By Eliseo J. Pérez-Stable, M.D.
Director, National Institute on Minority Health and Health Disparities
The past few weeks have been an extremely difficult time in the United States. George Floyd’s death was so painful to witness. Even more painful is the knowledge that he was only one in a long, long line of African American men and women who have been killed by police in America. It is a relentless, terrible history, and his death was yet another reminder of injustice in our lives. It is the same injustice that American Indians suffered in colonial times and the 19th century, losing their lands and being victimized by war. It is the same injustice that led to mass deportation of Mexican Americans—people born in the United States—in the 1930s. It is the same injustice that led to the internment of Japanese Americans during World War II. This is our history.
I have watched the protests—at times coupled with violence but mostly peaceful—and been heartened by the Americans of all races who have continued to show up, day after day, to say that Black lives matter and structural racism must end. This is a society that is proud to say that all are created equal, with liberty and justice for all, but the history of injustice is clear. People are not standing for it anymore.
Here at the National Institute on Minority Health and Health Disparities, we spend a lot of time thinking about inequality. In our 10 years as an institute and our 10 years as a center before that, we have funded countless studies on minority health and on the health disparities that exist in our country.
Race and ethnicity are social constructs defined by self-identity and encompass culture, tradition, history, and biology all at once. But the effects of these social constructs are real and influenced by appearance, skin color, and social class. Racial and ethnic minorities in the United States face a disproportionate burden of many conditions, including heart disease, diabetes, obesity, and asthma.
We have funded many studies on the reasons for these problems and how to help. Social conditions are responsible for many of the health disparities affecting African Americans. African Americans are more likely to live in places with no full-service grocery stores—and with very easy access to cheap foods that raise the risk of diabetes, obesity, and other metabolic disorders. Low-quality housing and exposure to air pollution in their neighborhoods make asthma worse. A lack of educational opportunity and employment discrimination mean African Americans are more likely to work low-wage jobs without health insurance.
Over the last few months, my colleagues and I have watched, heartbroken, as health disparities have been made clear yet again through the coronavirus pandemic. African Americans, Latinos, American Indians, and Pacific Islanders are more likely to get seriously ill with COVID-19 and more likely to die from the disease. One reason for the disparity is the higher rates of underlying diseases such as diabetes that make COVID-19 worse. The other reason is the risk of getting infected in the first place. These groups are disproportionately the bus drivers, the supermarket cashiers, the frontline workers in pharmacies, the delivery drivers. They are less likely to have paid sick leave than White people are and less likely to be able to wait out the pandemic while working from home. People from these groups are more likely to live in dense housing with many family members, possibly several generations in a small space. Physical distancing, teleworking, and the option to self-isolate at home are novel markers of social privilege.
The underlying reason for these disadvantages is racism. Racism keeps minorities from being hired in many white-collar jobs and from feeling comfortable if they are hired. For decades, racism has kept African Americans and Latinos out of neighborhoods with strong schools—and poverty still does that today. Minority families have not had the chance to accumulate the generational wealth and security that many White families enjoy; racial discrimination in housing was banned only a little more than 50 years ago. And an African American man going for a run—getting the exercise that he knows he needs for his health—also has to wonder whether someone will murder him like someone murdered Ahmaud Arbery.
Racism degrades the health of African Americans and other minorities not only by limiting opportunity and sustaining poverty but also by increasing stress. We know from years of rigorous biological research that having high levels of stress hormones in the long term contributes to the development of chronic disease. We also know that getting suspicious looks, being followed in stores, and hearing racist remarks increase stress, as does poverty. Racism and the overpolicing of poor neighborhoods also increase the risk of dying from police brutality—yet another epidemic that has disproportionately affected African Americans for far too long.
We are all feeling roiled by a profound sense of unfairness, especially after months of watching the unequal consequences of the pandemic.
But I am an optimist, and I hope that these protests indicate the beginning of a change in our nation. As a teenager in Miami, I watched the news of the 1968 riots on our black-and-white television. Real change for the better has taken place since then. Now, in 2020, there is more for us to do. Real action to address systemic racism will not only reduce deaths from overpolicing, it will also improve the health of all Americans and move us toward a future in which all populations will have an equal opportunity to live long, healthy, and productive lives.