Racial Health Inequities Research Articles

Secondhand racism: What we know and where to go regarding the relationship between vicarious racism and mental and physical health

AbstractRacism has long been established to be a significant determinant of racial inequalities in health among racially minoritized individuals. Most of this research, however, has been focused on individuals' direct perceived experiences of racism, and far less has been conducted on the relationship between indirect, vicarious experiences of racism and mental and physical health outcomes and behaviors. In this review, racism and vicarious racism are defined, and what is known about the relationship between vicarious experiences of racism and psychological and physical well‐being and health behaviors is documented. Like direct experiences of racism, research on vicarious experiences of racism suggests it is also adversely related to anxiety, depression, general psychological distress, and physiological health (e.g., allostatic load, cardiometabolic risk). Lastly, future directions for research and clinical practice are discussed. Understanding the intricate interplay between vicarious racism and overall mental and physical wellbeing is crucial for informing interventions aimed at mitigating the adverse mental health outcomes associated with experiences with racism.

How the Struggle for Public Health in the Jim Crow South Reflected and Reinforced Systemic Racial Health Inequality

Abstract The twenty-first century COVID-19 epidemic revealed a U.S. public health system that countenanced health inequities and a U.S. public that resisted disease containment policies. This crisis, however, was only the most recent chapter in a longer struggle in the United States to institutionalize public health. We focus on two early twentieth-century public health campaigns in the American South, the unhealthiest U.S. region at the time. Black southerners—denied basic health, political, economic, and social rights under a rising Jim Crow regime—self-organized health services networks, including through the Tuskegee Woman’s Club, the Negro Organization Society of Virginia, and the Moveable School (1890s–1915). Around the same time, a philanthropic project, the Rockefeller Sanitary Commission (RSC, 1909–1914), seeded state-level public health agencies in eleven southern states, thereby installing public health in a top-down manner. We use archival data sources to explore key similarities and differences in the public health concerns and coalition-building approaches of each campaign and southern resistance to their efforts. We find Black-led campaigns often blurred the color line to form coalitions that provided services to the underserved while tackling environmental health risks at the community level. In contrast, RSC affiliates in southern states, as directed by RSC administrators, provided health services as short-term public dispensaries. Services reached Black and White communities willing to participate but in a manner that did not overtly challenge Jim Crow-era practices. Southern resistance to public health expansion persisted under each approach. The legacies of these struggles remain; the political-economic and ideological forces that limited public health expansion while marginalizing Black community health efforts reverberate in public health inequities today.

Exploring racial inequalities in maternal mental health outcomes

Abstract Perinatal mental illness affects around 1 in 5 birthing people globally and is associated with adverse outcomes for those affected and their families. Such adverse outcomes are not inevitable and there is now good evidence for a range of both preventive and treatment interventions. There are well-documented inequalities in mental health outcomes across a range of social determinants, including race; such inequalities are also apparent during the perinatal period. There are also racial disparities in mental health care delivery during the perinatal period. Racial inequalities in perinatal mental health are now being recognized as key policy priorities in both the United States and the United Kingdom. This presentation will present routinely collected epidemiological data, investigating the drivers of these racial inequalities in access to perinatal mental health services and associated maternal and child outcomes. It also will present qualitative approaches to exploring current initiatives to reduce inequalities. Findings have the potential to inform the development of culturally sensitive interventions to promote equity in this area for underserved populations in the U.K., U.S., and elsewhere.

The Racial Health Equity Progress Report: A Data-Driven Equity Action Tool

Health care leaders in Illinois, with support from the Commonwealth Fund, expanded their statewide Racial Health Equity Progress Report (Progress Report) into a nationwide pilot. This effort aims to mobilize data-driven action to achieve health equity across four domains of health care organizational influence: people (employees), organization, patients, and community. The goal of the Progress Report is to address the complex challenges of advancing equity across health care organizations. The Progress Report is a 34-item Web-based self-assessment questionnaire that measures an organization’s performance in implementing processes to address racial health and other health inequities. The questionnaire includes open-text response options as well as a specialized 0–5 Likert scale that assesses the degree of progress of an organization’s racial health equity efforts as Not in Place (0), Internal Socialization (1), Initiation (2), Piloting (3), Implementation (4), and Best Practice (5). The initiative includes individualized data analytic reports designed to assist boards and leaders in advancing health equity strategies and initiatives across their organizations. The Progress Report is aligned with both The Joint Commission and the U.S. Centers for Medicare & Medicaid Services regulatory standards for achieving health equity. The Progress Report also functions as a benchmarking mechanism, allowing health care organizations to measure progress over time, compare their performance with other organizations, and learn from others. Participants are encouraged to translate their Progress Report data into actionable strategies for improvement, including participating in 8-week virtual Improvement Action Networks. This framework highlights the importance of examining all aspects of an organization — not patient care alone — for inequities to successfully eliminate health inequities. Here, the authors describe the origins of the program, its development, and the preliminary results from the Progress Report responses submitted by 92 U.S.-based hospitals and health centers, as well as prospects for expanding and scaling the initiative.

