Health care inequity is destroying
lives. But it’s not just killing people. It’s creating needless suffering and
leaving a wake of disease and distrust in its lethal path.
Last week, the NFL announced it
would stop practicing “race norming,” and frankly, it’s about time. Race
norming on a broader scale is a methodology used to adjust test scores based on
race or ethnicity. It was originally developed to account for racial bias in
aptitude testing, meaning, it was intended to even the score, so to speak. In
the NFL, race norming has done the opposite, wreaking havoc on health outcomes
for Black players.
Instead of counteracting racial
bias, race norming, as applied in the NFL to evaluate players’ health, has
fueled it. As a result, it has widened the gap in health care disparities based
on race.
Here is how: The league’s testing
methodology places Black athletes at a lower cognitive functioning baseline
than other groups, which then makes it more difficult to show the effects of
post-concussive syndromes. Does that seem “fair”?
It gets worse.
Headaches
for the NFL
In 2016, the Supreme Court upheld
the $1 billion concussion settlement that calls for up to $5 million each to
former players diagnosed with certain neurological disorders. Attorney
Christopher Seeger, who helped negotiate the settlement for the retired players,
celebrated the terms of the settlement, saying that now players would finally
receive “much-needed care and support for the serious neurocognitive injuries
they are facing.”
Yes, this landmark settlement was
progress, but it held a dirty secret. This practice of race norming, which was
standard in NFL player health evaluations, put Black players at a disadvantage.
The race-based benchmarks skewed test results, made it more difficult for Black
retirees to show a deficit, and was used to deny them settlement money they
could have used to get health care services for brain injuries.
As a result, former NFL players
Kevin Henry and Najeh Davenport filed a class-action lawsuit accusing the
league of "explicitly and deliberately" discriminating against Black
players filing dementia-related claims. The suit asserts that, if white, Henry
and Davenport would have received their share of the settlement, but they were
denied on the basis of racist logic that, as Black people, their cognitive
functioning was already impaired or lower than their teammates’ before they
ever hit the field.
Simply put: Race norming robbed
Black athletes of the access to resources and health care–access that they
would receive if they weren’t Black.
As Najeh Davenport observed,
“That’s literally the definition of systematic racism.”
When I first read about it, my
blood boiled. This discrimination was happening in 2021! It brought me back to
when my son Jordan played professional football and team doctors gave him
advice or recommendations that I found questionable, not as a mother but as a
career health care professional.
Being in the NFL had been Jordan’s
lifelong dream. He’d worked tirelessly since he was a kid to hone his athletic
skills for a shot at getting into the league. I didn’t want to rock the boat.
Now, Jordan has been out of the NFL for years, and I am done being
agreeable.
COVID-19 -
Disparities’ Double
Over the past year, I have
witnessed the pandemic expose the harsh realities of health care inequities in
America. 2020 revealed how communities of color, underserved areas, and
lower-income populations are more vulnerable to the often-fatal effects of COVID-19
than others. I even wrote a blog
to educate and encourage players
and their parents to get informed and reduce their risks of contracting the
deadly coronavirus.
The common thread between the wrath
of COVID-19 in certain communities across America and what has been happening
in the NFL: health care disparity as a result of bias.
Health care disparities are often
viewed through the lens of race, but they also occur across socioeconomic
status, age, gender, sexual identity and orientation, and citizenship
status.
Social determinants-the conditions
in which people live, learn, work, play, and worship–also play a significant
role in the health care most people receive. Of course, having money helps, but
if you don’t have a solid foundation for nutrition or get medical help when you
need it, affluence won’t significantly impact your health.
It is a common assumption that
money can buy good health care outcomes. That is not often the case for people
of color. The contrast between who gets quality health care and who does not is
stark. But sadly, it is not new.
Inequality was rampant in hospital
rooms in Kentucky, where I earned my nursing degree. I witnessed a severe
contrast in care as Black patients were treated poorly by the medical staff.
This was just a few decades ago, when that type of behavior should not have
been acceptable, but it was expected.
No Fair
Play for College Athletes
Years later, as the mom of a
college athlete, I was aghast to see that health care disparities had seeped
into collegiate sports. Colleges spend thousands of dollars recruiting the best
talent possible. So of course, their priorities include keeping recruits in the
best possible health with quality health care, right? Sadly, no. The poverty
and limited health care resources that I grew up with in rural Kentucky are the
reality most collegiate athletes face. More than 8 in 10 come from families
that live below the poverty line.
A recent report by
the Knight Commission On Intercollegiate Athletics found that social and
economic inequities between Black and white student-athletes are worsened by
intercollegiate sports. I saw this first-hand.
While in college, Jordan befriended
a young man who also earned a football scholarship. From all appearances,
Jordan and his teammate were pretty similar. They played football, were there
by invitation from the university, and they both wanted to succeed. But
Jordan’s friend had a secret he was keeping under wraps.
Out of fear of losing his
scholarship, the young man hid his illness until he couldn’t anymore. Like many
others, he used sports to get a good education in the hopes of improving his
station in life. But he was suffering with a long-term chronic illness that
required medical attention.
It had become obvious to my
son that his friend needed care, but somehow, his coaches, trainers, and
medical professionals were able to turn a blind eye to it.
Very late one night, I
received a frantic phone call from Jordan. He was at the local hospital's
emergency room in College Station, Texas, with his friend who was having
seizures. Jordan knew his friend’s health was rapidly deteriorating. His friend
was ill with a fever and had a seizure right there in the hospital’s waiting room.
