Health Disparities, Discrimination, And Racial Gaps: An Honest Look Below The Surface Of An Otherwise Thriving American City – Forbes

How do you measure the success of a city? Is it by median income? A growing economy and the number of new jobs? Do you look at cultural diversity, and richness in community culture? Or track population growth? By all these measures, my hometown Nashville, Tennessee, is a booming success.

But there is one vital area where we get a surprisingly poor grade. It’s measures of the health and wellness of our people. And without underlying fundamentally strong and equitable health, a city cannot over time sustainably maintain its popularity, attractiveness, or prosperity, however great it is at a point in time.

As a physician, I believe to evaluate the success of a city, you must look past the short-term economic indicators, look beyond the energizing entertainment, sports, and dining attractions that make a place exciting, and more critically examine how that place impacts each resident’s health. At the end of the day—and the pandemic has made this clear—our health is what matters most. The richness of opportunities a city has to offer doesn’t matter if you don’t have the mental, physical, and spiritual health to participate in, take advantage of, or enjoy them.

So how does Nashville measure up?

We at the unique community collaborative NashvilleHealth, in direct coordination with the Metro Nashville Public Health Department, sought to establish a comprehensive baseline to answer that question in 2019. We hadn’t had a major survey that provided granular insights into citywide health in two decades, which is why we organized the Nashville Community Health + Well-being Survey. With scientifically representative responses from more than 1,800 county residents aged 18 years and over, what we found was disturbing. And a call to action.

Disparities. One of the most concerning themes arising in the data were racial and ethnic disparities in health and health outcomes. Black Nashvillians consistently reported higher rates of diabetes, hypertension, respiratory conditions, and obesity than their white counterparts. For example:

• 22% of Black respondents reported being diagnosed with diabetes, compared to 8% of White Nashvillians.
• 48% of Black Nashvillians (nearly half) reported being diagnosed with hypertension, compared to 27% of White Nashvillians.
• And 48% of Black Nashvillians (again, nearly half) reported being obese, compared to 24% of White Nashvillians.

Other minority groups also reported worse health outcomes, with Hispanic respondents generally outpacing White respondents in chronic conditions. For example, more than one in four Hispanic women indicated having been diagnosed with a respiratory condition (COPD, asthma, chronic bronchitis, or emphysema), and 42% of Hispanic Nashvillians reported being overweight, compared to 31% of White Nashvillians.

Discrimination. Our Nashville doctors, hospitals, health facilities, and other providers are nationally recognized as being among the best, but the survey uncovered troubling findings at the local level of the way care is delivered.

Alarmingly, but perhaps not surprisingly, our city’s Black and Hispanic populations reported feeling discrimination when seeking healthcare at rates respectively five and six times higher than Whites. As we know from extensive published research, this discrimination bias can translate into worse healthcare. As the National Academy of Medicine’s landmark 2003 report “Unequal Treatment” demonstrated, across virtually every therapeutic intervention, Blacks and other minorities received poorer quality care than Whites.

Experiencing discrimination also can manifest into negative health ramifications for the individual patient. One third (31%) of African American respondents and a third (31%) of Hispanic respondents reported feeling emotionally upset—angry, sad, or frustrated—in response to treatment based on race (only seven percent of White survey-takers reported similar emotions). Nearly one in five Black and more than one in seven Hispanic survey-takers said such treatment was more likely to have physical manifestations, including headache or stomachache, a pounding heart or muscle tension. In contrast, those symptoms were only felt by three percent of White respondents.

Mental Health. Mental health disparities were astounding: the survey recorded substantially higher rates of poor mental health in minority populations. Nashville’s Hispanic men and women (six days) and Black women (seven days) reported as much as a full week of poor mental health days a month.

And the egregious inequities in our city’s health and well-being extend beyond race and ethnicity. Our Lesbian, Gay, Bisexual, and Transgender (LGBT) population, as published in a recent Vanderbilt University analysis of the survey data, were more likely to be uninsured, report unmet medical care needs because of cost, and exhibit worse mental health outcomes. Nearly one in 10 of the survey respondents identified as lesbian, gay, bisexual, transgender, or other sexual and gender minorities. And approximately 30% of this population were uninsured, which was much higher than the 7.5% of non-LGBT Nashvillians.

Some have argued that differences in health access and outcomes are due to socioeconomic status—but that doesn’t tell the whole story. Place matters. Living in a neighborhood without green space, without access to healthy food options, that feels unsafe to play or walk on the sidewalks (if there even are sidewalks), that lacks clean air or clean water, or a tree canopy to provide shade, or accessible public transportation—all of these elements can be barriers to good health and well-being.

Social support. Communities can come together to support these underserved areas and make it a priority to close access gaps, but in Nashville, our survey found that communities of color disproportionately feel they do not receive the social and emotional support they need. While eight percent of White respondents said they rarely get needed social support, twice that—or 15% of African Americans—reported that they rarely or never get needed social support. And for Hispanics and Latinos the data are even more discouraging: a startling 23% of Hispanic respondents shared the same sentiment of receiving poor social support.

This survey was completed just prior to the pandemic, and thus represents an accurate baseline for Nashville in “normal” times; the disproportionate impact that the pandemic has had on people of color and vulnerable populations almost certainly has worsened the disparities and inequities observed.

I share these data because, as a lifelong Nashvillian, I want the health of our population to thrive just as our economy, tourism, music, and healthcare industries have. Without good, equitable health of all the population, our city will not maintain its prosperous trajectory. This survey provides a necessary baseline diagnosis for our city’s wellbeing, against which progress can be measured as we come together to address the stark disparities, discrimination, and poor health that was exposed and brought to light.

Our community collaborative NashvilleHealth, with the broad support of nonprofits, faith organizations, businesses, educational institutions, and our city government, will regularly repeat the Community Health + Well-being Survey so we can confidently track over time the health of our patient, the city of Nashville. When armed with timely, statistically accurate data that can reliably be disaggregated by ethnicity, race, and place, we can together as a community target equity-informed interventions that reach those most in need — and ensure the continued dynamic growth and wellbeing of our community.

We hope that this systematic, carefully designed and implemented population approach to a city’s health will serve as a model for other cities to gain a comprehensive understanding of the needs of their residents in order to develop a roadmap and action plan to measurably improve health and wellbeing. By wisely investing in the health of all people with an eye to equity, we will have a population that can truly partake in and benefit from all our city has to offer.

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