Bridging the gap: Political engagement and trust as mediators of racial health inequities and vaccine reluctance

This paper investigates how political engagement and trust can reduce health disparities in the context of COVID-19 vaccine hesitancy. It posits that active participation in the political process and trust in political institutions enable communities, especially marginalized ones, to advocate for equitable health policies, leading to more inclusive healthcare services. The study employs a multidisciplinary approach to understand how politics influence individual and collective health behaviors and decision-making. The research uses t-tests and logistic regression to analyze the relationship between political factors (like interest and participation) and trust in political and federal systems on COVID-19 vaccine hesitancy. The t-test examines disparities in vaccine hesitancy across racial groups, revealing significant differences and emphasizing the impact of race on health behaviors. Logistic regression, controlling for variables such as partisanship and media influence, further explores these relationships, showing a consistent negative correlation between trust in federal institutions and vaccine hesitancy across racial groups. The study also finds that this correlation varies by race, with trust in the political system and political participation influencing vaccine hesitancy to different degrees among racial groups. These findings underscore the complex interplay between political engagement, trust, and health behaviors, highlighting the role of politics in shaping public health outcomes.

Effect of same-sex marriage legalisation on the health of ethnic minority lesbian, gay and bisexual people: a quasi-experimental study

BackgroundThe UK legalised same-sex marriage in 2014. We examine whether same-sex marriage legalisation (SSML), an exogenous policy change, affected the health outcomes among ethnic minority lesbian, gay, bisexual and other...

Centering Racial Health Equity in Systematic Reviews Paper 5: A Methodological Overview of methods and interventions

We aim to 1) evaluate the methods used in systematic reviews of interventions focused on racialized populations to improve racial health equity, and 2) examine the types of interventions evaluated for advancing racial health equity in systematic reviews. We searched MEDLINE, Cochrane and Campbell databases for reviews evaluating interventions focused on racialized populations to mitigate racial health inequities, published from January 2020 to January 2023. We analyzed 157 reviews on racialized populations. Only 22 (14%) reviews addressed racism's role in driving racial health inequities related to the review question. Eleven percent (7) of reviews considered intersectionality when conceptualizing racial inequities. Two-thirds (105, 67%) provided descriptive summaries of included studies rather than synthesizing them. Among those that quantified effect sizes, 54% (21) used biased synthesis methods like vote counting. The most common method assessed was tailoring interventions to meet the needs of racialized populations. Reviews mainly focused on assessing interventions to reduce racial disparities rather than enhancing structural opportunities for racialized populations. Reviews for racial health equity could be improved by enhancing methodologic quality, defining the role of racism in the question, usingreliable analytical methods, and assessing process and implementation outcomes. More focus is needed on assessing structural interventions to improve opportunities for racialized populations and prioritize these issues in political and social agendas.

Centering Racial Health Equity in Systematic Reviews Paper 2: Themes from Semi-structured Interviews

ObjectiveIn the context of profound and persistent racial health inequities, we sought to understand how to define racial health equity in the context of systematic reviews and how to staff, conduct, disseminate, sustain, and evaluate systematic reviews that address racial health equity. Study Design and SettingThe study consisted of virtual, semi-structured interviews followed by structured coding and qualitative analyses using NVivo. ResultsTwenty-nine individuals, primarily US-based, including patients, community representatives, systematic reviewers, clinicians, guideline developers, primary researchers, and funders, participated in this study. These interest holders brought up systems of power, injustice, social determinants of health, and intersectionality when conceptualizing racial health equity. They also emphasized including community members with lived experience in review teams. They suggested making changes to systematic review scope, methods, and eligible evidence (such as adapting review methods to include racial health equity considerations in prioritizing topics for reviews, formulating key questions and searches, and specifying outcomes) and broadening evidence to include designs that address implementation and access. Interest holders noted that sustained efforts to center racial health equity in systematic reviews require resources, time, training, and demonstrating value to funders. ConclusionInterest holders identified changes to the funding, staffing, conduct, dissemination, and implementation of systematic reviews to center racial health equity. Action on these steps requires clear standards for success, an evidence base to support transformative changes, and consensus among interest holders on the way forward.

