Rooted in Racism: An Analysis of Health Disparities in Tennessee

By Kinika Young

July 27, 2020

Executive Summary

The disproportionate impact of COVID-19 on Black Americans is the latest of many examples of health disparities within this population. Dating back to the beginning of this nation, health disparities have existed and have plagued Black people and other people of color as a result of systemic racism, which influences every social determinant of health. Health disparities should be considered within the context of health inequities and the practices and policies that embody and reflect racism. One of the primary health inequities that causes poor health outcomes for Black people is the denial of access to health care because of political choices made by state leaders. Another factor is poor quality of care that is often linked to providers’ implicit racial bias.

Other than “Medicare for All” or some version of universal health care, expanding Medicaid to cover the uninsured, among which Black people are overrepresented, is one of the best, easiest options to address health disparities, including COVID-19. Insurance status is a key factor in health and mortality. Tennessee is one of eight Southern states that continue to reject Medicaid expansion under the Affordable Care Act, despite evidence showing that it improves coverage, access to care, and health outcomes, particularly for racial/ethnic minorities, and despite the economic and health benefits it would provide to help with pandemic recovery efforts. This rejection should be evaluated within the historical context of racism that is concentrated in the South and that has driven policy decisions ever since Africans were first forced into chattel slavery on this continent in 1619. Tennessee and other Southern states must reckon with this history, dismantle the racism that is driving political decisions, and finally adopt Medicaid expansion, which has been shown to reduce racial disparities.

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