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INTERVIEW: Unequal Health & Anti-Black Racism with Louis Penner
Issue 84: Unveiling the mechanisms behind racial health disparities with professor Louis Penner and his new book, Unequal Health
Racial health disparities have been in the spotlight in recent years in part due to the COVID-19 pandemic and the Black Lives Matter movement in response to systemic racism. This has led to hot debates about how to address these problems—as well as significant backlash. This week, we highlight research on this topic
Dr. Louis Penner, a co-author of Unequal Health: Anti-Black Racism and the Threat to America’s Health, explains that racial health disparities are driven by social and historical factors, rather than biology alone. He argues that “understanding social identity and intergroup relations is critical to understanding the role of anti-Black bias in racial health disparities”. Their book points out that anti-Black racism has and continues to be a part of the fabric of America society and medical care.
Lou considers this book, written along with co-authors John Dovido, Nao Hagiwara, and Brian Smedley, a capstone to his 50-year long research career in social psychology and racial disparities in medical settings. The book released in the U.S. earlier this week, and can be purchased on Amazon, Thirftbooks, Cambridge, and anywhere books are sold. Read his interview with us below and follow his LinkedIn to hear from him directly and grab a discount code!
What does your book teach us about social identity or group dynamics?
The focus of the book is about the role racial bias in racial inequities in health and healthcare. All three of the authors are social or clinical psychologists, and thus group identity and group dynamics are presented as concepts that underlie many of the discussions of how anti-Black racism endangers the health of Black Americans. We explicitly discuss these concepts in the chapter on the origins of racial bias. Understanding social identity and intergroup relations is critical to understanding the role of anti-Black bias in racial health disparities.
Even before the COVID pandemic, Black Americans had a significantly higher mortality rate and shorter life expectancies than White Americans. Within the same disease categories, Black patients are much more likely to die than White patients. Two glaring examples of these disparities is that the maternal mortality rate for Black mothers is three times the rate as for White mothers and the infant mortality rate is twice as high. This infant mortality disparity is significantly mitigated by racial concordance between the mother and her physician, suggesting a crucial role of racial identity in this disparity.
Racial inequities also exist in the quality of the healthcare Black patients and White patients receive. Black patients have less access to healthcare providers and have poorer outcome from their healthcare interactions. In almost every disease category, Black patients receive less aggressive and appropriate treatments than White patients. This results in higher mortality rates among Black patients with the same disease as White patients. For example, Black women have a marginally lower rate of breast cancer than White women, but die at a much higher rate. Both systemic and individual racial bias play important roles in these disparities.
At an individual level, studies (many by the co-authors) have shown that implicit racial bias negatively affects the content of and outcomes from racially discordant medical interactions.
What is the most important idea readers will learn from your book?
The readers should gain a greater understanding of how social factors influence people's health and how racial bias has harmed the health of Black Americans and other racial/ethnic minority groups across all of United States' history. Unlike other books on health disparities, we discuss at length the long history of exclusion and abuse of Black people by the American medical systems. These include the refusal to treat Black patients in integrated facilities until 1964, using Black people as "teaching tools" (e.g. patients and cadavers) in educational facilities that excluded Black physicians and patients, profound abuse of Black patients in medical experiments that continued to the 1990's, and active attempts to reduce the Black population by involuntary sterilizations.
Why did you write this book and how did writing it change you?
This book was a capstone to my 50 year career as a social psychologist. I an my co-authors (Jack Dovidio, Nao Hagiwara, and Brian Smedley) all have had career-long interests in the harmful effects of racism. Despite this experience, I think all of us were struck by how long anti-Black racism has jeopardized the health of Black Americans. It certainly made me much more receptive to providing some sort of reparations to Black Americans.
What will readers find provocative or controversial about your book?
For many readers, the core argument that social—rather than biological or genetic factors—are responsible for the large racial health disparities that exist in the US today could be provocative. Others may find the argument that anti-Black racism has been part of the fabric of America society and medical care since (and actually before) its founding to be controversial. In many ways, our book highlights the "fatal flaws" in how the American government has dealt with race relations over the past four centuries.
Do you have any practical advice for people who want to apply these ideas (e.g., three tips for the real world)?
We propose seven solutions in the final chapter of the book. However, most of them discuss more macro changes that are needed to reduce health disparities. Our suggestions for how physicians might treat Black patients better might be relevant to the general public.
Perhaps the most useful of these is not to treat a person who comes from a racial/ethic minority as a category but rather as a unique individual. Another is that people must be more aware of micro-aggressions, small behaviors that convey a lack of respect to a Black person or people of color.
News and Updates
We are starting a free book club for the Power of Us! Whether you have read the book already or planning to read it, we welcome you to join our virtual book club. Fill our interest form, in the meantime we will share more about the book club in the coming weeks.
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Catch up on the last one…
Last week’s content about teaching materials, our book club and syllabus with articles and activities garnered a great response from educators, students, and business leaders alike. We offer educational materials for a proposed course on identity that could be taught at universities. Check out what we put together and share it with an educator you know! You can also request additional materials such as slides, exam questions, and a class visit from Jay or Dom!
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