Abstract C169: Investigating the effects of ancestry in KRAS mediated lung adenocarcinoma: Exploring intratumoral heterogeneity and mitochondrial dynamics

Abstract Demonstrating a combination of high prevalence, late detection, and low survival, Lung cancer is the leading cause of cancer related deaths worldwide (Sainz de Aja J, 2021) and Lung Adenocarcinoma (LUAD) is its most prevalent pathologic subtype (Zhou, 2021). Emerging from within the distal alveolar epithelium, LUAD presents with vast heterogeneity in histology, mutational spectra, and epigenomic dysregulation (Sainz de Aja J, 2021) (Zhou, 2021). Additionally, LUAD’s considerable intratumoral heterogeneity manifests vast genomic and phenotypic diversity across tumor cells and cellular components of the tumor microenvironment (TME) within the same tumor tissue. LUAD also reveals significant racial disparities in incidence, survival and mortality rates between White and Black men in the United States. The occurrence of LUAD is approximately 68.3 per capita for Black men and 61.5 per capita for White men, reflecting an 11% higher rate in the former. Further, survival outcomes indicate that Black men generally exhibit lower 5-year relative survival rates compared to White men, highlighting greater mortality risk and conspicuously poorer prognosis (Siegel RL et al., 2023). While addressing the social determinants of health is vital for the mitigation of health disparities, understanding the genetic and molecular foundations that underly racial health inequities is essential for developing comprehensive interventions and advancing more precise therapeutic modalities for more diverse patient populations. Single Nucleotide Polymorphisms (SNPs) can influence oncogenic transformation and may be associated with distinct molecular landscapes in tumors and adjacent TME. Furthermore, ancestry may play a pivotal role in shaping individual susceptibility and risk for mitochondrial dysfunction and ensuing oncogenic transformation. To elucidate the biological underpinnings of racial health disparities in LUAD, 10 Black and 10 White male LUAD patients’ tumor and normal corresponding adjacent tissues underwent molecular profiling for KRAS mutation status, Whole Exome Sequencing (WES) to determine ancestry, and analysis of associated LUAD induced Mitochondrial Somatic Nucleotide Variants (mtSNVs). We also employed the 10X Visium HD spatial transcriptomic platform to evaluate spatially resolved molecular and cellular differences in KRAS mediated LUAD between Black and White men. Hypothesis: Thus, we propose that global ancestry is associated with variations in intratumoral heterogeneity, TME composition, and mitochondrial dynamics, indicating a potential role in the observed disparities in susceptibility, malignancy and mortality in LUAD across diverse patient populations. Citation Format: Eun Kyu Sung, Yuxin Jin, Yonatan Amzaleg, John Carpten, William Dean Wallace, Dan Raz, Aaron M. Neely. Investigating the effects of ancestry in KRAS mediated lung adenocarcinoma: Exploring intratumoral heterogeneity and mitochondrial dynamics [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr C169.

Racial Stress and Black Women’s Health in the United States: A Culturally Responsive Prevention and Health Promotion Intervention

Black babies and their mothers are dying at disproportionately high rates. Also, Black women are experiencing higher rates of racial discrimination than other racial-ethnic groups are facing in the United States. An intervention promoting the health of Black women and their unborn babies requires addressing the disproportionate level of racial stress that Black women experience. In this article, the creation of such a program is discussed. To consider individual, community, and systemic factors, three theoretical models were utilized: (a) Race-based traumatic stress injury, (b) stress-health model, and (c) racial identity model. This intervention was co-developed with community stakeholders by using community-based participatory research principles. This process resulted in the development of the Afya Black Women Wellness program, a multidimensional and strength-based intervention grounded in the experiences of Black women. Afya focuses on promoting holistic health through psychoeducation, skills building, and social support. The program is constructed to be implemented twice-a-week for 12 weeks. This will allow pregnant Black women to receive the maximum benefit from the program, improving the quality of life for themselves and their unborn children. Ameliorating health disparities in Black maternal health requires addressing the disproportionate amount of racial stress that Black women experience. Afya is a model intervention that provides practical strategies for addressing racial health inequities in Black maternal health. It does so by promoting the health of Black women at the individual and community levels.

