Title:Auditing history is key to eliminating health disparities

A Georgetown University team of scholars conducted an in-depth analysis into federal and local historical policies, practices, and events to understand the origins of health disparities—and why they continue to exist today.

In the February 2022 issue of the health and health policy thought and research journal Health Affairs, Christopher J. King, Ph.D., MHSc, FACHE, dean of the School of Health, along with a team of co-authors, conducted a historical analysis to elucidate how past social, economic, and political events have disenfranchised Black residents in Washington, D.C., from the District’s founding in 1790 to the present day.

“We inherited a system rooted in injustice,” says King. “It is our responsibility to first acknowledge the injustices are real.”

King’s interests in health and racial equity stemmed from his time working for a health center that served uninsured people. He recounts how the institution did everything medically to help patients stay well, but they weren’t “experiencing significant improvements in the health of the total number of patients served.”

In the analysis, King examines the significant differences in the health of Black versus the white residents, explaining that institutional racism plays critical roles in both past and existing policies.

“Equity means adjusting resources based on a person’s needs so everyone can improve collectively,” says King. “It requires us to see each person as an individual and ensure we have systems in place to meet their needs based on where they are.”

From his time in various health care leadership positions to his research analyzing historical events in the District, King notes one issue that is
not being addressed: systemic racism.

“We have to go back more than 400 years and examine the foundation of the United States,” he says. “Our systems have created profound inequities that have burdened, marginalized, and caused harm. It is incumbent upon us to acknowledge the intergenerational effects and apply an atonement lens in future practice and policy.”

In the analysis, King explains that the pathway to achieving racial justice in Washington, D.C. will require operational awareness and intentionality because many inequities can be indistinct—or even unintentional.

“All people, not just people of color, need to have the backbone to dismantle vestiges of our past and critically audit our work, institutions, and disciplines to see where we fall short,” he says.

King notes that eliminating institutional racism is a pre- requisite for eradicating disparities and ultimately improving the health and productivity of the nation. Examining the structures our society is built on through a racial lens is intense, emotional work that is going to take everyone’s diligence.

“I don’t think we’re going to fix the system in our lifetime, but we can definitely put a dent in it, and create a world that is better than it was when we found it.”