The Legacy of MLK and the Social Determinants of Health

This past Monday  the nation commemorated the birthday of Dr. Martin Luther King Jr. who was a civil rights activist that was assassinated April 4, 1968 at the Lorraine Motel in Memphis, TN. Since his death, there have been songs written in his honor, a holiday in his name, and countless books, speeches, and content created around his work. The one thing that often happens is little light is shed on King’s core mission which is citizenship for Black Americans. 

I know it’s been a while since I have written an entry. Needless to say 2022 was extremely busy. I was fortunate to travel the country and give speeches about economic repair for Freedmen and helped push the notion of normalizing Atheism in the Black Community. I also became a parent to a little boy whose mother passed away 5 days before Christmas in 2021. I’ve been doing some producing and hosting on different podcasts and trying to do what I can to push activism in my own way. I thought it would be fitting that my first post for 2023 would be on King’s legacy and how it ties into the Social Determinants of Health for Black Americans. 

Social determinants of health are the conditions in which people are born, grow, live, work and age. They include factors like socioeconomic status, education, neighborhood and physical environment, employment, and social support networks, as well as access to health care. When discussing these determinants concerning Black Americans we can pick each factor and see where we are.

Socioeconomic Status:

According to The Economist, two years before the passage of landmark civil-rights legislation and the Great Society programme, the average wealth of white households was seven times greater than that of black households. Yet after decades of declining discrimination and the construction of a modern welfare state, that ratio remains the same. The mean of black household wealth is $138,200—for whites, that number is $933,700. Median wealth is smaller, but even more lopsided. The typical black family has just $17,100 compared with the typical white one, which has $171,000. The discrepancies are caused by low incomes and by debt. Compared with whites, black Americans have higher debt loads: 19.4% of black households have net wealth at or below $0, compared with 9.2% of whites. There had been slow improvement over the decades, but the Great Recession of 2007-08 wiped this out, since blacks were disproportionately harmed by the subprime mortgage blow-up. Because of that, home-ownership, the conventional wealth-building tool of the middle class, stands at 42% among blacks—only one percentage point higher than it was in 1968—compared with 73% for whites.

Education:

According to the National School Boards Association:

In 2018, nearly one third of Black students lived in poverty (32%), compared with 10% of white students in families living in poverty. The percentage of Black students who lived in households where the highest level of education attained by either parent was a bachelor’s or higher degree was 27%, compared with 69% of Asian students and 53% of white students.

  • 64% have parents whose education level is less than high school.
  • 45% live in mother-only households.
  • 35% live in father-only households.

In fall 2017, of the 50.7 million students enrolled in public elementary and secondary schools, 7.7 million were Black. Only 7% of Black students attended low-poverty schools, compared with 39% Asian and 31% white students.

  • 45% of Black students attended high-poverty schools, compared with 8% of white students.
  • About 25% of Black students were enrolled in public schools that were predominantly Black.

The long-term trend shows that the achievement gap between Black and white students has narrowed. However, the progress is minimal, and the gap is still there. The National Report Card (NAEP) shows that from 1992 through 2019, the average reading and math scores for Black 4th, 8th, and 12th graders had always been lower than those of their white peers.

  • Only 9 out of 100 Black students performed at or above the NAEP proficient level in civics.
  • Only 13 out of 100 Black students performed at or above the NAEP proficient level in math.
  • Only 15 out of 100 Black students performed at or above the NAEP proficient level in reading.

Nationwide, the overall dropout rate decreased from 9.7% in 2006 to 5.3% in 2018. During this time, the dropout rate for Black students decreased from 11.5% to 6.4%. Nevertheless, the dropout rate for Black students remained higher than that for white students (4.2%). Additionally, 22% of Black 18- to 24-year-olds were neither enrolled in school nor working, which was much higher than the percentage of all U.S. 18- to 24-year-olds youth (14%).

  • Nearly 8 out of 100 Black males dropped out of school.
  • About 6 out 100 U.S.-born Black students dropped out of school.
  • About 37 out of 100 institutionalized (such as in correctional or health care facilities) Black students dropped out of school.

In school year 2017–18, the national adjusted cohort graduation rate (ACGR) for public high school students was 85%. However, the ACGR for Black students was 79%, below the U.S. average.

