What will it take to end the crisis of Black deaths in the U.S.?

In the last two decades, Black Americans have suffered 1.63 million excess deaths compared to white Americans. Experts gathered at the STAT Summit in Boston last week to discuss the crisis of Black deaths in the U.S. and interventions that can help advance health equity.

“If we continue to have a maternal health crisis, if we continue to have an infant mortality crisis … then we’re going to potentially see a situation or circumstance where Black people can be extinct in the future,” said panelist Monica McLemore, a professor and interim associate dean for equity, diversity, and inclusion at the University of Washington School of Nursing. “And as long as I’m around and a whole lot of other people are, we’re not going to allow that.”

Black women are two to three times more likely to die from pregnancy-related complications compared to white women — and this disparity increases with age, said McLemore. The drivers of such disparate outcomes are structural racism and discrimination rooted in the U.S. health system, said the summit panelists, who research health equity solutions at their respective institutions.

An essential step toward addressing structural racism in the medical system is acknowledging these racial biases, said Harlan Krumholz, a cardiologist and Yale professor of medicine as well as founder and director of the Yale Center for Outcomes Research and Evaluation.

“It’s like you have to be a white supremacist to be a racist. No. We’re all racist,” Krumholz said. “We’re like two fishes looking at each other going, ‘What’s water?’ It’s like you’re so immersed in it that we don’t even realize that it’s going on.”

Dismantling structural racism and advancing health equity will also require addressing the social determinants of health that continue to disproportionately harm Black Americans, such as poverty, segregation, and environmental degradation, the panelists said.

“If we wanted to improve health outcomes in the United States alone, there’s a very simple intervention,” McLemore said, “and that is paid family leave.”

“I have moms who, 10 days after a C-section, are out driving for Lyft and Uber. That’s the last thing they should be doing after abdominal surgery, but they need money,” she said. “So maybe we should give some citizens a basic minimum income during pregnancy and childbirth.”

Panelists also discussed the ways that the lack of Black people in the medical profession contributes to health disparities. While Black people make up over 13% of the U.S. population, only 5% of doctors are Black. “I’ve been a registered nurse for 30 years, and I just got a Black primary care physician,” McLemore noted.

Monica Peek, the Ellen H. Block Professor for Health Justice at the University of Chicago, emphasized how Black patients can have better health outcomes when being treated by providers who look like them.

“We have to create safe spaces, emotionally safe spaces, in addition to physically safe spaces where we think we’re delivering the best standards of care,” she said. “And we’re only going to do that if we have a loving workforce that is representative of the people that we’re trying to serve.”

As a potential solution, McLemore said, “If we want to be serious about thinking about how to get at this excess death, maybe what we need is health care reparations. Maybe we need some really crazy ideas. Like debt-free education for anyone who wants to go into health professions.”

There’s still a long way to go in addressing health disparities affecting Black people. For example, Sen. Cory Booker (D-N.J.) and Reps. Lauren Underwood (D-Ill.) and Alma Adams (D-N.C.) have introduced the Black Maternal Health Momnibus Act in Congress, a set of 13 bills that makes critical investments to end the nationwide maternal health crisis and save new mothers’ lives. But while the legislation is ready, there has been no progress on this since 2020, McLemore said. (A spokesperson from Underwood’s office later noted that President Joe Biden did sign the Protecting Moms Who Served Act, a bill within the Momnibus Act, into law at the end of 2021.)

Krumholz noted that immediate actions taken now can pave the way for landmark legislation like the Black Maternal Health Momnibus Act to be instituted in the future. “I want to see this accountability and the actions that we can take today that will make a meaningful difference in the near term,” he said.

This story has been updated.