Clarence C. Gravlee, Tampa Bay Times, April 15, 2020

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It is heartening to see health inequities getting the attention they deserve at the highest level of government. Yet it is disconcerting that messages from the White House erase what we have known for decades—that racial health inequities are a consequence of systemic racism, not race.

Our leaders’ silence about the systemic causes of health inequities creates two problems.

First, it leaves a vacuum that is likely to be filled with noxious ideas. One example is the suggestion that racial health disparities are rooted in innate biological differences. This assumption has a sordid history in American medicine and persists despite overwhelming evidence that it is wrong.

Last Wednesday, Louisiana Sen. Bill Cassidy perpetuated the myth of innate racial difference in an interview with NPR. Cassidy, a physician, claimed that African Americans might experience higher rates of diabetes because of “genetics.” {snip}

That brings us to the second problem: Evading the systemic causes of racial health inequities deflects attention from steps we could take right now to reduce unequal suffering.

Systemic racism refers to policies and practices that create and enforce racial inequities in major systems of society—our legal system, education system, health care system, and so on. Research makes clear that these systems are the source of racial health inequities. The evidence is particularly robust for the “underlying conditions” that appear make COVID-19 more deadly: obesity, diabetes, hypertension, and asthma.

The most obvious inequity is racialized poverty. Federal Reserve board data show that, for every dollar of wealth in median white households, median black households have about a dime. {snip}

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Beyond systems, we know that the stress of dealing with racism is toxic. Studies show that exposure to discrimination has far-reaching biological effects, including obesity, elevated blood pressure, poorer diabetes control, impaired immune function, and accelerated cellular aging. {snip}

In a White House briefing last week, President Trump expressed bewilderment at the magnitude of racial inequities. “This is something that has come up,” he said, referring to disproportionate death rates from COVID-19. “Why is it that the African American community is so much, numerous times more [likely to die] than everybody else? It doesn’t make sense.”

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