ACOG Committee Statement No. 10: Racial and Ethnic Inequities in Obstetrics and Gynecology.

Disparate health outcomes and unequal access to care have long plagued many communities in the United States. Individual demographic characteristics, such as geography, income, education, and race, have been identified as critical factors when seeking to address inequitable health outcomes. To provide the best care possible, obstetrician-gynecologists should be keenly aware of the existence of and contributors to health inequities and be engaged in the work needed to eliminate racial and ethnic health inequities. Obstetrician-gynecologists should improve their understanding of the etiologies of health inequities by participating in lifelong learning to understand the roles clinician bias and personally mediated, systemic, and structural racism play in creating and perpetuating adverse health outcomes and health care experiences.

A Few Doctors Will See Some of You: The Critical Role of Underrepresented in Medicine (URiM) Family Physicians in the Care of Medicaid Beneficiaries.

Despite being key to better health outcomes for patients from racial and ethnic minority groups, the proportion of underrepresented in medicine (URiM) physicians remains low in the US health care system. This study linked a nationally representative sample of family physicians (FPs) with Medicaid claims data to explore the relative contributions to care of Medicaid populations by FP race and ethnicity. This descriptive cross-sectional study used 2016 Medicaid claims data from the Transformed Medicaid Statistical Information System and from 2016-2017 American Board of Family Medicine certification questionnaire responses to examine the diversity and Medicaid participation of FPs. We explored the diversity of FP Medicaid patient panels and whether they saw ≥150 beneficiaries in 2016. Using logistic regression models, we controlled for FP demographics, practice characteristics, and characteristics of the communities in which they practiced. Of 13,096 FPs, Latine, Hispanic, or of Spanish Origin (LHS) FPs and non-LHS Black FPs saw more Medicaid beneficiaries compared with non-LHS White and non-LHS Asian FPs. The patient panels of URiM FPs had a much greater proportion of Medicaid beneficiaries from racial and ethnic minority groups. Overall, non-LHS Black and LHS FPs had greater odds of seeing ≥150 Medicaid beneficiaries in 2016. These findings clearly show the critical role URiM FPs play in caring for Medicaid beneficiaries, suggesting physician race and ethnicity are correlated with Medicaid participation. Diversity in the health care workforce is essential for addressing racial health inequities. Policies need to address problems in pathways to medical education, including failures to recruit, nurture, and retain URiM students.

Discrimination and Racial Inequities in Self-reported Mental Health Among Immigrants and Canadian-Born Individuals in a Large, Nationally Representative Canadian Survey.

We examined the link between discrimination and self-rated mental health (SRMH) among immigrants and Canadian-born individuals, stratified according to an individual's identification as racialized or white. Using data from Canada's General Social Survey (2014) (weighted N = 27,575,000) with a novel oversample of immigrants, we estimated the association of perceived discrimination with SRMH separately among immigrants and Canadian-born individuals and stratified by racialized status. Among immigrants, we also investigated whether age-at-arrival attenuated or strengthened associations. The prevalence of discrimination was higher among racialized compared to white immigrants (18.9% versus 11.8%), and among racialized compared to white non-immigrants (20.0% versus 10.5%). In the adjusted model with immigrants, where white immigrants not reporting discrimination were the referent group, both white (adjusted prevalence odds ratio [aPOR] 6.11, 95% confidence interval [CI] 3.08, 12.12) and racialized immigrants (aPOR 2.28, 95% CI 1.29, 4.04) who experienced discrimination reported poorer SRMH. The associations were weaker among immigrants who immigrated in adulthood. In the adjusted model with non-immigrants, compared to unexposed white respondents, Canadian-born white respondents who experienced discrimination reported poorer SRMH (aPOR 3.62, 95% CI 2.99, 4.40) while no statistically significant association was detected among racialized respondents (aPOR 2.24, 95% CI 0.90, 5.58). Racialized respondents experienced significant levels of discrimination compared to white respondents irrespective of immigrant status. Discrimination was associated with poor SRMH among all immigrants, with some evidence of a stronger association for white immigrants and immigrants who migrated at a younger age. For Canadian-born individuals, discrimination was associated with poor SRMH among white respondents only.

