Social Determinants of Health
With Dr. Marion Henry & Dr. Erica Newman & Dr. Victor Garcia · hosted by Dr. Todd Ponsky · Live Event Content
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What the experts said
Bias affects medical decision-making including who gets referred for procedures and who gets surgery
A healthy African-American woman has a greater likelihood of giving birth to a premature baby even with excellent prenatal care and college education
A Black mother with a college education has a higher risk of giving birth to a premature baby than a white woman who has not graduated from high school
African-American children and minorities who are poor have lower cognitive abilities as evidenced by educational achievement and economic attainment
Black children and adults have higher incidence of cardiovascular disease, strokes, and high blood pressure
Black children in these neighborhoods have higher incidences of high blood pressure
There is a difference in life expectancy and disparities between Mexicans who come from Mexico to Chicago versus Puerto Ricans and Dominicans who come to New York City
Puerto Ricans and Dominicans are an admixture with African ancestry, and Dr. Garcia's father from Puerto Rico was discriminated against because of his darker complexion rather than being treated as Hispanic or Latino
Racism exists in the United Kingdom and has been written about
What is uniquely American is the way slavery has contributed to racism and how long-standing it was before slavery was abolished, with traces of discrimination still visible
For African-Americans in Greater Cincinnati, depending on what neighborhood you live in, you will have a 20-year life expectancy that is shorter than somebody living in a more affluent neighborhood
The vast majority of African-American children grow up in neighborhoods with conditions like the picture Erica showed (child with junkyard next door)
Toxic environments include exposure to air pollution from traffic and lead poisoning
If we do not solve the challenge of worsening disparities, it will be economically unsustainable and will compound what we see with the next epidemic or pandemic
In zip code 45229, chronic absenteeism at Rockdale Academic Elementary School is 39%
Despite $68 million a year being spent by nonprofits in zip code 45229 (Cincinnati), not much has changed in economic distress indicators
There are not many low-poverty neighborhoods that will be welcoming to Black people coming in because of inherent biases
Recent Pediatrics article shows Black children are more likely than white peers to die or have complications after surgery, making national newspaper headlines
African-American children are more likely to die after congenital heart surgery, neurological procedures, and experience delays getting onto kidney transplant lists and are less likely to receive transplants
African-American children are more likely to have complications from appendicitis, solid tumors, extremity sarcomas, and gastroschisis
The recent Pediatrics study looked at children who were all healthy (ASA 1 or 2) undergoing inpatient surgical procedures, eliminating the impact of poor baseline health, and race still had an impact with African-American children having higher risk of postoperative complications and mortality
Data from the Implicit Association Test (IAT) collecting data from millions of participants shows all healthcare providers have bias that favors whites
Children and adolescents experience bias not only in healthcare but in education and the criminal justice system
Biases are not hard-wired, can be changed, and can be replaced with new associations
According to Rob Sampson's data, the worst urban context in which whites reside is considerably better than the average context of Black communities
Your zip code is more of a predictor of your life span and quality of life than your genetic makeup, as commonly seen in the literature
Concentrated poverty by neighborhood impacts every organ system according to neurocognitive scientists and anthropologists
Poverty affects the prefrontal cortex (causing children not to pay attention in school), hippocampus (impairing memory), and amygdala (making them more likely to fight than flee)
The incidence of chronic inflammation for parents and children in poverty is significantly higher, helping explain why African-American women have higher prevalence of lupus and autoimmune diseases
95% of Black children grow up in concentrated environments that are not only materially deprived but toxic
According to Raj Chetty's study of 20 million individuals in every urban setting in the United States, if a child born in Cincinnati does not move out of that environment before age 10, there is a steady decline in the likelihood of improving adult outcomes
It is estimated that 350 million jobs globally are going to disappear with automation and AI
In Sweden, which has universal healthcare, similar disparities are seen based on neighborhood locations affecting health outcomes
According to W.E.B. Du Bois in 1899, the issues with minority infants and health are due as a consequence of their economic plight