How US Politics Can Shape Your Patients’ Health Outcomes

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A recent analysis of all-cause death rates found that there were 74,402 more deaths among blacks than whites each year between 2016 and 2018 in the 30 largest US cities. This tragic inequity is no accident, according to a leading health equity expert.

“It is no coincidence that certain groups of people in America experience higher premature death rates or poor health outcomes than others,” said Daniel E. Dawesprofessor of health policy and executive director of the Satcher Health Leadership Institute at Morehouse School of Medicine.

“The health of the nation is not an organic outcome,” Dawes said, noting that government policy has been used to embed racism and discrimination into “the structural foundations of this country.”

Dawes, author of the 2020 book The political determinants of healthmade the remarks while speaking to “Righting the Wrong: Addressing Health Inequalities”, a virtual summit organized by the Hastings Center and co-sponsored by the AMA.

Dawes noted that there is growing recognition that the social determinants of health, such as people’s level of food insecurity and housing, often have a greater impact on well-being than care services. of health they can receive.

But he added that the political determinants of health that form “upstream” of the social determinants provide the impetus needed to create and maintain health inequities.

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“The political determinants of health involve the systematic process of structuring relationships, distributing resources, and administering power,” Dawes explained. “These political determinants of health inequitably distribute social, medical, and other determinants, and create structural barriers to equity for population groups that lack power and privilege.”

Learn about the AMA Center for Health Equity and the AMA’s strategic plan to mainstream racial justice and advance health equity. The Satcher Health Leadership Institute at Morehouse School of Medicine and the AMA have collaborated to offer the Medical Justice in Advocacy Fellowship.

The political determinants of the country’s health began to take shape very early. In 1670, the legal code of the New England Colonial Liberties Corps was amended to require that the offspring of enslaved women be born slaves.

“From the perspective of the political determinants of health, this is where the roots of inequality began to take root and incubate in America,” Dawes said. “When corporate interests – wanting to maintain their slavery business model – worked with policy makers to codify this evil institution into law.”

After the United States gained independence, abolitionists petitioned to “ensure the blessings of freedom” to all, Dawes said, but were rebuffed by Congress. The majority of those members of Congress enslaved people, he noted.

In the 20th century, the US government continued to create racist policies, even though they were often “easily neutral”, Dawes said.

These included:

  • Home Owners’ Loan Act of 1933, which led to qualifying neighborhoods as high risk and denying loans and investments that could have created economic opportunity in low-income areas.
  • Social Security Act of 1935, which intentionally excluded domestic workers and farm laborers who were mostly African Americans or immigrants at the time.
  • Federal-Aid Highway Act of 1956, which leveled poor neighborhoods to build highways while sparing middle and affluent white areas.

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Today, Dawes argued, there is a “poverty tax” levied on low-income neighborhoods that results in higher interest rates on mortgages, higher premiums for homeowners and insurance. automobile and, in some cases, even higher grocery prices.

The effects of these policies are clearly visible in the higher rates of asthma, cancer, heart disease and lupus found in economically or socially marginalized areas “due to the structural conditions in which these communities find themselves,” said Dawes.

Watch a ‘Prioritizing Equity’ video discussion on the long-term effects of political determinants on health equity.

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