Policies and Indicators to Operationalize Structural Racism for Quantitative Health Research.

The field of structural racism is developing rapidly, with researchers moving from commentaries and review papers toward empirical research that aims to quantify the impact of exposure to structural racism on racial and ethnic inequities in health. Despite the increasing recognition of the impact of structural racism on health outcomes, its measurement in the empirical literature has focused on a limited set of area-based measures. This paper proposes two ways to expand the measurement of structural racism in public health research. First, by situating indicators of structural racism within the broader context of discriminatory policies that gave rise to racial and ethnic inequities, and second, by broadening the range of area-level indicators of structural racism beyond what has been used in the extant literature. The paper provides practical tools, including an extensive list of discriminatory federal policies, a list of common and novel indicators of structural racism across multiple domains, and an applied example showing how to connect policies and indicators of structural racism. These tools will aid researchers in developing a robust empirical evidence base to examine the role of structural racism in long-standing health inequities and advance quantitative research on the impact of structural racism on health inequities.

Incorporating Anti-racist Principles Throughout the Research Lifecycle: A Position Statement from the Society of General Internal Medicine (SGIM).

Biomedical research has advanced medicine but also contributed to widening racial and ethnic health inequities. Despite a growing acknowledgment of the need to incorporate anti-racist objectives into research, there remains a need for practical guidance for recognizing and addressing the influence of ingrained practices perpetuating racial harms, particularly for general internists. Through a review of the literature, and informed by the Research Lifecycle Framework, this position statement from the Society of General Internal Medicine presents a conceptual framework suggesting multi-level systemic changes and strategies for researchers to incorporate an anti-racist perspective throughout the research lifecycle. It begins with a clear assertion that race and ethnicity are socio-political constructs that have important consequences on health and health disparities through various forms of racism. Recommendations include leveraging a comprehensive approach to integrate anti-racist principles and acknowledging that racism, not race, drives health inequities. Individual researchers must acknowledge systemic racism's impact on health, engage in self-education to mitigate biases, hire diverse teams, and include historically excluded communities in research. Institutions must provide clear guidelines on the use of race and ethnicity in research, reject stigmatizing language, and invest in systemic commitments to diversity, equity, and anti-racism. National organizations must call for race-conscious research standards and training, and create measures to ensure accountability, establishing standards for race-conscious research for research funding. This position statement emphasizes our collective responsibility to combat systemic racism in research, and urges a transformative shift toward anti-racist practices throughout the research cycle.

Sealy-Jefferson et al. Respond to "Toward Naming Who and What is Accountable for Racial Inequities in Adverse Black Maternal Mental Health".

Sealy-Jefferson et al. Respond to "Toward Naming Who and What is Accountable for Racial Inequities in Adverse Black Maternal Mental Health".

Improvements in data completeness in health information systems reveal racial inequalities: longitudinal national data from hospital admissions in Brazil 2010–2022

BackgroundRace and ethnicity are important drivers of health inequalities worldwide. However, the recording of race/ethnicity in data systems is frequently insufficient, particularly in low- and middle-income countries. The aim of this study is to descriptively analyse trends in data completeness in race/color records in hospital admissions and the rates of hospitalizations by various causes for Blacks and Whites individuals.MethodsWe conducted a longitudinal analysis, examining hospital admission data from Brazil’s Hospital Information System (SIH) between 2010 and 2022, and analysed trends in reporting completeness and racial inequalities. These hospitalization records were examined based on year, quarter, cause of admission (using International Classification of Diseases (ICD-10) codes), and race/color (categorized as Black, White, or missing). We examined the patterns in hospitalization rates and the prevalence of missing data over a period of time.ResultsOver the study period, there was a notable improvement in data completeness regarding race/color in hospital admissions in Brazil. The proportion of missing values on race decreased from 34.7% in 2010 to 21.2% in 2020. As data completeness improved, racial inequalities in hospitalization rates became more evident – across several causes, including assaults, tuberculosis, hypertensive diseases, at-risk hospitalizations during pregnancy and motorcycle accidents.ConclusionsThe study highlights the critical role of data quality in identifying and addressing racial health inequalities. Improved data completeness has revealed previously hidden inequalities in health records, emphasizing the need for comprehensive data collection to inform equitable health policies and interventions. Policymakers working in areas where socioeconomic data reporting (including on race and ethnicity) is suboptimal, should address data completeness to fully understand the scale of health inequalities.

