US BIPOC HEALTH DISPARITIES

First recognized in December 2019, the Coronavirus Disease 2019 (COVID19) was declared a global pandemic by the World Health Organization on March 11, 2020. To date, the most utilized definition of ‘most at risk’ for COVID19 morbidity and mortality has focused on biological susceptibility to the virus. This paper argues that this dominant biomedical definition has neglected the ‘fundamental social causes’ of disease, constraining the effectiveness of prevention and mitigation measures; and exacerbating COVID19 morbidity and mortality for population groups living in marginalizing circumstances. It is clear - even at this early stage of the pandemic - that inequitable social conditions lead to both more infections and worse outcomes.” ‘Most at risk’ for COVID19, Preventive Medicine October 2020 Abstract Systemic racism is an inherent explanation for a root cause of US BIPOC health disparities (Black Lives Matter, 2020; Surviving Race, 2021).

During this time of global pandemic the odds are rising for BIPOC individuals who are unable to survive barriers inherently in place socially15 . In the United States systemic racism and psychiatric oppression (Brown and Padron, 2021) is endemic and borders on it requiring an imminent Public Health Emergency status (Declaration Act of 2021). BIPOC Americans dying nearly four times higher22 than the national average of Non BIPOC populations requires an immediate Health Emergency statement (Louis-Jean, J., Cenat, K., Njoku, C., et al., 2020). This research paper was originally written for a Valdosta State University School of Social Work, Valdosta, Lowndes, Georgia coursework paper for Spring Semester 2021 in Dr. Diane Hollim’s course around my exploring reasons for US BIPOC Health Disparities and Equity issues, initiative and change agency. I performed a broad literature review in my research and/or analytical methodology.

My main findings, results and/or arguments are based in the fact that Systemic racism is an inherent explanation for a root cause of US BIPOC health disparities (Black Lives Matter, 2020; Surviving Race, 2021). Impact The gross impact of this particular paper is significant. It led to the eventual pairing for a Resolution urging the United States Senate to enact the US BIPOC HEALTH DISPARITIES DECLARATION FOR A PUBLIC HEALTH EMERGENCY ACT OF 2021 submitted to US Senator HEALTH DISPARITIES IN THE US BIPOC POPULATION 2 Raphael Warnock (ATL-D). Implications Implications are positive and that this proactive academic paper positions itself as imminently supportive of the Resolution urging the United States Senate to enact the US BIPOC HEALTH DISPARITIES DECLARATION FOR A PUBLIC HEALTH EMERGENCY ACT OF 2021 (US Senator Raphael Warnock).

Disparities is often used in health dialogue referencing racial or ethnic difference in achieved health status. When there is a noticeable, “… greater/lesser outcome between populations,” (US Department of Health and Human Services, 2020) it is considered a disparity1 . This is not a recent phenomenon, having been in existence in the US for BIPOC population showing “differential health outcomes” for 400 years at least (Hammonds, E., Reverby, S., 2019). There exist many health disparities in the United States, but it is clearly discernable within the US Black, Indigenous People of Color (BIPOC) populations. Healthy People 2020 defines a health disparity as “… health difference closely linked with social, economic, and/or environmental disadvantage.”2

US BIPOC people are sustaining centuries of racial oppression3 and historically have experienced poorer health outcomes because of our experienced racial and/orethnic assignment. Dr. T.M. Luhrmann states, “We argue that above all, it is the experience of “social defeat” that increases the risk and burden of schizophrenia, and that opportunities for social defeat are more abundant in the modern west. And anthropology plays a new role in the science of schizophrenia” and “… where standard psychiatric science cannot tell us what it is about culture that has that impact.” (Luhrmann, T.M., 2016). Where COVID19 has effected the US BIPOC populations greater than non BIPOC HEALTH DISPARITIES IN THE US BIPOC POPULATION 3 populations from COVID19 (transmission, death) showing the disparities in health care access and treatment, it is solemnly tantamount to the 1918 Influenza pandemic and subsequently, today, refocuses our attention to BIPOC Americans effected by COVID19. It exemplifies a continued complex intertwining of systemically racism based inequities compounding access to care, propogating racial health disparities through a “lens of health equity,” (Cooper, L., Krishnan,L., Ogunwole, S., 2020).

