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Recognizing and Addressing Social Determinants of Health

Two groups of people living in nearby zip codes in Atlanta have drastically different health outcomes and projected life spans: residents of predominantly white, high-income neighborhoods have an average life expectancy of 84, while those who reside in predominantly Black, low-income areas have an average life expectancy of 71. Why is there such a life-shortening disparity?

“Social determinants of health play a major, major factor. If you’re not accessing healthcare, if you don’t have access to healthcare, if you don’t have education and education systems you’re matriculating to,” coupled with “the politics, stigma, and racism [Black Americans] are often the victims of, plays a fundamental difference in our health outcomes,” says Rashad Burgess, vice president of Advancing Health and Black Equity at Gilead Sciences.

Awareness is critical when addressing health disparities impacting Black Americans—such as life expectancy—but it must be coupled with meaningful policy changes.

This was one of the key takeaways from the session “Recognizing and Addressing Social Determinants of Health” (SDOH), a panel held as part of Black Enterprise’s inaugural “Health is Wealth” Weekend, in Nashville, Tenn., Feb. 10–11 and hosted by Walmart.

The session, sponsored by Gilead/Kite, featured an expert line-up of panelists, including Burgess, who leads Gilead’s strategy in tackling health equity and systemic issues of structural racism; Dr. Jacqueline Dow, CEO of J. Dow Fitness and a public health research scientist; and Dr. Bernard Ashby, a vascular cardiologist who founded Miami-based Comprehensive Vascular Care.

SDOH represents all external and societal factors that impact health outcomes. According to the Centers for Disease Control and Prevention (CDC), these “nonmedical factors” include one’s birthplace, age, community, and workplace, as well as issues such as economic and social policies, racism, climate change, and politics. The panel dissected how these elements influence health equity—or inequity—specifically for Black Americans.

Dealing With Factors From Racism to Healthcare Providers

Ashby maintained police brutality, which frequently tops national headlines, serves as a determinant but also pointed out that the overall criminal justice system—including “the war on drugs, over-policing of our communities, weaponizing laws to specifically target communities of color, mass incarceration”—all serve to “drain the wealth and a lot of fathers and mothers from Black communities.”

All panelists agreed that racism, declared a public health crisis by the CDC, offers a major barrier to Blacks gaining access to and treatment within the healthcare system. In fact, Dow told the audience about her fear and concerns when she became a first-time mother due to the alarming statistics on Black maternal health.

“Being pregnant is supposed to be a blissful and happy experience, but in today’s time, it could be a death sentence,” she asserts, adding that her discharge OB-GYN looked like her, and insisted she remains under hospital care for an additional 24 hours after giving birth. “I really appreciated that, but that wasn’t the story of my friends. Every Black woman that was pregnant with me had issues.”

Addressing the Determinants 

So, what must be done to address social determinants?

Burgess immediately voiced the need to expand Medicaid. “Many states that have not expanded Medicaid are in the South, where Black folks live,” says Burgess, which means “Black people are left without having access to adequate healthcare.”

Dow says policymakers and health officials must deal with skyrocketing healthcare costs. “Being sick is very expensive, and that has a direct impact on an individual’s ability to receive the healthcare that they need…and that has a direct impact on their longevity,” she said.

The panel offered other tangible remedies. Burgess reminded the audience that all can reach out to their legislators and lobby them to expand Medicaid, while Ashby advocated the need to “reimagine healthcare” and urged audience members to “be proactive in building ourselves up.”

Within the corporate world, Dow maintains many leaders are concerned with public diversity, equity, and inclusion efforts and community outreach but should instead focus on staff development: “Make sure they’re treating their employees right. Make sure they have training at all levels [CEOs and board of trustees] before they go out into the communities.”

Lastly, the panel agreed Black Americans must be their own healthcare advocates, promote the expansion of trained medical professionals of color, and use their clout to empower communities.

Asserts Burgess: “We are a powerful group of people, and we have to recognize every moment the power that we have. When we show up in rooms, in spaces, in corporations, and [in] businesses, own that power that is within yourself and realize that the company hired you because of who you are. The worst thing we can do is sit at that table and say nothing.”