 Hello, this video was to talk about the relationship between racial, economic inequality and health care to spare. First of all, I hear a couple kinds of comments that I think are reasoning errors when it comes to race and inequality in any area. The most significant one and the most serious one is the belief that if it's happening to other people such as poor whites, then it can't be a race problem. And that's just not true. What makes it a race problem is the gap between what happens in the different groups. The other problem that people have, especially with my research is I focus on African Americans. And I hear people say, well, it's not just just and the emphasis is on just happening to African Americans. And that's a true statement. It doesn't at all change, discount what is happening to African Americans. I focus on African Americans for several reasons. Number one, I believe that history is important to why we have inequalities and people have very different histories. And it's important to understand those histories and not combine everybody in one group. For instance, Japanese Americans have been here many centuries. But when they came, the initial groups came over, they were all well educated and task and people with professions. And that was largely because the emperor of Japan wanted to be sure that the image that Japanese put forth would reflect well back on Japan. So Japan in the 17th and 18th century would not allow poor people to immigrate, only people with skills could immigrate. So what we had coming to America were a lot of Japanese who were educated and a lot of farmers. And it's not to say that Japanese didn't and don't, they continue to experience discrimination. But if you compare Japanese Americans to African Americans who were legally kept uneducated until the 20th century and even then received really bad quality education until the middle of the 20th century, you're comparing apples and oranges as minority groups. The other thing to know about Japanese is Japanese had a large part of their wealth taken away from them during World War II. They were as a group, fairly wealthy farmers in California. And I won't get into all of this because I want you to take, if you can take my racism course or if you had another school take the racism course. But my point is that groups have a racialized history that impacts where they are and to put every group and to group all groups together, then all the groups suffer. I think for instance, Appalachian whites suffer from being in the white group as opposed to an ethnic white minority. They have some of the worst health statistics and economic inequalities, but they don't get broken out. So I am a proponent of breaking out groups and talking groups individually. Doing that in no way implies that I'm doing a hierarchy of pain. In fact, when I give my talks nationally, I start off by saying I'm not doing a hierarchy of pain. I'm not trying to say who is the worst off in America, who has the most pain in America. That's an irrelevant discussion. I'm just trying to give you an overview of inequality based on race. It's not to say that whites don't and aren't suffering and that some whites may be suffering even more than some blacks. But there is a racial component that is centered around whites be having a better status. So the worldview that you have to start is racism impacts everything in America. And you may have seen this before, but I'm going to go over it again. This is my slide of how everything is impacted, how health is impacted by everything and how racism impacts everything. So what we have is African Americans who come to this country as slaves and then suffer through legal apartheid and then continue to suffer through racism. Those that provides both a historical and a current deprivation and oppression. And what that means is we have embedded social and racial inequalities in all our systems. And you can't separate out one system and say, well, in this system, we have racial inequalities, but in these other systems, we don't. We have racial inequalities in all the systems. I'll come back to that in a minute. But what I want to show is those inequalities impacts what is available for communities and what is available for individuals. So when you focus on individual behavior and choices, and no doubt that's an important point that always when you're talking about population health versus individual health. So if you were talking to me, I'm overweight. And if you were talking to me, you certainly would want to counsel me about exercising and the food choices I made. But if you're talking about changing the population's health, then you've got to look at the environments in which they live and change those environments. And all of that chronic stress of racism, all of that affects health. Going back to the point that I want to make here is the embedded racial inequality. There are wealth and income inequalities, and I'm going to go in great detail in that in a minute. There's educational inequality. There has been a significant growth from out of slavery to now in the percentage and number of people who are educated. You're talking about less than one digit coming out of slavery to over 85% now who graduate from high school. So there's been a significant growth, but there's disparities. So even into the profession. So what you see, for instance, law school is a good example. Law schools admit whites at a much higher rate than their representation in the LSAT pool. So I'm not even talking about in the population pool. I'm talking about in the pool of people who want to go to law school and take the LSAT. Whites have an advantage in that admission process. In criminal justice system, when you control for severity of crime, you get blacks with longer sentence. In fact, one study showed that the more black you looked, the longer your sentence was. And that was true as if in fact you were white, the more black looking white people got longer sentences than the more white looking white people. When we're talking about environment, studies have shown that the number one factor to predict where a toxic dump will be placed is the race of the community and then the income. That is a toxic dump is more likely to be placed in a place closer to a black middle class community than it is to a poor white community. Now I'm not saying that toxic dumps aren't placed in these communities. Remember, we're talking about disparities. We're not talking about all or nothing. Housing over and over again, we continue to see that housing discrimination and housing loan. One of the reasons that