical psychology and psychiatric nursing, we know this elevated risk for African Americans is not uncommon. It is true regardless of income, education level, or health care access. And it is true for other things besides COVID-19. African American women are more than twice as likely to die from childbirth than white women. Even if the African American women were educated and wealthy, they were more likely to die from childbirth than uneducated and poor white women.

Racism: the root cause

An analysis by the National Academy of Sciences found African Americans receive poorer quality care than white patients across all medical interventions and routine health services – even when insurance status, income, age, co-morbid conditions, and symptom expression were equal. Experts point to racism as a root cause for these disparities. Indeed, the American Academy of Pediatrics has outlined how racism impacts health outcomes for African American children. We suggest the same is true for COVID-19 outcomes among African American adults.

Other barriers negatively impact the health of African Americans. That includes implicit bias – attitudes, thoughts, and feelings existing outside of conscious awareness – as patients and providers communicate with each other.

Implicit bias from a doctor or nurse affects the quality and quantity of information shared with the patient about health conditions and treatment plans. The worst case scenarios: when providers withhold critical information about a health condition; when they don’t include the patient’s voice during decision making about care; and when they don’t refer the patient for further tests or specialty care. Implicit biases from health care workers can result in patients being less likely to understand their health conditions, which is necessary for patients to manage an illness effectively.

Averse interactions with physicians lead to long-lasting consequences for the patient, including unequal treatment and disparate health outcomes. And when it comes to ineffective patient-provider interactions, African Americans suffer the most.

Location, location, location

The location of hospitals, clinics, and other health care facilities are often a barrier to care. Transportation – or the lack of it – impacts the patient’s ability to receive services. African American patients have noted the frustration when health care facilities are not close to their homes. To get there, many of them rely on public transportation. The result: missed or cancelled appointments, sometimes due to policies regarding late arrival times by patients.

Differences also exist between African American and white patients in the length of wait time for appointments and the ability to schedule follow-up appointments. This can result in delayed health care – which leads to poorer health outcomes for illnesses, including COVID-19.

Recommendations for addressing racism

Consumers who are well informed about their health and confident in managing their care have better outcomes virtually across the board: in HIV-AIDS, cancer, diabetes, cardiovascular disease, and mental health conditions such as schizophrenia.

That said, here are three recommendations to address racism and reduce racial disparities in health care services:

1.      Health care professionals need to become more aware of their implicit bias. Identify the problem, as the saying goes, and you’re halfway to solving the problem. One way to become more aware: take the implicit bias test here.

2. Doctors and nurses need to be attentive and collaborative when communicating with patients. Empower the patient by encouraging questions and letting them express opinions. When patients believe the providers are there to support them, they manage their illness better. They also have a better perception of quality care. Ultimately this leads to improved health outcomes.

3.     Hospitals, clinics, and doctor’s offices should provide more flexibility in delivering services. Telehealth – when doctors and patients communicate online, instead of an in-person visit – should be one of those services. They should also restructure scheduling policies, emphasizing shorter wait times and more slack if patients are late.

Health inequity for African Americans is not a new phenomenon. COVID-19, however, shined a light on the problem. Racism is not isolated to health care services, and it remains pervasive throughout our society. But by taking the tangible steps outlined here, providers can begin to solve the problem.

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Tamika C.B. Zapolski is an Associate Professor of Psychology at Indiana University Purdue University ( IUPUI)
Ukamaka M. Oruche is an Associate Professor & Director of Global Programs at Indiana University Purdue University ( IUPUI)

This article is republished from The Conversation under a Creative Commons license. Read the original article.

#BLM highlights need to re-imagine America

End Racism. NOW!

By Gregory L. Brown

America is in crisis and racism is the culprit.