Obstacles to good (or better) health exist from disparate socioeconomic status, gender, age,mental health, cognitive, sensory, or physical disability, sexual orientation or gender identity, geographic location is closely linked to discrimination and exclusion (US Department of Hand Human Services, 2020). To better explain health disparities and how it has effected the US BIPOC population, Healthy People 2020 references the context of the health disparities in this population.4 The Department of Health and Human Services Action Plan to Reduce Racial and Ethnic Health Disparities (2011) prepared the ground for Healthy People 2020 and did outline anaction plan to reduce health disparities among BIPOC, “promoting integrated approaches, EBT programs and best practices.”5

In 2008, the U.S. population was estimated at 304 million people.6 ? In 2008, approximately 33%, or more than 100 million people, identified themselves as belonging to a racial or ethnic minority population.7 ? In 2008, 51%, or 154 million people, were women.8 ? In 2008, approximately 12%, or 36 million people not living in nursing homes or other residential care facilities, had a disability.9 ? In 2008, an estimated 70.5 million people lived in rural areas (23% of the population), while roughly 233.5 million people lived in urban areas (77%).10 ? In 2002, an estimated 4% of the U.S. population ages 18 to 44 identified themselves as lesbian, gay, bisexual, or transgender.11 Since the Health People 2008 study, Healthy People 2020 brings health equity into focus taking it to the next step beyond health disparities in Healthy People 2008. Health equity brings a health for all people. Achieving health equity requires valuing everyone equally with focused and 1 Healthy People 2020, derived from Disparities | Healthy People 2020, March 20, 2021 HEALTH DISPARITIES IN THE US BIPOC POPULATION 4 concentrated effort towards study of equalizing a playing field for achieved health status for US BIPOC people.

Healthy People 2020 defines health equity as, “… attainment of the highest level of ongoing societal efforts to address avoidable inequalities, historical and contemporary injustices, and the elimination of health and health care disparities.”12 Dr. Ruqaiijah Yearby, J.D., M.P.H., who is the Co-Founder and Executive Director of the Institute for Healing Justice and Equity at Saint Louis University wrote in the September 2020 issue of Journal of Law, Medicine & Ethics “… social factors cause racial inequalities in access to resources and opportunities (resulting) in racial health disparities,” (Yearby, R., 2020) relational to the US BIPOC population poorer health status; however, Dr. Yearby continues, “this recognition fails to acknowledge the root cause of these social inequalities: structural racism” resulting in health disparities. Systemic racism is then the inherent explanation and root cause for much of US BIPOC health disparities (Black Lives Matter, 2020; Surviving Race, 2021).

In the United States systemic racism and psychiatric oppression (Brown and Padron, 2021) is endemic and borders on it requiring an imminent Public Health Emergency status. The current and historically relevant US national division is entrenched in systemic racism towards BIPOC people, “… in economic and social lines(that) have long been and continues to be defining features of American life with health disparitiesacross racial groups considered consequences of these economic and social division.” (Moore, K., 2019). The US BIPOC population are individuals which includes those living with disabilities facing basic and inherent challenges in addition to being a person of color13. In the seminal January 28, 2021 letter from the American Consortia of People with Disabilities and the Consortia for 2 Ibid. 3 Journal of Comparative Family Studies, retrieved March 20, 2020., Vol. 51 Issue 3/4/2020, p. 418. HEALTH DISPARITIES IN THE US BIPOC POPULATION 5 Persons with Disabilities to the United States Department of Health and Human Services, Secretary Designate Xavier Becerra, they state, “Disability is most prevalent in women and in Black, Indigenous, and People of Color. People with disabilities experience poverty at disproportionate rates.”14

During this time of global pandemic the odds are rising for BIPOC individuals who are unable to survive barriers inherently in place socially15 . To exemplify how COVID19 is directly impacting the US BIPOC populations, the Disabilities Consortia further state, “… Two thirds of all coronavirus deaths have been BIPOC people with disabilities and staff in congregate settings. As we have seen in coronavirus data more broadly, congregate settings that primarily house residents of color, no matter their location, size, or government rating, have experienced deaths due to COVID19 at two to three times the rate as congregate settings that primarily housed white residents.”16

The US BIPOC populations are no stranger to existing in the midst of racial crisis. With COVID19, US BIPOC populations face further challenges (Forman, H., Nunez-Smith, M., Tiako, M., 2021). Globally, “… 4 percent of the world’s population in the US accounts for 25 percent of the global number of confirmed COVID19 cases,” (BeLue, R., Chaney, C., Davis, D., 2020). BIPOC Americans have a disproportionate morbidity and mortality due to COVID1917 . To date, the numbers of effected BIPOC resulting in deaths to COVID19 is 63 million and 1.5 deaths globally18. BIPOC individuals have a greater susceptibility to contracting COVID19 out of age, a propensity for living with diabetes, hypertension and underlying respiratory and cardiovascular comorbidity associated with an increased risk to the virus (and developing COVID19 mutations) resulting in greater mortality19 forthe US BIPOC citizenry.

