Despite the widespread idea that white and Black Americans have achieved racial equality in the 21st century, the health disparities between the two groups prove that this sentiment couldn’t be any further from the truth. Black and white Americans experience vastly different health outcomes – a consequence of historic racial and segregation policies that lasted centuries. To establish real equality between white and Black Americans, it is imperative to understand how racism and race are connected to the downstream mechanisms that influence racial health disparities and develop the proper policies necessary to address the issue.

Research on the relationship between race and health outcomes shows that Black Americans generally have worse health outcomes than white Americans on several metrics: Black Americans have higher rates of heart disease, poorer self-rated health, and are far more likely to die from cancer, strokes, kidney disease, septicemia, hypertension, and homicide according to a study done by the National Vital Statistics Reports. Studies done on the causes of these health disparities largely revolve around the negative impacts of discriminatory behavior, residential segregation and institutionalized racism on Black Americans. 

Black Americans suffer disproportionately from discriminatory behaviors and practices than white Americans. One such example is in the area of employment: a study done by Northwestern University professor Devah Pager found that Black Americans without a criminal record were less likely to receive a callback from employers than white Americans with a criminal record. This racial disparity is even greater between similar criminal statuses of both races: white Americans without a criminal record were around 2.5 times as likely to receive a call back than Black Americans without, and white Americans with a criminal record were three times as likely to receive a call back than Black Americans with one. 

The study concludes that regardless of incarceration, race continues to play a dominant role in employment outcomes, more so than a criminal record. The importance of a job and income cannot be understated–it allows individuals to purchase health-promoting goods, as well as determine the quality of their housing, schooling, and healthcare. A lack of both only limits the ability of individuals to move up the socioeconomic (SES) ladder and maintain good health for themselves and their families.

The historical discrimination of Black Americans manifests itself in the form of wealth disparity: they have the highest rate of poverty and the lowest median household income out of the major racial groups in America. This is exacerbated and perpetuated through the practice of redlining, which is a designation given to neighborhoods with a high number of Black residents, dissuading investors from those areas. The legacy of redlining continues in segregated neighborhoods to this day, which has resulted in drastic differences between white and Black dominated neighborhoods; due to the poor quality of services, lack of social support and leverage ties, and higher levels of food insecurity, Black communities often experience more stress, higher health risks and a lack of coping resources to deal with these problems. 

When looking at the research on the health disparities between white and Black Americans, it is clear that racism – as a fundamental cause of disease – plays a paramount role in determining health outcomes.

Given how entrenched systemic racism is, what are some solutions to address the racial health disparities in the U.S.?

One potential policy for reducing racial health disparities is a federal job guarantee. As mentioned earlier, Black Americans are twice as likely to be unemployed than white Americans at every level of education, so implementing a job guarantee program would greatly benefit Black people who are more impacted by unemployment, thus reducing the unemployment disparity between Blacks and whites.

A study done by Rutgers University professor Mark Paul advocates for legislation that guarantees every American adult a government-provided job through the permanent establishment of a hypothetical National Investment Employment Corps (NIEC). The NIEC would then provide a job with living wages that start at $11.56 an hour, or $24,036 a year; benefits, which include health insurance; and paid leave and vacation. By giving jobs to the unemployed, the country will see a return on investment in terms of built infrastructure, as well as reduced poverty rates. This will benefit racial minorities who are more likely to be unemployed, due to discriminatory practices or other circumstances, which will bridge the income and employment gap between marginalized communities and white Americans. 

Another potential policy is the basic income guarantee. Due to the intricate connection between poverty and poor health, supplementing a guaranteed annual income (GAI) would address the financial issues that heavily impact racial minorities. Professor Evelyn Forget of the University of Manitoba conducted a study that concluded that the introduction of a GAI has an association with a reduction in healthcare utilization, resulting in healthier individuals who aren’t as reliant on healthcare resources. As an upstream policy, guaranteed income can benefit a wide range of people, and influence downstream factors that can positively impact health. The extra income will reduce stress stemming from financial burden, allow people to take off sick days, and open up greater access to more health-improving resources. Additionally, a guaranteed income led to higher high school completion, a reduction in hospitalizations, and fewer visits to the doctor. 

Education is an important component in developing the skills needed for success and good health, as well as providing individuals with social networks and better job opportunities; by increasing education among Black Americans, we will be one step closer to bridging the racial health disparity.

In the wake of rising health disparities due to COVID-19, more action must be taken now to ensure that the divide between Black and white health outcomes does not grow even further. 

Since Black Americans have far higher rates of unemployment than White Americans, policies that guarantee employment should be implemented. Additionally, Black Americans have lower rates of income and wealth, so a guaranteed income should be introduced to lighten financial burdens.