Help Us Understand Health Disparities in West Palm Beach!

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To learn more about the efforts of the Health Subcommittee, please visit the Health Project Library here to read the agenda and meeting notes from previous meetings. To stay up-to-date on the next steps, attend the Task Force meetings. The next meeting date can be found on the Calendar of Events.

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Why Does Racial Equity Matter?

By 2044, people of color will become the majority in the U.S., and yet these communities continue to disproportionately experience poor health, chronic disease, lower wages, disinvested neighborhoods, and limited access to educational, health and employment opportunities.

1. Poverty and unemployment take a big toll on the health of people of color.

People of color, and especially African Americans, face health risks rooted in centuries of racial discrimination that have limited access to jobs, healthy food, safe neighborhoods, home ownership, and good schools, among other things. Claiming health as only an individual’s responsibility distracts from the fact that our lives are shaped by structural forces, too.

Health researchers have been paying closer attention to the social determinants of health. Research by the University of Wisconsin Population Health Institute (2016) has found that over 40% of the factors that contribute to the length and quality of a person’s life are social and economic; another 30% are health-related behaviors directly shaped by socioeconomic factors.

For most working-age people, employment is their predominant source of income. Studies show a strong association between unemployment or lack of sufficient income and physical and mental illness, drug addiction, and suicide.

Children who grow up in poverty have a greater risk of starting school behind their peers and scoring lower on achievement tests. They are more likely to end up unemployed or to earn less as adults. And when they grow up, they are more likely to have to cope with poor health. Due to lower economic productivity and increased costs of health care and other social services, child poverty alone costs an estimated $1 trillion per year to the U.S. economy.

A 2020 Commonwealth Fund analysis ranks Florida’s health system among the worst in the nation. In 2018, Florida had more than a 5% disparity in uninsured rates between white adults and black and Hispanic adults. Florida’s lowest scores were for access and affordability and prevention and treatment.

In West Palm Beach:

• 17% of African Americans and black immigrants are unemployed, compared to 3% of whites (and 5% of white and Latino immigrants) and 6% of U.S.-born Latinos.
• 42% of African American residents live below the poverty line.
• 40% of black immigrants live below the poverty line.
• 25% of Latino residents and immigrant Latinos live below below the poverty line.
• 18% of Asian residents live below the poverty line.
• 12% of White residents live below the poverty line.

Workers in West Palm Beach may work full-time and still struggle to pay their bills, with little or no money to invest in the future. When workers earn low wages they may find it extremely difficult to find affordable childcare, and thus experience greater family instability and worse health than higher-wage workers.

2. Lack of access to health information and services for the uninsured/underinsured.

According to Tanya Young Williams, an African American resident of Delray Beach and co-owner and CEO of an addiction-treatment center in the West Palm Beach area, very few African Americans approach her for help. The people of color who do reach out to her for treatment are uninformed and unaware that there is support available to them, she says.

According to a 2018 National Survey on Drug Use and Health, 6.9% of African Americans have a substance use disorder, a number nearly equal to the 7.4% of the total population purported to have this disorder. The opiode crisis has hit African Americans in West Palm Beach particularly hard.

According to Dr. Karl Michel, a board member of the Thomas Leroy Jefferson Medical Society in Palm Beach Gardens, many African American communities lack access to information like where they can get treatment if uninsured or what opioids do to those prescribed for chronic pain. Williams agrees.

In West Palm Beach, 65% of Hispanics and 29% of African Americans ages 26-34 years old lack health insurance, compared to only 18% of non-Hispanic whites. (Source: American Community Survey, 2019)

3. Decades of disinvestment and legacies of racial segregation have negatively impacted black and Hispanic neighborhoods.

Today, too many people do not have the opportunity to be healthy because they live in places that make choosing healthy behaviors extremely challenging: they lack access to healthy foods and places that make physical activity easy and are exposed to environmental toxins. A building or project’s impact extends beyond its physical walls. Some neighborhoods or real estate developments offer little opportunities for building social ties and connections and/or lack easy access to important sites, like parks and playgrounds, job centers, libraries, schools, grocery stores, etc.

One recent study of Palm Beach residents examined the relationship between race and access to the ocean. Professor Howard Ernst, a Seiden-Levi Fellow at the Eisenhower Institute, pointed to the fact that the most of Palm Beach Spring’s minority residents live well outside walking distance to the ocean, in part because of lack of available parking.

