Racial disparities in health care didn’t happen by chance. They result from centuries of political, economic, and social decisions woven into the framework of the nation.
Those are the sentiments of Daniel E. Dawes, a health policy expert, researcher, and attorney who helped craft federal health legislation, including the Affordable Care Act. Dawes, a keynote speaker at Children’s Hospital Association’s Transforming Quality Conference, is dean of the School of Global Health at Meharry Medical College.
“It isn't a fluke that some groups experienced poverty for generations, blocked from achieving the American dream. You see, our system has not always valued each person equally or realized the long-term implications that policies have on our people,” he said.
As examples, Dawes cited legislation such as:
- Home Owners’ Loan Act of 1933, which precipitated “redlining,” or the process where lenders deem certain neighborhoods too risky for financial investment.
- Social Security Act of 1935, which excluded farm laborers and domestic workers, most of whom were Black or immigrants.
- Federal-Aid Highway Act of 1956, which routed four-lane highways through poor neighborhoods, avoiding middle-class and affluent white areas.
“You can see how policies, even when they are facially neutral, have been utilized over time to harm certain populations,” Dawes said. “All of these laws have essentially created a poverty tax on these communities in the form of higher payments for auto insurance, lower property appraisals, and higher mortgage interest rates on home mortgage loans.”
Despite efforts to address these historical inequities, Dawes said their effects continue to carry over into health care, decreasing life expectancy and causing thousands of deaths among Black Americans and minority groups each year.
“Life expectancy continues to go down while our cost to address these issues continues to go up,” he said.
What can we do?
To ensure issues surrounding health equity resonate with policy makers, Dawes said it's vital to illustrate disparities’ financial impact. He cited studies that put the cost of health disparities in mental health and chronic health conditions in the billions per year.
“As the country becomes more racially diverse, the cost of inequities will continue to increase,” he said. “For us to be among the healthiest nations, we really need to reach up higher to the determinants of health, and we've got to embrace health equity as an agenda item.”
Even with the challenges, Dawes said with more states expanding Medicaid coverage and enacting other equity-focused pieces of legislation, the country is making progress toward a more equitable healthcare system.
Continuing to chip away at inequities requires knowledge, partnerships, and tremendous courage. “It can be easy to become apathetic but ... we cannot allow pessimism to push us further into hopelessness,” Dawes said. “By harnessing the power of collaboration, we can truly move the needle forward in a manner that many of us never dreamed possible.”
Daniel E. Dawes, JD, was a keynote speaker at Children’s Hospital Association’s 2024 Transforming Quality Conference.
