Dorothy Charles PNHP Annual Meeting November 4, 2017 Separate is not equal Single payer as a solution to racial health inequities Dorothy Charles PNHP Annual Meeting November 4, 2017

Overview - Defining structural racism - Structural barriers to health and healthcare - Segregated medicine - Single payer as a solution to racial health inequities

What is structural racism? “the normalized and legitimized range of policies, practices, and attitudes that routinely produce cumulative and chronic adverse outcomes for people of color, especially black people” Brown University Center for the Study of Race and Ethnicity in America

"When white terrorists bomb a black church and kill five black children, that is an act of individual racism, widely deplored by most segments of the society. But when in that same city—Birmingham, Alabama—five hundred black babies die each year because of the lack of power, food, shelter and medical facilities, and thousands more are destroyed and maimed physically, emotionally and intellectually because of conditions of poverty and discrimination in the black community, that is a function of institutional racism. When a black family moves into a home in a white neighborhood and is stoned, burned or routed out, they are victims of an overt act of individual racism which most people will condemn. But it is institutional racism that keeps black people locked in dilapidated slum tenements, subject to the daily prey of exploitative slumlords, merchants, loan sharks and discriminatory real estate agents. The society either pretends it does not know of this latter situation, or is in fact incapable of doing anything meaningful about it."

What structural barriers to health and healthcare exist?

Segregated Healthcare Photo: Public Health Service dispensary #32, Washington, D.C., 1920s, Library of Congress

Desegregating Hospitals Hill-Burton Act of 1946 Eaton vs. Board of Managers of the James Walker Memorial Hospital (1956) Simkins vs. Moses H. Cone Memorial Hospital  (1962) Civil Rights Act of 1964 Social Security Amendments of 1965 Read more: U.S. Hospitals and the Civil Rights Act of 1964

Segregated by Insurance Private Insurance Medicare Medicaid CHIP Indian Health Service Veterans Administration Uninsured/self-pay

Racial discrimination by Proxy Disproportionate Representation in Medicaid US Population Non-Elderly Medicaid Enrollees Black or African American 12.6% 19% American Indian or Alaska Native 0.9% -- Hispanic or Latinx 16.3% 31% Asian or Pacific Islander 5% 8% (“other”) White 72.4% 42% Some caveats: - Hispanic vs. Latinx -- white Hi 2010 US Census Data Kaiser Family Foundation: Distribution of the Nonelderly with Medicaid by Race/Ethnicity

The A Solution: Single Payer The rationale is that separation is inherently unequal. Creating a segregated healthcare system has served to disadvantage Black and brown people by essentially siphoning resources away from communities of color. This is part of an age-old strategy of racialized capitalism that relies on the formation of boundaries and borders in order to police resources and maintain power and control for wealthy elites. Collectivism is the answer. We need to break down these socially constructed divisions for the sake of true racial equity and health justice. And one way to quite literally break boundaries is to create a single payer system in which we truly mean, “everybody in, nobody out!” The A Solution: Single Payer Everybody in! Nobody out!

Separate Is Never Equal “With all, we wish it had not been necessary to establish the Douglass Hospital. We deprecate the present trend in the dominant public mind to create in many sections of the country hospitals and medical schools, especially for colored people -- it means extravagance, inefficiency, duplications of effort, and is undemocratic in that it establishes caste.” Dr. Nathan Francis Mossell Photo from the University of Pennsylvania Archives

Questions? @dn_charles www.dncharles.com heydorothy@dncharles.com