Is being Black a preexisting condition?

Panel looks at the causes and potential fixes for disparate health outcomes

by Mike Ferguson | Presbyterian News Service

Photo by the National Cancer Institute via Unsplash

LOUISVILLE — The extent to which being Black is a preexisting condition that can foster poorer health outcomes was the among the topics addressed during a webinar put on Tuesday by Union Presbyterian Seminary. Click here to watch the hour-long webinar, sponsored by the seminary’s Center for Social Justice & Reconciliation and its Katie Geneva Cannon Center for Womanist Leadership.

Dr. Rodney S. Sadler Jr., Associate Professor of Bible at Union Presbyterian Seminary and the director of the Center for Social Justice & Reconciliation, hosted the forum. Sadler’s guests were the Rev. Dr. Shakira Sanchez-Collins, who practices internal medicine at Northwestern Medical Group and is the associate pastor at St. James AME Church in Chicago, and Dr. Augustus G. Parker III, medical director for Women’s Urgent Care Centers in Charlotte, North Carolina, and Novant Health’s facilitator for Diversity and Inclusion as well as Novant Health’s community ambassador. Parker attends Friendship Missionary Baptist Church in Charlotte.

The Rev. Dr. Shakira Sanchez-Collins

Sanchez-Collins said a number of factors contribute to health outcomes for people of color that often fall short of health outcomes for white people. Among them are higher rates of poverty, access to grocery stores, the lack of nearby greenspaces for simple acts like walking and other exercise, and the gap in access to health insurance, which has narrowed since the passage of the Affordable Care Act in 2010. More complex factors, including systemic racism, also have impacts on the health of Black Americans, Sanchez-Collins said.

The longstanding practice of redlining is another contributor to less desirable health outcomes for people of color, according to Parker. Because they were systematically excluded from desirable neighborhoods, people of color often ended up living near factories and had to deal with breathing polluted air and drinking water tainted by chemical runoffs. Many live in food deserts and have poorer access to educational resources.

“Being Black, weathering, intersectionality — there’s a lot of work being done that shows those impact you cradle to grave,” Parker said. “Maybe your immune system doesn’t respond as it should. It’s not necessarily racism, but it may be race.”

Dr. Rodney S. Sadler Jr.

Sadler recalled his days as a student at Howard University, where psychology professors were conducting pioneering research on the impact of racism on hypertension and other conditions. “The stresses of being Black,” Sadler said, “can contribute to poor health outcomes.”

So can perceived racism, Sanchez-Collins said.

“If you felt you were in a racist moment” as a patient, Sanchez-Collins said, “that causes a stress response, like the fight-or-flight response. That weathering adds up, and over time there is microbiological damage on the body,” which can lead to higher incidences of diabetes, cancer and other chronic diseases, she said.

“What is the pathology of the environment a lot of Black Americans are living in?” she asked. Disparities are particularly apparent in differing death rates between Black and white mothers — even comparing Black mothers with college degrees with white mothers with a high school diploma or the equivalent.

Sadler asked the physicians about the amount of time and the treatment health professionals give to their white patients and their Black patients.

“A lot of studies talk about how patients are treated differently based on race or sexual orientation,” Parker said. Black patients are referred fewer times for chemotherapy or an appointment with a specialist, and “a lot of their concerns are thought to be unfounded. They aren’t listened to,” Parker said.

Dr. Augustus G. Parker III

Infant mortality rates for Black children are at least 2.5 times greater than for white babies, Parker noted. “If we can’t take care of our most vulnerable population, what does that say about our adult population?”

Black women die at least twice as often as white women do while giving birth. Parker said sometimes when Black women “say they don’t feel right” during a visit with their provider, “their concerns are dismissed.” African American men live 5-12 years less than their white counterparts. “Those are benchmarks we have to pay attention to,” Parker said, “and figure out a way to close the gap in health disparities.”

Medicine has both objective and subjective practices, Sanchez-Collins said. The way a patient winces “makes you lean toward one test or another,” she said. “A lot of subjectivity creates that space for biases.”

Turning the tide in the disparities of health outcomes includes patients knowing what to ask for — and even what to demand of their healthcare providers.

“You have to have a patient advocate,” Parker said, such as a doula for helping a mother during childbirth and post-partum. “The more support and advocacy you have demanding the attention of healthcare professionals, the better off you’ll be.”

It’s also important to engage more people of color as healthcare providers — as physicians of course, as Parker’s children are, but also as nurses, mental health providers and administrators, he said.

As he does during most of the webinars he moderates, Sadler asked what role faith communities can play in helping to narrow the gap.

In the African American community, churches “have always been the place where we could address our concerns,” Sanchez-Collins said. The first-ever bishop of the AME church, she noted, was a nurse who helped patients dealing with yellow fever.

“We are in a good place to make a response,” she said of churches and other faith communities. “We can make sure there is relevant messaging by paying attention to what’s going on with people. The church should be a balm in Gilead, addressing anxiety, depression and other mental health concerns. They are spaces where people can feel supported.”

Many churches, she noted, have become sites where COVID vaccines and testing are offered. Those churches are “points of access where we can supplement what is typically done in healthcare settings,” Sanchez-Collins said. Churches have “a lot of chances … to put the [healthcare] message in a form that’s understandable and accessible. I think the church is a great place to do those things.”

When it comes to “trusted, iconic leadership” for delivering healthcare messages, “it’s not Dr. Parker,” Parker said. “It’s usually pastors.” Parker’s church in Charlotte has a concerted campaign to raise awareness about healthcare disparities and get people connected with a healthcare professional.

“I’m proud our pastor gets up every Sunday and says, ‘Wear your mask,’” Parker said. “Some Black pastors toe the line with politics and don’t want to seem partisan,” but “God gave us a brain for discernment and tools to help us. As physicians we are tools to further that message and provide great care for our communities.”

“The church is listening to you tonight,” Sadler told his guests. “What is your word to the church?”

The church should focus on both big and small things, Sanchez-Collins replied.

Among the former: Many health problems “are due to systemic issues,” including access to quality food, decent housing and environmental justice. “Those are the big things we need to advocate for,” she said.

But small needs are important as well. “What can you do to partner with the church or a health organization to provide points of access to healthcare and to informed information so that people can better care for themselves?” she asked viewers.

Parker took that a step further.

“Church communities should demand an audience with major healthcare institutions [in their community] to discuss the healthcare concerns of their parishioners,” he said. “There are dollars out there to address some of those concerns. Now is the time to demand the dollars and do it.”

“We can do so much more,” Sadler said, “if we work with partners in the community.”

“We’ve got work to do,” Sadler said. “Let’s get busy.”