As America commemorates the birthday of its independence, African American are bitterly reminded that the freedoms and liberties associated with America’s independence have not ever been fully and completed bestowed upon them. African Americans continue to suffer disproportionately from police brutality and violence, expanding disparities in health care and status, and deepening levels of wealth and income inequality. These conditions are the result of a society organized around a hierarchical racial construct that has White people at the top and Black people at the bottom. This racial hierarchy historically and currently informs the acquisition of wealth and property, employment and housing opportunities, health and wellness, and political power. Thus, the effects of racism support the notion that the Black lives do not matter.

the effects of racism support the notion that the Black lives do not matter

America is not working for Americans, particularly African Americans!  A recent survey determined that seventy percent (70%) of Americans believe the country is moving in the wrong direction. Currently, African Americans are acquiring and dying disproportionately from the COVID-19 virus, a once in a one-hundred-year public health pandemic that does not have a cure and is spreading out-of-control.  The closing of America’s enterprises to reduce the spread of the virus has led to the greatest level of unemployment and economic distress since the Great Depression.

While the nation confronts the effects of a deadly global public health pandemic and unprecedented economic distress and dislocation, racism has again raised its ugly head to let all Americans know that it is alive, well and continuing to plague society. The incidents related to the unnecessary use of lethal force against unarmed and in many instances subdued African Americans by police officers and White vigilantes during these challenging times have become the catalyst for right-minded people to protest racism, unjust police violence and unfair treatment.

Millions of people are protesting and marching in the streets of America to bring attention to propositions that “Racism in America must End, NOW!” and “Black Lives Matter”.  This protest movement has emerged when people are fearful of catching and/or dying from the COVID-19 virus and amid a national economic crisis that has created financial uncertainty for millions. Nevertheless, a multi-racial, multi-ethnic, multi-cultural protest movement has emerged, demanding that this country immediately eliminate racism in all forms.

Ending racism immediately has both moral and practical implications. As a moral imperative, racism in all forms is wrong! Racism disregards and dismisses our humanity. Racism not only diminishes its targets; it also diminishes the racist.

From a practical perspective racism is expensive. Maintaining institutions, systems, policies and practices based on racist views means society heavily invests in allowing some people to prosper socially, economically and politically while others are held back and held down for no other reason than they have different skin color. The cost of racism is so deeply embedded in the legal and cultural fabric of America that very little consideration is ever given to the ratio between costs and benefits to society or how much return is received for America’s investments in racism. 

Americans must dismantle and disassemble the America we know for a new re-imagined America we do not know and can only envision.

The time to end racism in America has finally arrived. It is time to make real America’s stated creed that “All Men Are Created Equal” and “Everyone is Endowed with the Inalienable Rights to Life, Liberty and the Pursuit of Happiness.” America for centuries has overpromised and underdelivered on the tenets of its founding documents. It must now do what is required to make right its implied and stated promises to all Americans.

The solution to racism in America is to eliminate it in all its forms in society. This really means Americans must dismantle and disassemble the America we know for a new re-imagined America we do not know and can only envision.

The first step is to convene tribunals across the country to confront truthfully the wrongs of racism historically and currently and develop opportunities for people and the country to reconcile racism’s wrongs by identifying a new re-imagined American society that is diverse, inclusive and equitable. America must finally reconcile the experiences of those who have been the targets of racism the evils and ills associated with it.

Next, America must envision a new and improved 21st century public safety plan. The current racial justice movement has determined that “defunding the police” is a public policy initiative to specifically address police violence towards African Americans and better identify how public safety meshes with health and wellness and social concerns. Defining new and improved ways to integrate public safety, social services and health will result in the most effective use of public and other funds to build the capacities of all people to be prosperous and healthy.

Additionally, we must create a national system that makes it very easy and accessible for anyone eligible to vote. We must develop and enforce policies that make it illegal for anyone to use strategies and tactics that suppress eligible African American voters’ rights and opportunities to vote.

To eliminate racism, we need all of society’s stakeholders to actively and jointly envision and design the framework and plans for the physical, social, economic and political renaissance of this country especially in urban communities. PolicyBridge and other local stakeholders from all segments of Northeast Ohio are currently developing an urban agenda to reinvigorate and empower neighborhoods and communities and the people residing in them that have been left behind.  

America is in crisis and racism is the culprit. Eliminating racism throughout America is the answer. The time to act is NOW! 

Gregory L. Brown is  Executive Director of PolicyBridge, a nonpartisan, African American led public policy think tank, based in Cleveland, Ohio.