For Black and Latinx People, What Does Race Have to Do With Health?

by Pilar Ortega, MD, and Brian Williams, MD -For Black and Latinx individuals, what does race have to do with health?

If you find yourself in the emergency department, meeting your doctor for the first time, you make thousands of assumptions about that person based on what you see — as they do of you. It is subconscious and can influence conscious behavior without realizing the influence of race, ethnicity, gender, and more. Doctors, particularly those who work in emergency settings, are trained to make quick decisions based on limited observations. In the era of COVID-19, incorrect assumptions leading to these decisions can be lethal.

As a Latina emergency room doctor and a Black trauma surgeon, we know that our initial impressions — like the assumptions patients might make about us — are not always on target.

Ironically, the communities we represent are also facing a disproportionately high risk of death due to COVID-19. We are concerned that public health messaging is not setting them up for success.

For example, home quarantine guidelines do not tell a multigenerational household what to do if they live in a one-bedroom, one-bathroom apartment. Nor do work restrictions apply to essential workers, most of whom are Black or Latinx. This is more concerning for undocumented workers, who may face unemployment for choosing health over a paycheck.

Health literacy and language barriers also lead to worse health outcomes. According to a study in the Journal of General Internal Medicine, patients who do not speak English have worse health outcomes in chronic conditions such as diabetes if they do not have a doctor who speaks their language. Non-English speakers are also less likely to know how to manage their health through online portals and telemedicine, which have become necessary during this pandemic but do not always include capacity for integrating medical interpreters or patient advocates.

There is clear evidence that close physical contact, lack of appropriate personal protective equipment, and uncontrolled chronic medical conditions are risk factors for increased mortality due to COVID-19. Yet, the very people who are at the highest risk are often ignored by public health messaging and by leadership charged with emergency preparedness. Government leaders base their COVID-19 re-opening decisions on data from the general population without accounting for geographic variations in infection rates and mortality.

Areas densely populated by Black and Latinx people are more likely to have worse outcomes, but these communities are less likely to be counted or have their demographic characteristics accurately reported. It seems as if the system is allied to ensure that communities of color fail rather than flourish. To simultaneously ignore that this failure is happening perpetuates a feeling shared by many Black and Brown communities that society views us as “expendable.”

Furthermore, it is critical to acknowledge that the separation between Black and Latinx identities is an artificial, socially imposed distinction. Given the traumatic history of colonization, enslavement, and racism that still plagues many Latin American countries and Latinx communities in the U.S., we would do well to mind the words of Chicago Afro-Latinx scholar Ángel Vélez, who said, “there would be no Latinx community without Black people.”

Many Latinx people report feeling more connected to their national ancestry (e.g., Peruvian, Mexican, Colombian, Costa Rican, etc.) than as a single ethnic group category (“Hispanic,” “Latino,” “Latina,” or “Latinx,”). Therefore, they may self-identify with multiple races. This includes Black or Afro-Latinx and those who self-identify as or “pass for” white. The experience of Blackness within Latinx identity must be acknowledged, along with the recognition that Latinx people themselves (particularly those who are or pass for being white) may negatively contribute to needless divisiveness among themselves based on skin color.

Wouldn’t it, therefore, be more useful to use our unique perspectives and our shared experience as immigrants and minorities to build each other up? To demand a just health system that addresses our needs? To build an educational system that treats our children fairly and that truly values diversity and encourages multilingualism? To choose elected officials who are aware of the realities of our communities’ lives and who appropriately respond to them?

While Black and Latinx people may experience unique barriers to health on both individual and community levels, we importantly share lived experiences that, when united, may strengthen our voices and uplift each other.

Our understanding of race and ethnicity must become more nuanced. At the doctor’s office, at the supermarket, at the workplace, at our children’s schools, at the voting booth, we cannot assume we know more about the person in front of us than they do about themselves.

Race, ethnicity, language preferences are just the beginning. The box or boxes we check on those forms will never suffice to define us; but, they can be an opportunity to say something about who we are and to demand that we are heard together.

Pilar Ortega, MD, is a clinical assistant professor of emergency medicine and medical education at the University of Illinois College of Medicine in Chicago and president of the Medical Organization for Latino Advancement (MOLA)Brian Williams, MD, is an associate professor of trauma and acute care surgery at the University of Chicago and special advisor for health equity for Dallas County (Texas) Judge Clay Jenkins.

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