New York City’s Rapid Response to the 2022 Mpox Outbreak

Human society is facing emerging infectious disease threats with increasing frequency, potentially with novel medical countermeasures available, but often with initial limited access and supply. Long-standing racial health inequities create barriers to accessing critical new treatments that can further exacerbate health disparities in an emergency. During the 2022 mpox outbreak, the antiviral tecovirimat was made available from federal stockpiles for the treatment of mpox disease. Here, the authors describe New York City’s multipronged approach to ensure access to mpox therapeutics, which built on related work during the Covid-19 pandemic. This approach can serve as a road map to addressing systemic barriers to treatment and care during emergency responses. It includes (1) targeting messaging and outreach to providers serving marginalized communities, (2) use of a centralized pharmacy process for medication access, (3) setting up a treatment evaluation and referral process, and (4) monitoring utilization through integration of data across multiple public health data sources. The result was tecovirimat treatment prescribed to 32% of all patients with mpox in New York City. This approach to tecovirimat access during the mpox outbreak in New York City illustrates a model for public health and health care delivery partnerships that could be implemented when novel medical countermeasures become available in the setting of an emerging infectious disease outbreak.

Still Separate, Still Not Equal: An Ecological Examination of Redlining and Racial Segregation with COVID-19 Vaccination Administration in Washington D.C.

Racial residential segregation has been deemed a fundamental cause of health inequities. It is a result of historical and contemporary policies such as redlining that have created a geographic separation of races and corresponds with an inequitable distribution of health-promoting resources. Redlining and racial residential segregation may have contributed to racial inequities in COVID-19 vaccine administration in the early stages of public accessibility. We use data from theNational Archives(historical redlining), Home Mortgage Disclosure Act (contemporary redlining), American Community Survey from 1940 (historical racial residential segregation) and 2015-2019 (contemporary racial residential segregation), and Washington D.C. government (COVID-19 vaccination administration) to assess the relationships between redlining, racial residential segregation, and COVID-19 vaccine administration during the early stages of vaccine distribution when a tiered system was in place due to limited supply. Pearson correlation was used to assess whether redlining and racial segregation, measured both historically and contemporarily, were correlated with each other in Washington D.C. Subsequently, linear regression was used to assess whether each of these measures associate with COVID-19 vaccine administration. In both historical and contemporary analyses, there was a positive correlation between redlining and racial residential segregation. Further, redlining and racial residential segregation were each positively associated with administration of the novel COVID-19 vaccine. This study highlights the ongoing ways in which redlining and segregation contribute to racial health inequities. Eliminating racial health inequities in American society requires addressing the root causes that affect access to health-promoting resources.

The Public Health Implications of the Global Financial Crisis

The Global Financial Crisis resulted in significant economic problems that subsequently led to a public health crisis worldwide. For example, the unemployed suffered from more severe physical and mental health problems than the employed due to the loss of employer-sponsored health insurances. The crisis further exacerbated racial health inequalities that subsequently worsened maternal and child health outcomes, which negatively affected health status of the future generations. This paper provides a comprehensive discussion of the influence that this crisis has had on physical and mental health, health inequalities, and the intergenerational health impact. To respond to the health implications, the government implemented the Affordable Care Act and the Continuation of Health Coverage (CORBA). In the future, policymakers need to increase social safety net programs, especially government health insurance, for vulnerable populations so that another global financial crisis will likely not have such a negative and profound impact on public health outcomes. The motivation of this paper is to emphasize that higher-quality and more comprehensive unemployment health insurance that covers a broader and more diverse set of populations should become available for the unemployed during economic downturns. This article concludes that policymakers need to design health policies in a way that prevents future financial crises from depriving low-income and unemployed people of their right to health care. Policies must become proactive in advocating for health equity and creating opportunities for people to access medical services in a timelier manner, especially during times of financial downturns.