Still, he couldn’t get anyone there to help, so he called me. I told him to put
a doctor or nurse on the phone. I let them know that I was a nurse and that
this young man needed help immediately.
Jordan’s friend finally received medical
attention as soon as we hung up. He spent the next three days in the intensive
care unit. He could have died that day. This was the first time that I
recognized how widespread health care disparity is. It was the beginning of my
advocacy.
The lack of urgency to treat
this young Black athlete, and the way other people of color, lower-income
people, and other marginalized groups are often treated, may have more to do
with the implicit bias that is pervasive in medicine. There may not be a
written standard or guideline, like the NFL had with their race norming
protocol, but there doesn’t have to be. It’s happening anyway, and it is its
own pandemic.
An
Unhealthy Dose of Reality
Numerous health care studies indicate that Black people’s pain is often perceived by
medical personnel to be less severe than their non-Black counterparts. These
scenarios play out every day. Requests, pleas, and cries for help like the ones
Jordan made on behalf of his friend, go unheard, unseen, or misunderstood.
That’s how disparity shows up for many people in urgent care centers, doctor’s
offices, and hospitals.
The end result is that the
disparate are sicker, and they have shorter lifespans. Many factors likely
contribute to the increased morbidity and mortality among these groups.
However, it is undeniable that one of those factors is the care they receive
from their providers. They are simply not receiving the same quality of health
care, and this second-rate treatment is shortening their lives.
The end result is staggering.
Harvard sociologist David Williams equates it to a jumbo jet with 220
passengers crashing every day. That’s how many Black people die daily in
America because of how racism chips away at their health.
220.
Preventable deaths of Black
Americans, DAILY.
Due to inadequate, inferior health
care.
In a recent commencement speech at
Emory University, Dr. Anthony Fauci, the country’s leading expert on infectious
diseases, said that “the undeniable effects of racism” have led to unacceptable
health disparities that especially hurt African Americans, Hispanics, and
Native Americans during the pandemic. "COVID-19 has shown a bright light
on our own society's failings," Dr. Fauci warned, referring to the
pre-pandemic disparities that have long existed.
While I spent my career in health
care, I experienced the bias myself as a patient. When I would go to a new
facility or doctor for medical treatment, I was first asked if I had insurance;
then I was asked my address. When both of my answers were acceptable, there was
a shift in how I was treated, but none was greater than when I shared my
profession.
Disparities show up in
life-or-death situations, often with deadly outcomes. For example, according to
the Centers for Disease Control and Prevention, Black, American Indian, and
Alaska Native women are two to three times more likely to die from pregnancy-
or childbirth-related causes.
High-risk childbirth isn’t just
happening to poor women. Serena Williams and Beyoncé are wealthy superstars.
Beyoncé is an international performer and record-breaking Grammy winner.
Williams is arguably one of the best tennis players of all time. Each
experienced life-threatening complications in their pregnancies.
My commitment to being an advocate
for equitable health care continues today. I’ve worked in a range of health
care roles for more than 30 years. I am also an advisor for the Football
Players Health Study at Harvard University– a research initiative focused on
addressing the wellbeing of former NFL players.
Last year, our study examined
health disparities among former NFL players. But despite their physical
training, advanced education, and higher income, Black former players were
significantly more likely than their white counterparts to experience
diminished quality of life due to impaired physical functioning, pain,
depression, anxiety, and cognitive troubles.
The researchers suggested that
factors like discrimination before, during, or following a player’s time in the
NFL could account for the disparities.
Healing the
Divide
Acknowledging racism and
disparities is a first step in reducing them. However, significant changes are
needed to ensure all Americans have equal opportunities to live long and
healthy lives. I identified four pillars that should help level the playing
field and reduce unfairness in health care:
The first pillar is TRUST.
I urge everyone to have a trusted
advisor. This can be a family member, friend, or colleague who is able to
provide reliable advice and/or resources. In our family, I fulfilled that role
for my son. There were times when he was given medical advice or told he was
clear to play after receiving a concussion, and I knew it wasn’t right. Having
a trusted health advisor adds a layer of protection and advocacy.
Another pillar is EDUCATION.
There are strong links between
education and better health. Education can mean landing a better job that
provides health-promoting benefits, like health insurance, paid leave, and
retirement. Conversely, people with less education are more likely to work in
high-risk occupations with fewer or no benefits. Knowing more about accessing
affordable health care and practicing good nutrition and physical fitness are
also paramount.
The third pillar is ACCESS.
Having access to resources and knowledge
can mean having better access to health care. So does living in a place where
there are fewer physician shortages. Comprehensive, high-quality health care
resources are more prevalent, and thus accessible, in communities where
residents are well-insured, but the type of insurance matters too. Medicaid
patients experience greater gaps in access than patients with private
insurance.
My final pillar is HISTORY.
For many people of color, mistrust
of the medical profession is deeply rooted in history, including the infamous
U.S. study of syphilis that left Black men in Tuskegee, Alabama suffering
needlessly from the disease. History informs the past, present, and future. If
someone has a history of being treated well, they won’t hesitate to seek
medical help. Hopefully, one day soon, we will create a new history that is
more equitable when it comes to medical care.
For now, health care disparities
are all too real. It starts in the womb and continues way into adulthood. Yet,
erasing racial and ethnic inequality is possible. The first step is admitting
to it and committing to change this system that ignores some of the country’s
most vulnerable individuals. “Primum non Nocere” is Latin for “first do no
harm”. It is recited by doctors around the world as part of the Hippocratic
Oath. Imagine if we stopped reciting it and applied it to patients.
© 2021, 50-Yard Line Mom®
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joann.pugh@50yardlinemom.com
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