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Home > Confronting Reality
The Whole Story
The benefits of next-gen policies and whole-health approaches.
Community partnerships can help bridge gaps and change behaviors.
By Karen Dale
Martin-DM/Getty Images
For a long time, people got the relationship between race and health outcomes backward: People were blamed for their own poor health.
It's past time to acknowledge that there are other factors at play — and they've been there for generations. For example, we have cities around the country that participated in real-estate redlining for decades, intentionally concentrating Black people in certain neighborhoods and then choosing not to resource those communities with basics like grocery stores, parks and walkable spaces. It's not difficult to see the effect of that legacy in someone today who is living in a food desert and dealing with the consequences of poor nutrition.
Another factor is the physiological impact on Black people called "weathering" — a term coined by University of Michigan public health professor Arline Geronimus. Weathering refers to the premature aging of Black people's bodies that is associated with the "fight-or-flight" response mechanism in all humans, which is triggered by stressful situations. Stress causes a person's heart rate to accelerate and their mind to race, which then triggers the release of the cortisol hormone. Cortisol gives people more energy to confront whatever is causing their stress. It is beneficial in the short term if an individual is responding to danger, but over time, cortisol can negatively affect a person's health. When an individual is chronically stressed, which is the case for so many Black people — related to jogging while Black, shopping while Black, driving while Black, a constant news cycle of Black people being killed and having to worry all the time about the safety of their children — the cortisol builds up and becomes a health risk for illnesses like diabetes, hypertension and high cholesterol, and emotional disorders such as depression and anxiety.
THE PERSISTENT HEALTH DISPARITIES IN MINORITY COMMUNITIES WILL CERTAINLY NOT BE SOLVED OVERNIGHT. BUT AT LEAST WE'RE BEGINNING TO TALK ABOUT THEM IN THE RIGHT WAY.
These are real biological impacts that create disparate health outcomes, not only for Black people, but also for Latino people, Indigenous people and other people of color. There are feelings of exclusion, as well. Many people in minority groups distrust the health system, resulting in health care outcomes that lag those of white people. In Washington, D.C., for example, there is a very high rate of insurance coverage and several beautiful, federally qualified health centers that sit underused because many people in the surrounding communities with large minority populations don't trust them. They would rather stay away from the health system and default to the emergency room when they need care.
To bridge that exclusion gap, AmeriHealth Caritas created a Member Wellness Advisory Council and a Youth Wellness Advisory Council. These are not focus groups where we just extract information — the council members' voices are meaningful; they get to ask probing questions and are active in co-authoring solutions. At one of those meetings, a woman who was taking care of her preventive health needs acknowledged that she hadn't been to a dentist in several years. I asked why: It was because the last time she had gone, the dentist made her feel ashamed because of the state of her teeth. It was crushing to hear, yet very familiar to many of the participants who nodded in agreement. When we treat patients in a way that diminishes them, the care offered is not truly accessible.
Marginalizing patients happens far too often in communities of color. Over the years, I've frequently heard about women who visit the doctor because they're pregnant, only to receive a lecture or an eye-roll. Such experiences help us identify the points at which those feelings of distrust and exclusion are felt most acutely so we can design effective bias training programs for providers that are more than a box to check — they genuinely change behaviors.
The persistent health disparities in minority communities took years to develop, so they will certainly not be solved overnight. But at least we're beginning to talk about them in the right way and to design solutions based on a more complete understanding of the factors in play.
To improve outcomes, AmeriHealth Caritas is addressing myriad factors. In Washington, D.C., for example, our company helps improve nutrition by contracting with community organizations and national vendors to deliver healthy and medically tailored meals to our members with high-risk pregnancies and those suffering from chronic diseases. Our company also contracted with a community-based organization to implement a "Produce Prescription (Rx) Program," which enables our members to receive a prescription from their primary care provider for fruits and vegetables — a voucher they can redeem at the local supermarket. Finally, peer support workers and doulas, recruited from the communities we serve, engage with pregnant people in order to support a culturally responsive and tailored pregnancy journey.
Karen Dale is AmeriHealth Caritas' chief diversity, equity and inclusion officer, and also market president of AmeriHealth Caritas District of Columbia.
TOPICS: Social Determinants of Health, Diversity, Equity, and Inclusion