Public health professionals use “Social Determinants of Health Outcomes” to measure community health. Health outcomes reveal the social, economic and environmental structures of our society shaped by our political priorities. In spite of the advancement of modern medicine and healthcare systems, the aforementioned factors continue to reveal significant disparities in public health outcomes. These outcomes are interconnected to our social structures and public policies, affecting every facet of our life, including life expectancy. I am not a health professional, but my work in the community has exposed me to look at such disparities closely. Serving at Minority Health Equity Advisory Council for Region V (includes Illinois, Indiana, Michigan, Minnesota, Ohio and Wisconsin), I realized that health disparities among ethnic minorities are similar in these states.
The social determinants of health outcomes reflect our national priorities on societal well-being, burdening the healthcare system. The powerful and vocal sectors of U.S. citizenry consider access to affordable healthcare a privilege, not a fundamental right to sustain life. Therefore, negative health outcomes are the results of federal and local policies, disproportionately affecting the poor and people of color. For decades, the Catholic Church has been an ardent advocate for health equities. In the history of healthcare in the United States, almost all our hospitals started as charitable entities for the poor by churches. The Catholic Church is part of this august legacy. Sadly, as the society became more affluent, the original mission of the healthcare system lost its purpose, marginalizing the poor. Though the Catholic Church is consistent on health equities to bridge health disparities, many Catholic public officials do not align with the Church’s vision.
The stratification of our socio-economic structures mirrors the successes and deficiencies in community health. Consequently, the U.S. social structure based on income, education and geographic location plays a significant role in health outcomes and life expectancy. Poverty as a primary indicator is concentrated in African Americans, Native Americans, Asians and Latinos. Therefore, skin color highlights the health disparities and negative outcomes in ethnic minorities because of systemic racism, depriving resources and affecting their qualities of life.
Advancing the dignity and welfare of the human person is at the core of the Social Teaching of the Church, hinging on two pillars: justice and charity. Social justice strives to address the root cause that undermines the dignity of the human person, while charity addresses the symptoms, as a temporary fix. Therefore, they complement each other. Unfortunately, some policy makers consider the Church’s advocacy for social justice as political interference. Yet uttering her prophetic voice for social justice is part of the Church’s identity.
In the last decades, we have witnessed the fall of life expectancy among white males in the rural areas due to lack of employment. Economic stressors led to despair, causing drug addictions and a lower quality of life. Unemployment and underemployment are primary factors for poor health outcomes in these communities. The systemic exclusion of African American communities from gainful employment created a generational cycle of poverty. Therefore, drug addiction, which ravaged African Americans for decades, was criminalized, causing mass incarceration in the name of law and order. When drugs started affecting rural whites, it became a public health issue, requiring treatments and mobilizing resources.
The War on Drugs resulted in creating a new money machine, the Prison Industrial Complex, further destroying generations of African Americans. The Wisconsin African American population is about 5 percent but makes up more than 50 percent of the state inmates. The majority of those in prison need treatment, not incarceration. Paradoxically, the prisons are built in rural areas as job opportunities to residents. The prison industrial complex is a new means of segregation and criminalization of a whole community. “Get tough on crime” became a code phrase for racial bias, leading to an unequal justice system.
The economic shifts caused by globalization have been going on for more than four decades, calling old industrial areas as the Rust Belt cities. African Americans are majority residents in these decaying cities. As the land of immigrants, demographic shifts in urban areas are not new to the U.S. In the 1950s, government incentivized suburbanization caused “White Flight.” African Americans, who were excluded from such opportunities, moved into old white neighborhoods. The houses were not only old, there were also health hazards due to decaying utilities, lead paints, asbestos and mercury residues, affecting thousands of children. Additionally, urban communities have to carry heavy tax burdens, sustaining old infrastructures with little return to improve their quality of life. Environmental injustices disproportionately affect urban poor residents. Flint, Michigan, is a recent example of environmental injustice.
Systemic racism is the root cause of health disparities, imbedded in government policies that still disenfranchise many of its citizens, namely African Americans and Native Americans. Pseudo-sciences and theology created to justify such exclusions continue to operate, ingrained in the psyche of the dominant culture, perpetuating debunked myths and stereotypes.
It was only in 1979 that the U.S. Catholic Church emphatically condemned racism as a sin. Prior to that, racism was treated as a lack of charity, not as a fundamental violation of human dignity; therefore, injustice. Recently, Milwaukee County called racism a public health problem, underscoring the negative health outcomes. For generations, systemic racism has compounded health disparities among African Americans and Native Americans. We can no longer give blind eyes and deaf ears to such injustices and sin.
The Church divides sin into individual and communal. Racism is a communal sin that needs a community atonement. People object to reparations for slavery without assessing the direct correlation of generational trauma, resulting in negative health outcomes. The Black-on-Black crime and other social ills in the African American communities is also linked to generational trauma from systemic racism.
African Americans developed a resigned attitude toward employment. “Last to hire, first to fire” is a reality. In a society where job defines ones identity, depriving African Americans from gainful employment is rendering them nobody. One cannot have a stable family without a stable job and access to resources. Such an eco-system stunted the growth potential of African Americans and other minorities. The disproportionate health problems we witness in African Americans, such as hypertension, diabetes, obesity, coronary disease, substance abuse and alcoholism have direct correlations to systemic racism.
Consequently, the morbidity and mortality rates of African Americans and Latinos caused by COVID-19 cannot be isolated from issues of systemic racism. As Catholics, our silence or inactiveness make us participants in the sin of racism by omission. For many, such social ills seem insurmountable. However, our faith informs us, “Nothing is impossible for God.” In the midst of our sinfulness, grace abounds for atonement and redemption. In St. Paul’s words, “Where sin increased, grace overflowed all the more.” (Romans 5:20) We unequivocally are aware racism is a sin. Therefore, our Catholic faith compels us to eradicate this sin from our society. We have a moral and historical obligation to free ourselves from the sin of racism, and remove its curse from the next generation, too.