For immediate access to COVID-19 United States Cases by Country, States and Territories, please visit the Johns Hopkins University & Medicine Coronavirus Resource HEALTH DISPARITIES IN THE US BIPOC POPULATION 6 Center located at https://coronavirus.jhu.edu/us-map20 . Where I live in Valdosta, Lowndes County, State of Georgia, there are 11.5 new daily cases per 100,000 people BIPOC individuals comprise 41% of the population (Black or African American combined with Hispanic or Latino) and 40% of all deaths to COVID19.21 To date, in the State of Georgia 34% are vaccinated and where 97% of all new cases are to unvaccinated (CDC, 2021), the Delta Variant has entered the South Georgia region and is rampant. Lowndes County is “High Risk” for transmission, contracting resulting in death due to COVID19 according to the Centers for Disease Control, Atlanta, Georgia. Within the national context of health disparity, referring to differential health outcomes between BIPOC and Non BIPOC populations, limited access to medical care, resources and supportive services plays a vital role in the interplay between BIPOC higher numbers to morbidity and mortality (e.g., COVID19). COVID19 shows a terrible healthcare crisis in the US for people of color.

With Black or African Americans dying nearly four times higher22 than the national average of Non BIPOC populations requires an immediate Health Emergency statement (Louis-Jean, J., Cenat, K., Njoku, C., et al., 2020). Surviving Race: Intersection on Injustice, Disability and Human Rights stated in their formal recommendations to the President Biden Transition Team 2020-2021, “The pandemic has shone a bright light on racial disparities in health and health care — as Black and Brown Americans have suffered and died from the coronavirus at rates far higher than white Americans. We are seeing a national reckoning on racial justice and the tragic human costs of systemic racism in the murders of Black men, women, and children.”23 BIPOC individuals’ health disparities extends into psychiatric oppression (Mental American Monster: The Sprawl of American Psychiatry, 2021) with firm evidence to the predominance of disparate mistreatment of individuals Disparities. The National Plan for Action Draft as of February 17, 2010 [Internet]. Chapter 1: Introduction. Available4 Ibid. 5 “HHS action plan to reduce racial and ethnic health disparities: a nation free of disparities in health and health care,” US HEALTH DISPARITIES IN THE US BIPOC POPULATION 7 of color.

Psychiatric oppression, for example, is not separating BIPOC from the >25+ year earlier morbidity and mortality in the US Public Community Mental Health System (Parks, et al., 2006; World Health Organization, 2020) remains the rule instead of the exception. In the US, Black Americans make up 13.4% (US Census Bureau, 2019); However, mortality numbers for Blacks is 2.2 times greater than the rate for Latinos individuals and 2.4 times greater than the rate for Asians, which is 2.6 higher than the rate for White Americans (Belue, R., Chaney, C., Davis, D. 2020). BIPOC racial health disparities propagate hate and ignoble systemic racism and discrimination towards people of color in the US. In what I consider a critical seminal text24, “Eliminating Race-Based Mental Health Disparities: Promoting Equity and Culturally Responsive Care Across Settings,” (Kanter, J., Rosen, D., Williams, M., 2019) the authors craft EBT practice and recommendations for clinicians and educators alike on how to best combat BIPOC health disparities in the behavioral health field utilizing multicultural competency and nonacculturalization of the US BIPOC community for nonbiased Recovery (clinical, medical model included) in general. Effects of the influence of racism and bias on BIPOC (mis)understood bias on behavior certainly shows for the disproportionate numbers of BIPOC individuals receiving questionable Serious Persistent Mental Illness diagnosis (e.g., Schizophrenia Spectrum Disorders and Psychosis, Bipolar Disorders).

Race-based stress and experienced trauma occurs frequently. Contextually and historically, BIPOC individuals comprise perhaps a majority of incarceration and inpatient psychiatrization derivative of archaic systemic racist practice and effected practice for learned assessment, diagnosis and treatment.25 Teachings on race, racism and cultural competence now addresses “… biases, resistance, egocentrism,” of non BIPOC practitioners and providers (O Kanter, J., Rosen, Department of Health and Human Services (2011) 6 U.S. Census Bureau, American FactFinder. American Community Survey. 2008 American Community Survey 1-year estimates HEALTH DISPARITIES IN THE US BIPOC POPULATION 8 D., Williams, M., 2019). With COVID19 (SARS-C0V-2) especially, the global pandemic has shown how “racialized” health inequality existing in the US compares to Non BIPOC populations (Louis-Jean, J., Cenat, K., Njoku, C., et al. (2020).

In summary, I have discovered that there is an immense library of literary resources available on my topic of BIPOC Health Disparities in the US including historical contextual perspective and information. My references to examples of BIPOC health disparity through psychiatric oppression of this historically vulnerable population and to the global pandemic of COVID19, does show how American BIPOC numbers of individuals experience a greater and disproportionate number of individuals in need. BIPOC populations are at greater risk due to the burden of living with a Mental Health diagnosis, being psychiatrized and who are effected by COVID19. People living in low-income geolocations are more apt to not be able to easily access desperately needed medical attention, care, supports and services. The BIPOC health disparities as I have clarified did not begin with COVID19 but the virus shows and highlights the pre-existence of racial health inequities experienced by the US BIPOC populations today.