Student Micaylah Bowers, who worked on the research project, notes that many residents are severely restricted by barriers put in place by gated communities where most residents are wealthy and white. The researchers also discovered that public parking access funnels minority beachgoers into places with the lowest water quality. This is an example of environmental racism.

Finally, the study found that the clear water of incoming tides attracts crowds of mostly white snorkelers that push out minority residents. Read more.

4. Limited or no access to the Internet is cutting low-income individuals from telehealth options.

Some healthcare organizations are using telehealth to fill the care gap caused by COVID-19 limitations, but access to reliable broadband is not something every resident can afford. In early 2020, the American Health Association and  American Medical Informatics Association (AMIA) asked the Federal Communications Commission to consider broadband and digital health access a social determinant of health.

According to AMIA president and CEODouglas B. Fridsma, MD, PhD, FACP, FACMI: “Race, ethnic, and age disparities in patient portal use and readiness and preferences for using digital communication for health-related purposes have shown to be significant, and this, in turn, reduces their ability to participate in many new and exciting mHealth solutions.”

5. Racial disparities specific to certain groups are not well documented or tracked.

In terms of health disparities, research often focuses on major demographic characteristics like race and ethnicity. The United States comprises a diverse ethnic/racial population, which is typically categorized into five distinct groups: African Americans/Blacks, Latinos/Hispanics, American Indians/Alaska Natives, Asian Americans/Native Hawaiians/Pacific Islanders, and Whites. Despite these broad categories, however, significant variation exists in the histories and experiences within each of those ethnic/racial groups, all of which can influence health outcomes as well as risk factors for poor health and well-being.

The inequities in health outcomes that persist in American society do not show up just at the level of broad racial categories but as disparities experienced by more specific groups. When Afro-Latinos make the case to be recognized, not obscured within a much larger, undifferentiated Hispanic category, they are seeking information about their own community and also to be a more visible part of the American fabric. When members of individual Hispanic groups, or refugees from Central America, seek to be counted and have their life circumstances documented, theirs is a call for visibility and full inclusion as well.

Major Support Organizations

Leading organizations that strive to advance new state and local policies.

National Collaborative for Healthy Equity
NCHE’s goal is to undo the health consequences of racism, particularly its less visible – but more insidious – structural manifestations, such as the heavy concentration of health risks in communities of color. NCHE’s believes its 3 pillars addresses these structural issues in order to bring about necessary changes in achieving health equity. These include: (1) Racial Healing – Dismantling the belief in racial hierarchy and its harmful consequences; (2) Research & Data-Driven Policy, and Practices; and (3) Leadership for Health Equity.

Research Resources

Online resources focused on new state and local policies.

Building a Movement, Transforming Institutions: A Guide for Public Health Professionals (PolicyLink)
PolicyLink convened leaders in the field of public health field to learn, connect, and strategize with one another about how health equity can be advanced. PolicyLink interviewed them and documented their evolution and activities, seeing in them the emergence of a movement for positive change in the field. Their ideas and actions have informed this document, which is intended to advance this work. The opening section is an account of why it will be important to institutionalize equity in public health practice and what its early advocates have learned about how to bring that about. The second part of the document is a guide to the growing array of resources in the field, designed for easy access to materials on the Internet.

Racial Equity Resource Guide – Family & Education
These resources on racial equity include journal entries, books, magazines, videos and more.

Articles and Publications

Articles, reports, and papers.

The American Medical Association, the Nation’s Largest Group of Doctors, Deems Racism a ‘Public Health Threat’ (USA Today, 2020)
This article discusses the AMA’s passage of a policy that recognizes racism as a public health threat. The new policy recognizes racism as a social determinant of health, and highlights the health disparities and lack of access to health care that have significantly hindered good health in Black and other historically marginalized communities in the U.S. The American Medical Association’s House of Delegates – which includes 600-plus members from every medical specialty – released a statement that describes three tiers of racism detailed in the policy: systemic, cultural and interpersonal. Each poses specific barriers to quality medical care and good health and hinders the advancement of health equity, the group wrote. Read more in this article.

Black Men Have the Shortest Lifespans of Any Americans. This Theory Helps Explain Why. (ProPublica)
The unrelenting stress of fighting systemic racism can alter a body’s normal functioning until it starts to wear down. The theory, known as John Henryism, helps explain racial health disparities. Sherman James is a social epidemiologist who has spent the past four decades exploring why Black men have higher rates of diseases that lead to shorter lifespans than all other Americans. His conclusion is that the constant stress of striving to succeed in the face of social inequality and structural racism can cause lasting physical damage.