this the housing bubbles burst impacted the black community so significantly is because the whole predator lending practices were tried out on the black community before they were imported into the white community. For years, for instance, here in Dayton, Ohio, about 10, 12 years ago, the city of Dayton, which is half black, tried to pass an ordinance that would restrict the predatory lending practices of banks in housing because it was such a bad problem and mostly affecting black people. And they passed an ordinance, but the state of Ohio overturned it because they saw it as a unique problem to the black community and they didn't want to burden the housing industry with it. The TGAD means targeting of gun, alcohol, and drugs. And if you read my tobacco article in my Dying While Black book, you will see that there is significant targeting of the community. People are just not being treated equally that people are going after selling drugs, going after marketing guns. One of the things that we tried to do in the 1980s, which was unsuccessful, is to get rid of what was called the Saturday Night Special. It was a very cheap gun, who's small, and the only design for it was shooting people. And we tried to outlaw it on a strict liability claim we lost. Employment. I'm going to show you where blacks have more unemployment. And right now what is happening to the black middle classes is that there's growing discrepancy among the hiring of black professionals. And finally, food, water, and etc. The issue of food deserts is a significant issue. And if you are a black middle class community, you more likely live in a food desert than a white middle class community, maybe even more than a poor white community. So the point here is you can never say race is not a factor. So just because you move race as a factor in all of these dimensions, the racial inequalities that are built into our society and the law doesn't deal with, we'll talk about more, that then impacts health and impacts the quality of health. Now, one of the things I wanted to talk about is the impact of economic inequality on health care. So we like to believe that the color of money is green, and if you have enough green, that will take you out of racial inequalities. But the fact is, is racial wealth and income gaps are significant and growing. First, I want to go deal with racial income inequality. So what we see here is a distribution of income by race, white, black, and Hispanic origin for 2010. And what you see is a significant disparities. About twice as many whites make over $100,000 a year as blacks. And about 60%, almost 70% of blacks make less than $50,000 a year, while only about 45% of whites make less than $50,000 a year. So that income, that's an income impact that distribution, a racial distribution of income that is going to have an impact. Here's another way to see median incomes, racial gaps between 1989 and 2010. And if anybody's interested, this is a neat little chart you can go to and you can pull up different years, excuse me, years. But what you see is that there's always been a gap. In 1989, there was a $27,000 gap between non-whites and whites. And in 2010, there's about an $18,000 gap. So there's been a closing of the gap, but the gap still exists and the gap is more, is significant. One of the reasons for this growing gap is the jobless rate. The African American jobless rate has been growing significantly. It's at 14.4% compared to 7.4% of whites. Now, this is recent statistics. This doesn't even show the difference between young adults. The young black young adults have almost a 34% unemployment rate compared to a 10% unemployment rate for white young adults. So there's a surging joblessness rate. And in some parts, you have to ask yourself, is the recovery in the white community occurring because of discrimination towards blacks? Again, to show the gap in the median value between whites and blacks. And this is the wealth gap. It is true that white incomes have been decreasing over the years, but so has blacks and maybe, and at a larger portion, the gap now between whites and blacks is $6,000 compared to the low of 4,800. In the early 2000s, the racial wealth inequality. So, as I said in the other slide, the wealth gap between blacks and white has tripled since 1984. Okay, whites had a $90,000 in 1984, $90,000 wealth and blacks had around $6,000 and now whites have $265,000 in wealth in blacks, median wealth. That's half of the people, half of the white people have wealth over $265,000 while half of the black people have wealth of less than $28,000. So when you look at the wealth gap, which is even more significant than the income gap. You see that in 1989, there was a $23,000 gap in wealth between whites and non whites, and that that gap has actually grown over the last 20 years. Now the gap is $21,000, right? No, $31,000, excuse me. Now the gap is $31,000. So that's a huge financial assets because how you get in trouble is with medical bankruptcy, educating your children, all come out of assets. No one can pay for that just on the income they make. Finally, the white wealth growth goes to how fast the wealth has grown. So for every dollar in income increase yields $5 worth of wealth for whites, while it only yields $0.69 worth of wealth for black. Even when you control for the same amount of wealth to start off with, that is blacks and whites have the same amount of wealth, the growth is different. For every dollar in income increase when blacks have similar wealth to start, whites have a wealth growth of $5.19, while blacks have a wealth in growth of $4.03. So what does all this have to do with health care disparities? Clearly economic barriers to health care include the uninsured or the underinsured, which is over $45 million of every $45 million uninsured and underinsured. But blacks are disproportionately represented because they have a disproportionate percentage of unemployed. They have a disc of the people who are employed, they're more working class in jobs that have little or no insurance, and they have more disqualification for government programs. So economic barriers affect everyone, but we have a saying in the black community, and I think these statistics bears it out. When white people get a cold, black people get pneumonia. That is to say that because things are not equal in this country, there is not an equal impact. And if you want to make changes in your design programs, you can't just design programs thinking that they're going to have the same impact on each of the community. If you have any questions, feel free to post them on Moodle.