Williams Speaks on the “Inequities by Design” of Health and Healthcare in the United States

It can be believed, with COVID-19, that “we are all in the same storm,” said Harvard's Dr. David R. Williams during the annual Hakim Lecture on October 21st. “But we are not in the same boat. And some boats are better equipped to weather the storm than others.”

Speaking on “Understanding and Effectively Addressing Inequities in Health,” Dr. Williams presented a range of statistics on health and mortality disparities among races, including that the rate of death from COVID-19 is two to four times higher for Black, Latino and Native American individuals than for white individuals, and that the pandemic has had a negative effect on life expectancies that the U.S. has not seen since World War II—but even those effects are not uniform across races.

Socioeconomic status is the single biggest predictor of variations of health around the world, Dr. Williams explained, whether countries have universal health care or not. But even taking into account the important roles of income and education level, race still plays an important factor, as white households and minority households with the same socioeconomic status still have different life expectancies. So what role does racism play in these racial disparities of health?

Looking at residential segregation, an illegal but still prevalent system that has been locked in place in the United States since the 1940s, Harvard sociologists William Julius Wilson and Robert Sampson conducted a 1995 study of the 171 largest metropolitan areas in the U.S. and noted that “the worst urban context in which whites reside is considerably better than the average context of Black communities.”

“Your zip code is a stronger predictor of how long and how well you will live than your genetic code,” Dr. Williams noted, focusing not on individual beliefs of race, but on systemic and institutionalized racism, through which different groups are differentially allocated resources.

Dr. Dolores Acevedo-Garcia of Brandeis established the Neighborhood Opportunity Index, ranking every county in the U.S. on 29 opportunity indicators for children. The data shows that in the 100 largest metropolitan areas, two out of three Black children, and more than half of Hispanic children and Native American children come from low or very low opportunity neighborhoods, as opposed to just 18% of white children.

“Racial inequalities in socioeconomic status do not reflect a broken system,” he said. “Instead, they reflect a carefully crafted system, functioning as planned, successfully implementing social policies, many of which are rooted in racism.”

Studies also show that African American men are biologically aging faster—by 10 years—than white men, capturing the physiological effects of being exposed to environmental stressors triggers earlier onset of diseases such as hypertension and diabetes.

So what can be done? Dr. Williams offered several examples of ways to lessen some of these disparities. One is to build more “health” into the delivery of healthcare, citing an initiative by the state of Delaware focused on early detection of colorectal cancer. Fully supported by the state’s Division of Public Health and targeting underserved communities, the advisory council developed and implemented a comprehensive colorectal screening program and treatment program for the uninsured with household incomes up to 650% of the federal poverty level. In just a few years, the state had seen not only a decrease in incidence rates of colorectal cancer, but the near disappearance of the racial gap between incidence rates.

Other methods include eliminating inequities in the receipt of quality healthcare caused by a pattern of implicit bias among health care professionals, diversifying the healthcare workforce to meet the needs of all patients, focusing on improving the environments that cause illness rather than just treating the illness, and building community immunity for future pandemics by investing in early childhood opportunity and focusing on neighborhood improvements by investing in purpose-built communities.

While acknowledging these changes would not be easy or happen overnight, Dr. Williams noted that change starts with raising awareness levels of the disparities, as well as lessening the “empathy gap” that exists between different races by encouraging greater interracial interaction and reshaping the narrative to focus our similarities rather than our differences.

Watch Dr. Williams’s full talk for more information on these studies and others.

Dr. David R. Williams is the Florence and Laura Norman Professor of Public Health and Chair, Department of Social and Behavioral Sciences, at the Harvard T.H. Chan School of Public Health. He is also a Professor of African and African American Studies at Harvard University. An internationally recognized social scientist, Dr. Williams research has enhanced our understanding of the ways in which socioeconomic status, race, stress, racism, health behavior and religious involvement can affect physical and mental health. Dr. Williams is the author of more than 500 scientific papers and the Everyday Discrimination Scale that he developed is the most widely used measure of discrimination in health studies.

This annual lecture series was established by Dr. Raymond Hakim in honor of his late wife, Catherine McLaughlin Hakim ’70. A sociology major at Emmanuel, Catherine studied under longtime sociology professor Sister Marie Augusta Neal, SNDdeN, who left an especially indelible mark on her student experience. The lecture series commemorates Catherine’s life, her fondness for Emmanuel, and the relationships she formed at the College and continued to maintain throughout her life.