IInstitutional declarations of support for Black Lives Matter have been everywhere since the killing of George Floyd. The radical, transformative change demanded by hundreds of thousands of protesters across the country has not been implemented.
The health care system can and should help move the country in this direction. It is important to address urgent social needs, such as food security, shelter or access to health care, as some health systems are now doing. But to truly value Black Lives Matter, they must be willing to tackle one of the highest drivers of racial health disparities: the racial wealth gap.
Most importantly, wealth is the value of their assets minus the total amount of their debts. The racial wealth gap is huge, exists at every income level, and hasn’t changed in over a century. In 2019, the median net worth of a white family in the US was $188,200, compared to just $24,100 for a black family.
The reasons for this gap are numerous and complex. But many of them can be traced back to a common denominator of structural racism: the end of slavery, when black families were set free to “freedom” with little or no assets; the impact of historical reconstruction and differences in current home values on intergenerational wealth creation through home ownership; subtle differences in the tax code that disproportionately affect the amount black families receive in their refunds; and so on.
In an essay for the New England Journal of Medicine, we outlined opportunities for health systems to reframe their roles in creating black wealth. Wealth is important to health, which should make it a natural focus for health systems seeking to prevent and treat disease. Greater wealth is associated with a lower likelihood of early death, lower rates of chronic diseases such as high blood pressure and diabetes, and improved overall functional status throughout life. Given the racial wealth chasm, it’s no surprise that it’s hard to move the needle on health disparities without addressing this above determinant.
According to the antipoverty medicine model, we describe three main ways to do this—reducing spending, increasing income, and reducing debt/increasing savings—and provide examples of how to implement each. This work is easily accomplished through medical-financial partnerships. This cross-sector collaboration between health and community-based financial organizations can improve the financial, physical, and mental well-being of the people they serve.
To reduce costs, for example, health systems can connect employees and patients with public benefits to which they are entitled, allowing families to meet basic needs. To maximize revenue, health systems can provide employees with a minimum living wage or offer free tax preparation services to employees and patients to take advantage of thousands of dollars in tax credits. To reduce debt and increase savings, health systems could connect black employees and patients with long-term investment products such as Child Development Accounts and Education 529 plans, or make 401k contributions matching all employees.
Health systems can intentionally source goods, services, and food from black-owned businesses, providing greater opportunities for wealth creation. Health systems can also limit business practices that contribute to a lack of wealth, such as health system consolidation, which can reduce prevailing wages by increasing health care costs, and adopt aggressive bill collection practices.
We know some in the health care industry will protest: This indeed work of the health care system? Is it not enough to focus on providing health care in the health care system? Shouldn’t health care systems stay in their lane and resist this massive disruption?
We believe that attention to racial wealth disparities is critical if the health care system is to be in the business of health promotion. We recognize that many health systems are currently struggling with rising labor and delivery costs, but we believe this work complements their core role in health care.
Health systems, in fact, are uniquely positioned to address the racial wealth gap because they are often the economic engines in their communities, with job opportunities and purchasing power. In addition, the health care sector is the largest employer of black Americans, yet black workers often earn the lowest wages and experience poorer health outcomes. Health systems have internal expertise, including human resources and business management professionals, and can use an asset-based community partnership approach to engage external experts to help staff and patients address wealth issues.
Change isn’t always easy, but it’s necessary if black lives matter. Concrete steps like these are needed to make major strides in reversing the effects of racism, which sparked national outrage on an unprecedented scale two years ago.
The United States remains at a crossroads, with an opportunity to fundamentally rethink and redefine the impact of the health care system on addressing the damage compounded racism has done to black lives. By focusing on closing racial disparities in well-being, health systems have the potential to live up to their title as anchor institutions. Thus, in humble partnership with the communities it serves, the medical profession can say it not only values Black lives, but adds value to those lives.
George Dalembert is a pediatrician at the Children’s Hospital of Philadelphia (CHOP) Care Network and medical director of the CHOP Medical Financial Partnership. Atheendar Venkataramani is an assistant professor of medical ethics and health policy and director of the Health Affordability Laboratory at Penn Medicine. Evgenia S. South is an assistant professor of emergency medicine at the Perelman School of Medicine at the University of Pennsylvania and a faculty member at Penn Medicine’s Urban Health Laboratory.