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Progress is not Linear

Throughout the month of February, many organizations observe Black History Month.  It is an opportunity to celebrate the contributions, sacrifices and successes of African Americans, and the roles they have played in the history of our country. Black History Month also serves as a reminder that the people and their accomplishments are often overlooked, or discounted, or forgotten. The acknowledgement of their contributions to our society, culture and history also carries a message that we are a more enlightened, more inclusive people than in the past.

This year feels different. Progress is not linear. The events of the past year have brought our differences, and our inequities, into sharper focus. The pandemic, the murder of George Floyd, a divisive and bitter election and its aftermath, shook us, and required us to confront our perceptions and our beliefs about who we are. It is an opportunity to recognize the inequities that exist, and more importantly, find ways to address and eliminate them.  

Last year, the Health Policy Institute of Ohio issued a statement declaring “racism is a systemic and ongoing public health crisis with serious consequences for the health of Ohioans.” Similar resolutions were issued by the Cuyahoga County Council, the Cleveland City Council, the County Board of Health and other organizations. The Benjamin Rose Institute on Aging issued its own Statement on Racial Equity and Social Justice. For older adults of color, a lifetime of inequity contributes to lower incomes, less access to care, increased health disparities, and shorter lifespans.

People of color, on average, earn less than their white counterparts. Over the course of a career, white men earn one-third more than Black men, according to an analysis by the Urban Institute. African Americans, regardless of educational attainment, are more likely to experience unemployment, and lower wages than whites. And, they are less likely have access to have employer-sponsored retirement plans and health insurance.  A lifetime of earning less means less income in retirement. For African American retirees, one in three relies on Social Security as their sole source of income in retirement, compared to 18 percent of white persons age 65 and older.

The pandemic raised awareness of essential workers. People of color are more likely to be in frontline service jobs: in retail, restaurants and direct healthcare. Thus, these populations are far more likely to be exposed to the virus, accounting for a disproportionate share of illness and death from COVID-19. People of color are also more likely to have underlying chronic health conditions that make them vulnerable to the virus, including diabetes and hypertension.  

Social, economic and environmental factors have a profound impact on health and health outcomes. These “social determinants of health” are a focus of many conversations about older adults. Often, the discussion is focused on neighborhoods.  Where one lives determines much about how one lives. Zip code maps and census tracts provide statistical evidence of inequality that is based in part on a history of redlining, segregation and discriminatory practices. It can be difficult to look at. It will be difficult to solve. But it begins with a commitment to do better. To be better. Sometimes it might seem easier to look the other way. But, perhaps the best way to honor Black History Month is to help write the next chapter, together.  

Notes:
If you would like to explore more information on racial inequality among older adults, here are some links to resources referenced in this blog post.  
 
COVID disparities
Studies confirm social, environmental factors driving COVID-19 racial disparities

COVID19 impact
Ohio COVID-19 disparities by race

Health Policy Institute of Ohio 2020
HPIO statement on racism and health

The Legacy of Redlining in Cuyahoga County
https://insight.livestories.com/s/v2/redlining-and-health-is-there-a-connection-in-cuyahoga-county/1eb1e04f-c195-443e-8648-e45700702800

NIH article on racial disparities among Medicare recipients. 2012
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4474472/

Summary health assessment of older Ohioans
https://www.healthpolicyohio.org/wp-content/uploads/2020/06/SAPA_SummaryAssessmentofOlderOhioans_ExecutiveSummary_06022020.pdf

Social Security 
Social Security and People of Color | National Academy of Social Insurance

(For a different take on the historic role of Social Security and people of color, read this report from the   NAACP - (SS Admin disputes portions of this piece,)
NAACP | Viewing Social Security Through The Civil Rights Lens

Urban Institute
https://www.urban.org/sites/default/files/publication/100697/african_american_economic_security_and_the_role_of_social_security.pdf