How Does Racism Contribute To Poor Health In The Cleveland Area?

Ideastream’s health team is connecting the dots on how racism contributes to poor health outcomes in the Cleveland area. As government and health agencies have declared racism is a public health crisis, officials at MetroHealth tell us what they have been doing to target structural barriers at the root of health inequities.

In 2019, MetroHealth’s CEO Dr. Akram Boutros addressed the City Club of Cleveland about racism as a public health crisis. He specifically mentioned infant mortality, and how African American babies in Cuyahoga County are dying at a rate that’s four times greater than white babies.

“When we speak of this as an infant mortality problem and ignore race, we cloud the issue. And if there’s one thing we know about African American infant mortality is that it is due in part to structural racism,” Boutros said.

He went on to explain that structural racism refers to the ways in which societies foster racial discrimination through mutually reinforcing systems of housing, education, employment, earnings, benefits, credit, media, health care and criminal justice.

“How can we solve a problem we’re not being perfectly clear about while ignoring one of its root causes?” he asked.

MetroHealth CEO Dr. Akram Boutros addresses The City Club of Cleveland on June 7, 2019. [The City Club of Cleveland / YouTube]

Other organizations were not far behind in declaring racism as a public health crisis, agreeing with Boutros that structural racism has long been impacting public health.

Last summer, after a police officer murdered George Floyd in Minneapolis, and as the COVID-19 pandemic hit the Black and Hispanic communities harder than others, many Cleveland organizations declared that racism is a public health crisis.

Although the Black Lives Matter rallies and protests pushed racial inequality into the forefront for some, MetroHealth has been working on this issue for years, said Alan Nevel, MetroHealth’s Chief of Diversity and Human Resources.

 “We were doing it before it became “en vogue” if you will,” Nevel said.

Nevel, who is Black, said connecting the dots between racism and the impact on public health is very important to him.

“This is very personal to me because the effects of systemic racism and bias hit close to home. Not only for myself, but for the people I grew up with. For my children, for my grandchildren,” he said.

Click on this image to find out more about how you can partner with Ideastream Public Media to help connect the dots between racism and health. [melitas / Shutterstock]

MetroHealth doctors have seen how these disparities can contribute to the poor health of some patients, said Susan Fuehrer, the president of Institute for HOPE, a MetroHealth organization created to address these social determinants of health.

 “Can you imagine being a primary care physician with a diabetic patient who needs insulin and that person doesn’t have a home, or doesn’t have a refrigerator, or doesn’t have working electricity to make the refrigerator work? What are you supposed to do as a physician to solve that problem?” she said.

These issues that physicians and patients wrestle with didn’t happen by accident, Nevel said. Structural racism laid the foundation for all of these issues that show up in the doctors office or when patients show up at the Emergency Department.

“When we look at the systems that have resulted in these disparities, be it redlining from a housing perspective, even our nation’s highway infrastructure is set up to enable you to exit in certain parts of a town versus others. All of those things have that impact,” he said.

Redlining means that banks and insurance companies discriminate against certain neighborhoods and chose to not give out loans to people based on their race or where they live. That can impact health because where a person lives can impact their access to health care, healthy food, transportation, and much more. And over time, it can impact a person’s ability to accumulate wealth, if they aren’t able to leave a neighborhood due to redlining.  

MetroHealth is building an affordable housing complex that will include an Economic Opportunity Center, which will provide job training, financial and digital literacy training, and access to Tri-C classes. [Lisa Ryan / Ideastream]

Housing has a big impact on health, Nevel said, which is why MetroHealth is building an affordable housing complex close to their main campus in Cleveland’s Clark-Fulton neighborhood, on the west side.

“If you don’t have safe, reliable housing in the winter--because we have some unpredictable winters here--that impacts you both physically and mentally,” Nevel said.

Hospitals are uniquely positioned to use their power to help address racism as a public health crisis, said Michellene Davis, the CEO of National Medical Fellowships, which helps people of color become doctors and health care professionals.

“Hospitals have the opportunity to also leverage their government affairs and our policy frameworks to ensure that they are including issues that are of challenge to these communities. But you have to be in and of the community in order to really be able to identify those issues,” she said.

To Davis, that means not just releasing statements acknowledging racism can affect health, but actually changing policies to address it.

MetroHealth has changed its policies, including screening patients to see how the social determinants of health might be affecting them, Fuehrer said.

“In January, we actually had someone complete the form, it was very cold out, they didn’t have any utilities,” she said. “We were able to identify that they didn’t have any utilities, they didn’t have any heat at the moment, and we were able to intervene immediately.”

Right now, the process is reactive, but Fuehrer hopes in the future, they can be proactive in helping patients before those factors begin to influence their health.

“What we hope is that we will have predictive analytics at the actual local level where we’ll be able to say, this business just closed, and it had 250 employees that likely live nearby and we need to look at interventions,” she said.

MetroHealth's Dr. Brook Watts (at podium) visits a drive-up vaccination clinic in Old Brooklyn, on Cleveland's west side. [Lisa Ryan / Ideastream]

Dr. Brook Watts, who runs MetroHealth’s vaccination clinics all over the Cleveland area, said addressing historical racism is important, but it’s even more important to realize racism is a present-day issue too.

“This isn’t just a historical problem. People of color may be very uncomfortable with coming into health care settings, truthfully, because of bad experiences they had last week, or a month ago, or last year,” Watts said. “People are telling us stories that make you really focus on the changes we need to be accountable for now.”

And so, Watts said MetroHealth’s work is ongoing to try to create a healthier community, beyond the walls of the doctor’s office.