Social determinants, including racism, are the main drivers of health inequity, says Watson

Social determinants of health (SDOH) are the main determinants of inequalities found in health outcomes, and racism is clearly a social determinant linked to life expectancy, said Karol Watson, MD, PhD, in a speech on Sunday at Congress 2022. of the American Society for Preventive Cardiology, held in Louisville, Kentucky.

Social determinants of health (SDOH) are the main determinants of inequalities found in health outcomes, and racism is clearly a social determinant linked to life expectancy, said Karol Watson, MD, PhD, in a speech on Sunday at Congress 2022. of the American Society for Preventive Cardiology, held in Louisville, Kentucky.

Watson, Professor of Medicine / Cardiology at UCLA’s David Geffen School of Medicine, began with data that helped guide the SDOH conversation through medical specialties: the huge effect on mortality that the COVID-19 pandemic had on people of color.

“Just as the rich seem to get richer and the poor seem to get poorer, and this was the same with the life expectancy lost during the pandemic.”

In 2018, he said, the overall life expectancy in males was 78.8 years, although there were disparities by race. By 2020, at the height of the pandemic, overall life expectancy for males had dropped to 75.1 years, but for black males it dropped to 68.3.

“It is 3 years after you reach Medicare age, which is probably the time you will have your first grandchild,” Watson said. “This is shocking and unacceptable.”

These racial differences in results occur, he said, even if genetically the difference between races is barely noticeable: there is only about 0.1 percent difference in DNA.

“Race is a social construct, not based on biology or genetics,” Watson said. Rather, “Race refers to a group of people who typically share some physical characteristics.” Ethnicity refers to a group of people who share a culture; Watson said that race refers to the appearance of people, while ethnicity refers to how people live.

Yet, due to racism, many characteristics related to life expectancy segregate along racial lines. “So, it’s not a completely useless social construct,” Watson said.

He highlighted the influence of the Swedish botanist Carl Linnaeus, called the “father of modern taxonomy” for his work that classifies plants, animals and, subsequently, humans. Except his descriptions of the various races are quite racist. Whites, Watson explained, were “kind and imaginative”, while blacks were “deadpan and lazy”.

“This is where we get our races,” he said. “It started with racism.”

With Johns Hopkins’ Wendy Post, MD, MS, as first author, Watson just posted the results in Circulation which show that black participants in the MESA study had a 34% higher risk of all-cause mortality and cardiovascular disease. “Clearly, we see differences in life expectancy.”

In that study, she and Post controlled for SDOH factors, which eliminated some, but not all, of the differences.

Watson saw the effects up close. He described a patient who had just been discharged after an uncomplicated STEMI. He was given dietary advice; doctors made sure they got generic prescriptions and signed up for cardio rehab. But at the patient’s next appointment, he reported that he was having a hard time affording the drugs, which were $ 5 to $ 8 a month. And since he had 2 jobs, including 1 on weekends, he was missing rehabilitation visits.

He described the frustration of seeing patients come to the clinic with McDonald’s bags. “None of us like to see this.” But one patient told her it was breakfast she could afford and that Wi-Fi is free.

“We need to understand that social determinants represent more than many other things to many of our patients,” said Watson.

There are many modifiable factors that affect health, but income outstrips many others. He pointed to Whitehall’s famous study of British civil servants, which compared mortality across social classes. The assumption that high-ranking executives would have a worse mortality turned out to be completely wrong; lower-ranking workers fared worse.

“The impact of the social benefit on health is substantial,” he said. There is a 14-year difference in cardiovascular mortality in different regions of the country based on socioeconomic differences.

And as difficult as it is to measure, “We can’t forget racism.”

Overly racist acts are easy to recognize, he said. But unconscious bias is not, and structural racism is “almost invisible”.

The social determinants of health, he said, begin at birth and exist as people grow, work and age and need to be addressed. “Health differences are health differences,” Watson said. “Health inequalities are unjust and unjust ones”.

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