Counting a Diverse Nation: Disaggregating Data on Race and Ethnicity to Advance a Culture of Health (PolicyLink)
The Robert Wood Johnson Foundation commissioned a multiphase process that first aimed to level-set across ethnic/racial populations in terms of what is known and then sought to identify needs, gaps, and next steps for the field. The project brought together a diverse set of experts, demographers, practitioners, decision makers, and advocates to encourage leaders across sectors and ethnic/racial groups to talk to and work with each other. This report represents the culmination of those activities and the Foundation’s first step toward identifying solutions for improving ethnic/racial data disaggregation with the aim of promoting health equity in our nation.

Disrupting Narratives and Shifting Frames: Ambassadors for Health Equity Broaden the Meaning of Health
Too often, health is framed simply as an individual’s physical well-being. Individuals, alone, are assumed to be responsible for bettering their health. And when a community experiences high rates of illness or disease, a question often asked is “what is wrong within the community?” rather than “why are these poor health outcomes occurring?” Read more in this article.

Health Care and the Competitive Advantage of Racial Equity: How Advancing Racial Equity Can Create Business Value
Focuses on actions taken by companies in the health care sector to create business value by addressing the unique challenges faced by communities of color. The companies featured in this report — ProMedica, Kaiser Permanente, Cigna, and UnitedHealth Group — have adopted several business strategies that improve health outcomes for people of color and create a competitive advantage through reduced costs, avoided readmissions, and greater member satisfaction.

Addressing the Issue of Food Deserts in West Palm Beach: The History of Henrietta Bridge Farm (part of the Urban Growers Community Economic Development Corporation)

Implicit Racial/Ethnic Bias Among Health Care Professionals and Its Influence on Health Care Outcomes: A Systematic Review
This article shares findings from an investigation into the extent to which implicit racial/ethnic bias exists among health care professionals. Researchers examined the relationships between health care professionals’ implicit attitudes about racial/ethnic groups and health care outcomes. Based on their findings, they concluded that significant racial bias exists among healthcare workers, with more favorable attitudes towards whites and negative attitudes towards blacks and other people of color.

Racial & Ethnic Economic Inequality and the COVID-19 Pandemic
The Democracy Collaborative prepared a report, created for the Healthcare Anchor Network, that looked at how racial and ethnic disparities in the economy are showing up in the COVID-19 pandemic and in the public policy response to the pandemic. The report also covers how the economic effects of the pandemic will likely impact racial and ethnic inequality.

What are the Top Common Social Determinants of Health?
This article explores the most common social determinants of health and how the healthcare industry is beginning to tackle them. Some of these social determinants are housing, public goods, geographic location, and education.

Toolbox

Practical resources and interactive tools designed to help both on-the-ground practitioners and citizens.

The Anchor Mission Playbook
Anchor institutions can play a key role in helping the low-income communities they serve by better aligning their institutional resources—like hiring, purchasing, investment, and volunteer base—with the needs of those of communities. The recommendations in this “playbook,” drawn from research carried out to help Rush University Medical Center (RUMC) align around its Anchor Mission, are being published to help other hospitals and health systems accelerate their own efforts to drive institutional alignment with community needs.

Building a Culture of Health (Robert Wood Johnson Foundation)
Building a Culture of Health means working together to develop scalable solutions and take targeted action in our communities. Inspired by the ten underlying principles for a Culture of Health, the Action Framework identifies priorities, organized under distinct Action Areas, for driving measurable, sustainable progress and improving the health and well-being of all people.

Building Healthy Places Toolkit: Strategies for Enhancing Health in the Built Environment
Building Healthy Places Toolkit: Strategies for Enhancing Health in the Built Environment outlines evidence supported opportunities to enhance health through changes in approaches to buildings and projects. Developers, owners, property managers, designers, investors, and others involved in real estate decision making can use the strategies described in this report to create places that contribute to healthier people and communities and that enhance and preserve value by meeting the growing desire for health-promoting places.

Mental Health Issues Facing the Black Community: This collection of resources raises awareness on the impact that racism and discrimination have had on the mental health of African American Communities (Including light-skin privilege vs dark skin, especially for females).