Black children suffer from more severe chronic illnesses when compared with white children, and two new studies show it isn't about biology.
It's about inequities.
Cincinnati Children's Hospital Medical Center researchers looked at the issue, asking these questions: Why are so many Black children readmitted to the hospital for asthma? Why do Black children suffer more with a life-threatening complication of Type 1 diabetes, ketoacidosis?
“We didn’t find any genetic differences based on the race of the children," said Tesfaye Mersha, PhD, a researcher in the Cincinnati Children's Division of Asthma Research and lead author of the asthma-focused study.
If social and environmental inequities caused by historical racism were fixed, Mersha said, the gap in between Black and white children's hospital readmissions would narrow.
“It's not just asthma," he said. "This racial gap is everywhere.”
Poverty, housing, food availability often determine health outcomes for Black children
The second study found a disproportionate number of Black children with type 1 diabetes were admitted for ketoacidosis. The group of kids enrolled was 25% Black, yet 41% of admissions for the complication were Black children, the research showed.
The study shows that there are social constructs, stemming from inequities over time, that give Black children less of a chance to stay well, said study author Dr. Nana-Hawa Yayah Jones. A lot of it has to do with their environment, she said: "The places where you grow, live, work and play."
And that's often determined by income. More Black children than white children lived in families who lived below the U.S. poverty line from 2010-2019, according to the Annie E. Casey Foundation's Kids Count data center. The range for Black children living in poverty for those years was a high of 38% to a low of 31%, Kids Count data show. That compares with a range of 14% to 10% of white children living in poverty.
Jones says that something as simple as a parent having reliable transportation can make a world of difference in managing a child's diabetes.
"For some people the closest grocery store might be the Dollar Tree. You can imagine how hard it is to have access to fresh fruits, fresh vegetables, meats, proteins," Jones said.
About 700 children took part in Mersha's study on asthma readmissions. The scientists followed them for about a year.
They collected lead samples, checked the homes for water leaks and mold in carpets and measured air pollution outside. They followed closely whether and how often the children received medication, whether they had to sleep outside, the family's income and whether health care was covered by insurance. More than 77 social and environmental factors were examined.
The analysis after that year showed 79.1% of the children who were readmitted to the hospital for asthma were Black. About 20% were white. "Most of the differences came from the social and environmental factors," Mersha said.
None of it surprises Renee Mahaffey Harris, president and CEO of the nonprofit Center for Closing the Health Gap, in Avondale.
“None of this is new information,” said Mahaffey Harris.
But more people are aware of inequities, which have become pronounced during the COVID-19 pandemic, Mahaffey Harris said. "The fact that a child isn’t getting a chance to live a full, healthy life because of factors in which they live hasn’t gotten enough attention."
Understanding inequities is the start to fixing them
So what's the solution?
Mahaffey Harris said the United States' healthcare approach historically has been reactive, not preventive.
"Hospital systems are built to take care of people when they’re sick," she said. "Our country’s model of health is a sick model."
Prevention, she said, needs to be the focus, with the youngest children the target. "Kids, they’re sponges that absorb what they see."
Her suggestion to parents? Eat a meal together when they can.
"When you do that, you are cooking something together, and when you sit down and have that conversation, it’s the opportunity to slow down," Mahaffey Harris said.
"Society isn’t focused on us stopping and breathing. So we have to build it in. Even if it’s twice a week."
Jones, the Cincinnati Children's endocrinologist, said the systemic failures are complicated, but understanding inequities is a start to fixing them.
"These are structural inequities which you didn’t ask to be born in, live in, work in, play in. What I’m asking for is an awareness that you exist in privilege or that other people don’t exist in privilege," Jones said.
"I’m asking that, no matter what field you’re in, anything that you do, try to start looking at it with an equity lens."
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