Is systemic racism to blame?

Los Angeles County launched a Center for Health Equity in October to address the idea that “health predominantly happens outside the health care setting,” said its director, Heather Jue Northover, at a recent meeting. “It happens where we live, work, play and pray.”

The center will target five health disparities, including high rates of STDs among certain minority groups.

Nationwide, STD rates have been climbing for the past five years. More people were diagnosed with syphilis, chlamydia or gonorrhea in 2016 than ever before.

Some blame underfunding of STD prevention programs, as well as falling condom usage. There’s also speculation that people are having sex with more partners because of hookup apps.

But the picture is more complicated when it comes to the high STD rates among minorities. Gay and bisexual men make up the vast majority of new syphilis cases. In L.A. County, syphilis rates among African American women are six times higher than white women and three times higher than Latina women.

Northover said that officials need to evaluate what’s called structural or systemic racism, the way housing or education policies may negatively impact people and their health. Studies have found, for example, that people with HIV who had low levels of literacy were less likely to follow their treatment, and that poorer Americans were more likely to engage in risky sexual behavior, increasing their risk of STDs.

The Centers for Disease Control and Prevention released a white paper in 2010 saying the country could not close disparities in STD rates without addressing “the interpersonal, network, community, and societal influences of disease transmission and health.”

But that’s a tall order given how entrenched many social problems are.

Poverty or a lack of opportunity may be forcing women to exchange sex for resources, leading to the spread of STDs, Northover said. There also tends to be a mistrust of the medical system among African Americans, making them reluctant to seek care. Certain neighborhoods may be excluded from access to healthcare because of geography or finances, she said.

“We need to take a wider lens,” said Northover, who added that she’s still trying to get to the bottom of what’s driving STD rates.

County Supervisor Mark Ridley-Thomas , who represents South Los Angeles, convened several community groups in 2012 to try to bring down STD rates through collaboration. But the still-growing case numbers suggest the approach needs to be reimagined, said Dr. Michael Hochman, a senior health deputy for the supervisor.