Authors: Tonantzin Juarez & Jessica McCann
April is recognized by the U.S. Department of Health and Human Services as National Minority Health Month, an observance that builds awareness about health disparities that persist among racial and ethnic minorities including Black, Indigenous, and People of Color (BIPOC). This year’s theme, Be the Source for Better Health: Improving Health Outcomes Through Our Cultures, Communities, and Connections, focuses on understanding the impact of environments, cultures, histories and social determinants on the overall health of racial and ethnic minorities and AI/AN populations and encouraging actions to end these inequities.
Building on this theme, in this month’s blog the Weitzman Policy Team highlights four current issues that are impacting minority health and health policy.
- Changing Climate
The American Public Health Association calls climate change “one of the biggest health emergencies we face today,” yet Americans do not face this health emergency equally. Minoritized populations are disproportionately affected by health effects of natural disasters, extreme heat, and other harbingers of climate change, yet historically have had poorer access to health care than non-minoritized populations. According to a recent Environmental Protection Agency (EPA) report, Black and Hispanic/Latino populations are more likely than non-Hispanic whites to live in areas with the highest asthma rates due to poor air quality, areas with the highest mortality rates due to extreme heat, and areas with the highest rates of missing work due to extreme temperatures. American Indian and Alaska Native (AI/AN) populations, though encompassing a diverse range of experiences, are more likely than non-AI/AN populations to live in areas with most land lost due to climate change and the highest rates of missing work due to extreme temperatures. Yet, minoritized populations have the fewest resources to “protect against and recover from” effects of climate change.
The environmental justice movement has long recognized climate change as a threat to minority health. Tools like the EPA’s Environmental Justice Screening and Mapping Tool, which allow communities to identify their most vulnerable areas and target resources accordingly, are a start, as is the Biden administration’s Community Change Grants, which pledge $2 billion to ameliorate climate injustices across the U.S. We encourage more direct action on climate change, especially as it affects the health of minoritized populations.
- End of Affirmative Action
The end of affirmative action threatens public health programs, the health workforce and the overall health of the nation. Compared to their white counterparts, racially and minoritized groups continue to be underrepresented in higher education. This impacts their representation in the healthcare workforce with the ban impacting diversity in medical education and medicine in general. Currently, just under 6% of physicians are Black. Representation of marginalized groups in health care professions is key to understanding health inequities and improving the patient-provider relationship. Patients respond more positively to physicians that look like them and share life experiences. Among marginalized populations, a diverse health workforce results in positive health outcomes and improved patient experience. In states that ended affirmative action policies in the last 10 years a decline in enrollment and graduation rates from minoritized students was recorded.
For all of us that work in public health, what is alarming is how this decision will be used to dismantle public health policies and programs that use race and ethnicity as a basis for funding and creating health programs. Recently the Abundant Birth Project, which provides Black and Pacific Islander San Franciscans a $1,000 monthly stipend, along other San Francisco guaranteed-income programs serving artists, transgender people and Black young adults is being sued for illegally discriminating by providing stipends to only people of a specific race. The fear of similar lawsuits undertaking similar programs aimed at helping minorities’ health is real and should be widely discussed. What will public health aimed at improving minority health look like? How do we overcome these threats to health equity?
- Bans on DEI Programs and Policies
Diversity, Equity and Inclusion (DEI) initiatives and policies are at the core of public health work. Beyond the importance of a diverse workforce, addressed in the previous section, part of DEI is providing the tools that recognize the importance of addressing health issues that may otherwise be overlooked as they do not impact the general population. As the United States (U.S.) becomes more diverse, being able to identify the role unique factors play in health inequities observed is key. Understanding of DEI helps researchers identify for example the role race, ethnicity, gender, sexuality, socioeconomics & geopolitics in health and wellbeing. Embedding DEI into public health programs helps prepare future public health practitioners in considering for example the role of social justice issues in addressing health. DEI helps address public health equity challenges that may be disproportionately impacting communities of color and low socioeconomic status.
- Emergence of Artificial Intelligence (AI)
AI, loosely defined as computers using data inputs and algorithms to make decisions, is increasingly used in health care to aid diagnosis, treatment decisions, risk estimation, and workforce issues. For example, AI is used to detect tumors, recommend certain treatments or estimate future disease risk based on patient profiles, and help providers transcribe notes or schedule follow-up visits. However, AI is only as intelligent as the data and algorithms it is programmed with and, often, these inputs are extremely flawed. For example, if AI is trained to use the now debunked kidney function calculations that underestimate disease in Black populations, the system will merely perpetuate this. Similarly, if AI only sees data from non-minoritized populations, then it will make biased decisions. For example, AI trained to recognize skin cancer using only images of white patients will likely fail to recognize and accurately diagnose melanoma in patients with darker skin.
National Minority Health Month is an opportunity to recognize these biases as well as the promise AI holds in ensuring health equity and improving the health of minoritized populations. In theory, taking human bias out of any health-related decision and ensuring AI training data and algorithms are inclusive of all populations can go a long way in reducing health disparities. As researchers continue to identify and ameliorate biased AI systems, policymakers and AI experts are developing guidelines and other resources for stakeholders. For example, the Center for Applied AI at Chicago Booth’s Algorithmic Bias Playbook offers advice on minimizing bias in health care in the algorithm creation stage. In December 2023, the U.S. Agency for Healthcare Research and Quality and the National Institute of Minority Health and Health Disparities published Guiding Principles to Address the Impact of Algorithm Bias on Racial and Ethnic Disparities in Health and Health Care. In January 2024, the World Health Organization published guidance on certain AI models, and in March 2024, the Biden administration issued an Executive Order mandating humans oversee any AI that “supports critical diagnostics decisions” to safeguard patients and reduce health disparities. We applaud these efforts and encourage more anti-bias guidelines as AI proliferates in health care.
Looking Ahead
The four issues covered in this blog; climate change, end of affirmative action, bans on DEI programs and policies, and emergence of AI, impact the health of BIPOC communities. While policymakers are taking notice, more can be done to mitigate the effects of climate change on Black, AI/AN, and Hispanic/Latino populations. Equally, the end of affirmative action necessitates immediate steps to protect the groundbreaking interventions seeking to reduce health inequities, including Black maternal health disparities. DEI-related program bans also threaten the health of BIPOC communities. Finally, regulations to democratize AI are integral to increasing health equity and minimize the risks of AI on minoritized populations.