What makes you sick? Look to history of racial bias for answers

This article, the first in a series, was produced as a project for the Dennis A. Hunt Fund for Health Journalism, a program of the USC Annenberg Center for Health Journalism’s 2020 National Fellowship.

If you’re born poor and Black in Charlotte, statistics suggest you’ll die that way, too.

It wasn’t always that way, though.

In 1900, Charlotte was far from an urban powerhouse with a population of 18,091 and an economy reliant on agriculture and textiles.  Neighborhoods weren’t segregated by race although it was customary in most southern communities by that time, but change was coming. As Jim Crow laws took root at the dawn of the 20th century and gained momentum over the intervening decades, it created a gap in health access and outcomes that left Black Charlotte in a yawning chasm compared to whites.

“A lot of the tough stuff is falling on people of color, and that comes out of a history of systemic racism” that gained momentum at the dawn of the 20th century, said Tom Hanchett, historian-in-residence at the Charlotte Mecklenburg Library. “If you asked me how the South got segregated, I would have said it's always been segregated or after the Civil War or after Reconstruction in the 1870s. No, actually around 1900 there were big stresses on the system.”

The COVID-19 pandemic has exacerbated and revealed the width of gulf between races on many fronts, said Mecklenburg County Health Director Gibbie Harris, who leads the county’s coronavirus response. The crisis has laid bare longstanding racial disparities and neglect in American life that haven’t been addressed at scale.

“The fact that we are now talking about place matters where you were born, where you live, where you were brought up really can make a difference, not just in your life in general but specifically in yourself,” she said. “So, I'm just really encouraged by that. …I want to make sure that everybody understands that all of the other outcomes directly impact health, so where do you live, how you live, what's your housing situation, what kind of education you have access to, what kind of jobs you have access to.”

White supremacy campaigns at the end of the 19th century, in which terrorists overthrew the elected government of Wilmington in 1898 and intimidated Blacks here, changed the landscape of economic growth for African Americans by forcing them into a separate and unequal arrangement.

“Segregation is the result of choices that policymakers and other folks made over time, kind of layered on top of each other,” Hanchett said. “So, what we're dealing with right now is a playing field that we didn't create. We get to play and push in and change and make it better but understanding how the field got set up is really powerful.”

Charlotte customs and legislation widened the race gap. Discriminatory laws effectively left Blacks with limited access to education, housing and health care. Exclusionary practices like redlining Black neighborhoods and homeowner covenants that locked them out of white communities widened the economic gap by stripping Blacks of the means of producing generational wealth. As a reaction, the all-Black, work class Brooklyn neighborhood was created. By the end of the 1960s, it fell victim to redlining and lack of investment, then ultimately urban renewal, a politically expedient program to tear down substandard housing often owned by absentee landlords.

The legacy of the arbitrary redlining African Americans as bad credit risks is evident in modern homeownership rates: 42% of Blacks in the Charlotte region own a house compared to 69% of whites. Nationally, 47% of Blacks are homeowners as opposed to 76% of whites. As of 2017, Black Mecklenburg residents were twice as likely to be denied home loans as whites – 11.9% versus 5.6%.

“Brooklyn came into being as a response to that awful period of disfranchisement around 1900 when African Americans were literally displaced from moving into new suburbs,” Hanchett said. “All of the suburbs around the center city around 1900 had restrictive covenants in their deeds – Plaza Midwood, where I live, Dilworth, Myers Park, Villa Heights, all of those said, ‘members are Caucasian race only.’

“And so African Americans tend to move in and kind of clump together with a number of neighborhoods, the greatest of the neighborhoods was Brooklyn, a city within a city.”

Those economic pressures show up in health care as well. The United States has world-class medicine, but it is far from universal, leaving the free market to decide the depth of insurance coverage for individuals. For the poor, it’s hit or miss. According to Census data, 52,373 Black residents, or 18.04% of the entire Black population – equal to the entire city of Kannapolis – live in poverty. By comparison, 23,919 whites are similarly situated, or 6.89% of all in that ethnic group.

Government is of limited help, especially in health care. Fifteen percent of Mecklenburg County residents receive Medicaid or N.C. Public Choice insurance for low-income individuals, but an estimated 500,000 North Carolinians are uninsured, often limiting them to emergency room treatment that raises insurance premiums for everyone else. The Republican-dominated General Assembly has blocked Medicaid expansion for years, but three in four residents support extending the federal insurance program according to a recent Care4Carolina poll. North Carolina is one of 12 states that hasn’t expanded Medicaid, but 64% of Republicans, 76% of independents and 83% of Democrats support expansion.

Medicaid expansion, health care advocates say, would create 40,000 jobs at no cost to the state, add $4 billion to the economy, and pump funds into rural hospitals that lack the funding of facilities in urban communities.

In order to close the gaps in health care and outcomes, advocates say it’ll take an intentional societal effort to remove barriers to access the tools of economic growth and racial equality.

“To me, courage is the most important word because it will take courage within our system. It will take courage within our communities to challenge the systemic problems that we know are there,” said Dr. Jerome Williams, senior vice president for consumer engagement at Novant Health. “These problems are not new. They're rooted in intentional decisions and policies and behaviors and to be quite honest with you, the system is working just the way set up to work.”

[This story was originally published by The Charlotte Post.]