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.