Lesson Plan February 17, 2021

Public Health



“A Broken Health Care System” by Jeneen Interlandi (pages 44–45) 
Module Authors: Ariana Aboulafia, Kelsey Johnson, Maria Nasir, David Petrantoni, Emely Sanchez


“Professional societies like the American Medical Association barred black doctors; medical schools excluded black students, and most hospitals and health clinics segregated black patients. Federal health care policy was designed, both implicitly and explicitly, to exclude black Americans. As a result, they faced an array of inequities — including statistically shorter, sicker lives than their white counterparts. What’s more, access to good medical care was predicated on a system of employer-based insurance that was inherently difficult for black Americans to get.”

Key Names, Dates, and Terms

Health care, Freedmen’s Bureau, Black extinction theory, reconstruction, racial stratification, medical apartheid, “state’s rights” as a cover for racial discrimination, federal segregation of hospitals, structural racism, Medicare, Medicaid, Medicaid expansion, insurance, Affordable Care Act

Guiding Questions

1. What are the structural causes of the wide disparity in health care coverage and quality between white and Black Americans?

2. What are some of the ways in which the history of racism continues to impact Black access to health care? Do you think this has played a role in the disparate impact of COVID-19 on Black communities? Why?

3. What is the impact of existing programs like the Affordable Care Act (ACA) on health care for Black communities? Does a mix of government-subsidized health care and private insurance actually work in the United States?

4. Would passing universal health care as opposed to maintaining the Affordable Care Act (ACA) solve the issue of racism in health care? Or, would the disparities continue even in a fully socialized health care system?

5. If disparities would continue in a socialized medicine system, how else can we solve the issue of racism in health care?

6. Should we focus on outcomes or processes in addressing the disparities in access to and quality of health care for white and Black Americans?

7. Would removing barriers for Black students in medical education help end the inequalities in health care?

8. Should health care be considered a basic human right? If so, why is it not guaranteed to every citizen?

Additional Resources

"COVID-19 and African Americans" by Clyde W. Yancy
"COVID-19 and Racial/Ethnic disparities" by Monica Webb Hooper, Anna María Nápoles, and Eliseo J. Pérez-Stable
“Health-Related Outcomes among the Poor: Medicaid Expansion vs. Non-Expansion States” by Xuesing Han, Binh T. Nguyen, Jeffrey Drope, and Ahmedin Jemal
"Hospital Flight from Minority Communities: How Our Existing Civil Rights Framework Fosters Racial Inequality in Healthcare" by Brietta R. Clark 
"Inequality in Quality: Addressing Socioeconomic, Racial, and Ethnic Disparities in Health Care" by Kevin Fiscella, Peter Franks, Marthe R. Gold, and Carolyn M. Clancy 
Measuring Trends in Mental Health Care Disparities, 2000–2004” by Benjamin L. Cook, Thomas McGuire, and Jeanna Miranda  
“‘Rights without Access’: The Political Context of Inequality in Health Care Coverage in the US States" by Ling Zhu and Jennifer H. Clark
“Socioeconomic Disparities in Health in the United States: What the Patterns Tell Us” by Paula A. Braveman, Catherine Cubbin, Susan Egerter, David R. Williams, and Elsie Pamuk 
"Systemic Racism and U.S. Health Care" by Joe Feagin and Zinobia Bennefield
Wilks, Sabrina. Healthcare for All: Why Minorities Continue to Fall. Thurgood Marshall Law Review Online, vol. 43, no. 2, 2019.

Matthew, Dayna Bowen. Just Medicine: A Cure for Racial Inequality in American Health Care. NYU Press, 2015.  

Online Resources:
“Do Health Care Costs Fuel Economic Inequality in the United States?” by David Blumenthal and David Squires, published by The Commonwealth Fund
“Health Inequality Actually Is a ‘Black and White Issue’, Research Says” by Jordyn Imhoff, published by University of Michigan Health. 
“Racial Disparities in the Time of COVID-19” by Adrianne Haggins and Arline Geronimus, published by Michigan Institute for Healthcare Policy & Innovation 
“Racism and Discrimination in Health Care: Providers and Patients” by Monique Tello, published by Harvard Health
“Racism, Inequality, and Health Care for African Americans” by Jamila Taylor, published by The Century Foundation 
“Who Gained Health Insurance Coverage Under the ACA, and Where Do They Live?” by Bowen Garret and Anju Gangopadhyaya, published by Urban Institute and Robert Wood Johnson Foundation (2016)

You can find more educational resources at www.pulitzercenter.org/1619.

Educator Notes:

The 1619 Project Law School Initiative is a partnership of the Pulitzer Center, Howard University School of Law, and University of Miami School of Law. The initiative is also part of the Racial Justice initiative by the Squire Patton Boggs Foundation and its Deans’ Circle.

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Racial Justice

Racial Justice
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Health Inequities

Health Inequities