Race, law, and health policy

As the country moves toward reopening — and with it some sense of “normalcy” — UC Berkeley researchers said simply returning to normal isn’t enough. Rather, they said, dismantling structural racism must be part of any reopening strategy.

During a livestreamed Berkeley Conversations event, “Race, Law, and Health Policy,” on Monday, June 29, the panelists underscored that dismantling structural racism within America’s healthcare system — and tackling anti-Black racism — is essential for true reform.

While the scholars noted how social and economic inequities (including disproportionate poverty and incarceration rates) contribute to disparities, they also cited research showing how people of color receive lower quality health care than white people — even when controlling for insurance status, income, age, and severity of conditions.

Berkeley Law professor Khiara M. Bridges described a toxic combination of individual racism through implicit bias and structural racism that permeates the healthcare industry.

“These views lead medical professionals to make unintentional and ultimately harmful judgments about the care that they give people of color,” Bridges said. “But the disparity can’t entirely be explained by implicit bias. That framework causes us to think of racism as a private concern, which in turn mitigates any responsibility that the state and society more generally has for the eradication of racism and racial inequality.’

Mahasin Mujahid, associate professor of epidemiology, said structural racism reinforces underlying health conditions that COVID-19 has magnified—especially with people of color more likely to be essential workers, in high-risk jobs, and living where social distancing is difficult.

“Over 90 percent of those hospitalized at all ages had at least one chronic condition,” she said. “African Americans, Latinx, and other marginalized populations have more of these chronic conditions, which is a leading explanation for why things are worse in these communities.”

School of Public Health Professor Osagie K. Obasogie described how as a young man his father saw a doctor after breaking his ankle in a lawnmowing mishap. “A white doctor looked at it and almost immediately said they needed to amputate his foot,” Obasogie said. His father refused, had a cast put on, and has since had no problems with it.

“Anti-Blackness as a specific ideology is central to how medicine and public health are organized,” he added. “Health disparity conversations haven’t taken on anti-Blackness and how it’s embedded in every political, social, and economic institution.”

Tina Sacks, a School of Social Welfare assistant professor, said the double national crises of COVID-19 and racial unrest provides a chance to address anti-Blackness and the erasure of indigenous peoples, including through reparations. She also urged examining how other countries with better health outcomes, from infant mortality to life expectancy, spend more on social, housing, and child care services.

“At the core of this is an anti-Blackness that goes so deep and hasn’t been addressed in our country,” Sacks said. “We need targeted programs to deal with the legacy of structural racism that people of color have experienced intergenerationally for far too long in the U.S.”