Homelessness and Black History: Health Care Disparities

Over the last several years, there has been a growing understanding that health and homelessness are closely connected. Not only do we recognize that homelessness is associated with countless health vulnerabilities, but we also realize that lack of healthcare access and coverage can drive poor health outcomes and higher healthcare costs – both of which put people at risk of becoming homeless.

Adequate healthcare is notoriously inaccessible in the United States, and especially so for communities of color. Coupled with western history’s immeasurable examples of medical racism, lack of meaningful access to physical and mental healthcare has produced marked racial disparities in health status – and thus in homelessness.

COVID-19, Health Care, and Racism

The ongoing COVID-19 pandemic provides an archetypal example of racial discrimination in healthcare. While Black people in the US are 1.4 times as likely as white people to contract COVID-19, 3.7 times as likely to be hospitalized, and 2.8 times as likely to die of COVID, white people were vaccinated at a rate of 11 times that of Black people during the first month of vaccinations. Only 5.4% of those vaccinated between December 14, 2020 and January 14, 2021 were Black. Generations of medical abuse, along with access issues like the fact that Black communities tend to have fewer local pharmacies than other communities, help account for this disparity.

Lack of technology access or proficiency further contributes to disparities. People of color, particularly those of aged 65 and older – are less likely to have Internet access or access to Internet-enabled devices, and less likely to be able to complete the (in many cases) convoluted process required to secure a vaccination. Entrenched structural racism in the public health sector continues to harm Black people via exclusion, with COVID-19 being only a single example among many.

Hesitancy around the vaccine, stemming from a long history of racist discrimination in health care, may account for a portion of the racial discrepancy. By now, many are aware of the infamous Tuskegee Syphilis Experiments, wherein doctors from the U.S. Public Health Service misled hundreds of Black men into believing they were being treated for syphilis, and instead withheld treatment from the men.  The study, which lasted until the 1970s and was terminated due to a leak to the press, directly caused the deaths of nearly 200 Black men. Fewer may know the story of Henrietta Lacks, whose cells were harvested during a 1951 biopsy at Johns Hopkins University and, without her consent, have been exploited for medical use up to and including the present day.

Bias in the Medical Field

Racism in medicine continues to this day, often in far subtler and more insidious ways. Studies indicate Black people are less likely to be believed about the severity of pain they are experiencing, and are less likely to be assigned specialists. An academic study recently found significant biases in favor of white patients among healthcare workers. Those who showed a bias toward white patients were more likely to perform a necessary procedure on a white patient than on a Black one.

Partly due to discrimination like this, Black people in the US have, on average, lower life expectancy, lower vaccination rates, and increased strain on mental health. Stereotyping and internalized biases on the part of health care officials means Black people often do not get access to the treatment they need, which in turn is a contributing factor to the overrepresentation of Black people among the homeless population.

Beyond Physical Health

The impact of racial discrimination is not limited to physical health. Mental healthcare professionals, too, are less likely to take the concerns of Black patients seriously compared to white patients, and people of color are more likely to be criminalized for their behavioral health needs than to receive adequate treatment. Officials are less likely to diagnose depression in Black clients, and Black patients are more likely overall to be misdiagnosed or dismissed entirely.

Taken together with the deleterious impact of frequent, ongoing racial trauma on mental health (with Black adults twenty percent more likely to report serious psychological distress than white adults), these factors create the perfect conditions for a racial mental health gap, which itself carries over into homelessness.   

The Consequences of Inequitable Health Care

On the whole, Black people are less likely to have their health needs taken seriously. They are less likely to receive critical treatment, more likely to be dismissed or disbelieved, and, as a result of deep-rooted racism in healthcare, are more hesitant to seek necessary care. Black people are also more likely to be employed in jobs that do not offer benefits like healthcare, so they have less access to care from the start. Separately, any of these factors would be a crisis, but together, they not only help account for some of the racial disparities in homelessness, but also form a robust illustration of the material impact of structural racism.

Both the homelessness and healthcare sectors have work to do in eliminating discrimination, disparity, and eventually homelessness. While it is commonly understood by members of the homelessness field that healthcare systems feed into homelessness in a major way, it is crucial to apply the same reasoning to racial disparities in homelessness. Only by addressing these serious inequities can we even begin to end homelessness.