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The Burglar at Midnight

Feb. 14, 2022

How Unequal Opportunity Created Unequal Health

During the Health Equity Summit co-convened by The Hastings Center and the AAMC Center for Health Justice Jan. 19-20, Harvard scholar David Williams, MPH, PhD, examined how segregation is a driver of differences in income and education and how these racial inequities matter for life and health.

Williams is an internationally recognized expert whose TED Talk, "How Racism Makes Us Sick," has been viewed more than one million times. In his keynote address during the Health Equity Summit, "Righting the Wrongs: Tackling Health Inequities," Williams presented data on the gap in life expectancy between Black and white Americans that has not changed significantly in more than 70 years. He noted that in 1950, White Americans lived eight years longer than Black Americans; in 2020, they lived six years longer. Black Americans with a college degree or more education have lower life expectancy than White Americans with a high school degree.

"There is something profound about how your income and education matters to your health regardless of race. But race still matters, even with that in account."
- David Williams, PhD

Before a virtual audience of more than 2,600 attendees, he noted that segregation is a fundamental cause of racial disparities in health. "Think of segregation as a burglar at midnight," Williams said. "Once it shows up, valuables disappear like quality schools and safe playgrounds and good jobs and a healthy environment and safe housing and access to high-quality transportation and high-quality medical care. These are all shaped by where you live in the United States."

Williams also spoke about how racism is embedded in medical care, citing a report that showed that out of 1.8 million hospital births in Florida, Black babies are three times more likely to die in the hospital when cared for by a white doctor. But when Black babies are cared for by a Black doctor, the numbers are cut in half. 

Williams discussed a wide range of recommendations about what should be done to address these issues, including increasing the number of people of color who become doctors (a number that has declined since 1978), and increasing economic development in poor areas to improve housing opportunities.

He explained that there are three major barriers Americans must overcome in order to solve these inequities:

  • Awareness: Most Americans are unaware of the degree of problems we face.
  • Empathy: "We need to feel the pain that our fellow human beings are facing based on the policies that we have developed in this society," Williams said.
  • Science: Williams called for a science base that will guide and develop the political will to address racial and other social inequities in health.

“Why do we need to do this?” Williams asked. "Because it's about all of us. When one part of America hurts, all of America suffers."