The contribution of structural racism to metabolic health disparities in the USA

Abstract

In the USA, the 1985 Heckler report 1 Heckler M Report of the secretary's task force on black and minority health. Department of Health and Human Services, Washington1985 Google Scholar is the first government-sponsored comprehensive overview of health disparities among non-White populations. Its findings were startling—health disparities accounted for 60 000 excess deaths each year and six causes of death accounted for more than 80% of mortality among Black and other minority populations in the USA. Among those top causes of death was diabetes. The Heckler report outlined recommendations to reduce health disparities and improve data collection among non-White citizens. Following its release, the US Department of Health and Human Services Office of Minority Health was established, with Dr Herbert Nickens as the inaugural director. 2 Gracia JN Remembering Margaret Heckler's commitment to advancing minority health, health affairs blog. https://www.healthaffairs.org/do/10.1377/hblog20181115.296624/full/Date: Nov 16, 2018 Date accessed: May 23, 2021 Google Scholar Other outcomes included pivotal legislation, funding, policies, research and initiatives focused on minority health and health equity, and establishment of the NIH Office of Minority Health, the Center for Disease Control and Prevention, and the Health Resource and Services Administration. 2 Gracia JN Remembering Margaret Heckler's commitment to advancing minority health, health affairs blog. https://www.healthaffairs.org/do/10.1377/hblog20181115.296624/full/Date: Nov 16, 2018 Date accessed: May 23, 2021 Google Scholar Despite this investment of resources, the Institute of Medicine's 2003 report entitled “unequal treatment” showed persistence of race and ethnic disparities in health and health care, with ethnic-minority populations having less access to preventive care, treatment, and surgery, leading to delayed diagnoses and advanced disease presentations. 3 Smedley BD Stith AY Nelson AR Unequal treatment: confronting racial and ethnic disparities in health care. National Academy Press, Washington2002 Google Scholar These findings highlighted the major gaps of the 1985 Heckler report. Although its recommendations focused on lifestyle choices and behaviours to improve health outcomes of minority populations, it did not address the need to further desegregate medical institutions, improve access to quality health care, increase investments in preventive medicine, or change policies and living conditions that contributed to poor health. 4 Tuchman AM Diabetes. A history of race and disease. Yale University Press, New Haven2020 Crossref Google Scholar To improve the health of the nation and achieve health equity, understanding the historical contributions of structural racism to health and health-care disparities is crucial.