What does your race say about your health – or your health about your race?
Quite a bit. In the coming weeks and months, contributors to The Public's Health from diverse backgrounds and different communities will be exploring the interconnections between the two, and more generally the lived meaning of race for Philadelphians. The idea for this occasional series of posts grew, frankly, out of the outrageous recent cover story in Philadelphia Magazine, "Being White in Philly," a misguided attempt to start a conversation about race in Philadelphia.
We kick off a different kind of conversation today with the following piece from Regine Metellus, senior vice president and chief operating officer for The Urban League of Philadelphia.
– Michael Yudell
Later posts in the series:
For 2013, that number is .717 – meaning that, on average, an African American in the United States is 71.7% as well off as a white American in these categories. In other words, if equality were defined as each group having 100% of a pie, then African Americans, as compared to whites, are getting only 71.7% of that pie.
The pie breaks down like this:
In economics, African Americans enjoy 56% of economic opportunities – as measured by employment, home ownership and other factors – that whites do. They have 77% in health, which includes worse outcomes among blacks for heart disease and cancer, and lower life expectancy at birth (74.7 years vs. 78.8 years for whites). These statistics are exacerbated by worse outcomes related to obesity, diabetes and reproductive health.
While African Americans have made gains in school enrollment, disparities in curriculum quality and in graduation rates keep the education component at 80 percent. Their incarceration rates and the rate at which they become victims of crime add up to a social justice component of 57%.
The one area where there is equality is civic engagement. This measures the democratic process, community participation, collective bargaining, and government employment. The civic engagement index is 100%.
Each of these five quality-of-life components is weighted differently, resulting in 71.7% equality overall in 2013. The value in calculating the number is in helping us to understand the extent to which race impacts our daily lives – 71.7% speaks volumes about the huge disparity that still exists among the races. But the number alone doesn't explain what it really means to live on the short end of these disparities. How does one cope with consistently having to run 28.3 percentage points faster just to stand in place?
Understanding the five components is complicated by the fact that the causes for several of them overlap. It seems clear, however, that economics is at the epicenter of most of these issues. Someone who is disadvantaged by wealth is predisposed to receive fewer educational opportunities, less access to fair treatment in the criminal justice system, and poorer health. These, in turn, almost guarantee continued deficiency in the area of economics, and so on. Many organizations across the country, including The National Urban League and its 95 national affiliates, address these deficiencies through programs that help people prepare for and advance in their careers, prepare for the responsibilities of homeownership, avoid foreclosure through negotiation with lenders, grow small businesses successfully and access educational opportunities through charter schools and college scholarships.
Given that 43% of Philadelphians are African American, the disparities highlighted in the State of Black America report significantly affect the city. For example, 25% of Philadelphia's 1.5 million residents live below the federal poverty level, the highest of the nation's 10 largest cities. For health – the component that directly determines our ability to simply get up and out of bed every morning – Philadelphia ranks 67th out of Pennsylvania's 67 counties in health outcomes and the factors that influence them. Among big cities nationwide, Philadelphia has among the highest rates of hypertension (34.5% overall, 43.7% among blacks), cardiovascular disease (4.7%), diabetes (10.7% overall, 17.2% among blacks), and obesity (29.3%). Low-birth-weight babies, who are at higher risk for numerous conditions later in life, are nearly twice as common in Philadelphia as nationally (11.3% vs. 6%), much of it explained by demographics: African American women nationally have 60% more preterm births than white women do. Rates of infant mortality, fetal mortality, and perinatal mortality rates all are twice as high for African Americans as for white Americans.
To me, it is ironic that a city with some of the country's finest healthcare facilities and with a booming biotech industry in its backyard has such a disparity in health outcomes for its citizens. It is ironic that this city – the birthplace of our Constitution, a document that speaks to the need to "promote the general Welfare…" – has such an inequity in a need that is so basic to human life.
The resources to address all the components of the equality gap are here. Is the will?
Regine Metellus is senior vice president and chief operating officer of The Urban League of Philadelphia.