The graduation rates for Black students ranged from 67% in the District of Columbia to 88% in Alabama.

Arkansas, West Virginia, Texas, and Alabama were the only four states in which the graduation rates for Black students were higher than the U.S. average.

From 2000 to 2018, college enrollment rates among 18- to 24-year-olds increased for those who were Black (from 31% to 37%). Among Black males, college enrollment rates were higher in 2018 (33%) than in 2000 (25%). However, among Black females, the rate in 2018 was not measurably different from the rate in 2000.

Of the 16.6 million undergraduate students enrolled in fall 2018, 2.1 million were Black. Although there were 101 degree-granting, 4-year Historically Black colleges and universities (HBCUs) and 2-year HBCUs in operation—51 were public institutions and 50 were private nonprofit institutions, the number of Black students majoring in science, technology, engineering, and mathematics (STEM) is still low.

In 2017-18,

  • 13% of Black students obtained bachelor’s degree conferred in a STEM field.
  • 7% of Black students obtained associate’s degrees conferred in a STEM field.
  • 6% of Black students obtained master’s degrees conferred in a STEM field.
  • 5% of Black students obtained doctor’s degrees conferred in a STEM field.

Their concluding findings:

  • The poverty rate is still the highest for Black students.
  • A lack of internet access at home has become a barrier for Black students to learn.
  • A high percentage of Black students attend high-poverty schools.
  • More Black students with disabilities receive services for emotional disturbances.
  • The disproportion between Black students and Black teachers has not been improved.
  • The achievement gap between Black and white students has not been closed.
  • School dropout rate keeps high among Black students.
  • Graduation rates and college enrollment rates remain low among Black students.

Neighborhood and Physical Environment

California suburbs from a drone point of view.

Stark differences in predominantly Black Neighborhoods vs. White are still very present in the 21st century. According to J Health Dispar Res Pract, the absence of jobs for young, urban Black Americans has led to severe economic declines in many neighborhoods. The resulting economic and social disadvantage engendered many of the neighborhood characteristics associated with what Ross and Mirowsky (2001) describe as disorder, which includes poorly maintained built environments, crime, distrust, and unruliness. These by-products exacerbate the ongoing struggle for housing equality experienced by many African American residents. The problem is especially salient for older African Americans who experienced subpar access to housing resources through the widespread practice of de jure segregation. Many Black American neighborhoods were affected by exclusionary policies that limited the ability of residents to purchase high quality, neighborhood-enhancing housing. From the Great Depression until the late 1960’s, the Federal Government, real estate elites, bankers, and insurers participated in the systematic practice of denying loans and insurance to African Americans. This practice included identifying African American neighborhoods as risk hazards by using red lines (redlining) to delineate these areas . The Federal Housing Administration (FHA), created by Franklin Roosevelt in response to the housing crisis emanating from the Great Depression, refused to underwrite loans in red areas. Because of this, lenders were hesitant to provide financing to homebuyers without FHA support.

The macroeconomic transitions over the last quarter-century and patterns of housing inequities have contributed to unhealthy environments within disadvantaged African American neighborhoods. The problem is exacerbated by  patterns of racial segregation experienced by residents whose neighborhood environments are isolated from high-quality resources that promote positive health behavior in the form of schools, housing, infrastructure, and employment. Discriminatory policies and practices confining Black people—for whom the incidence of poverty was markedly higher than for white people—to particular city neighborhoods produced much higher poverty rates in those neighborhoods. High rates of poverty exacerbated the flight of capital and essential services, reinforcing the effects of racist policies and practices on neighborhoods. Today, virtually all urban and suburban neighborhoods with high poverty rates are predominantly occupied by Black Americans, and among households experiencing poverty, white households are much more geographically dispersed than Black households. 

The neighborhood environment affects many disparities in health outcomes between African Americans and other racial/ethnic groups.Research shows that the role of neighborhood environments in influencing health behavior can be examined along racial and socioeconomic lines.Disease-promoting environments, not genetic factors, contribute to poor health outcomes among many African Americans. The characteristics of the communities that Black Americans  live in account for much of the differences in illness mortality between Whites and African Americans. 

The legacies of early forms of discrimination have also proved more enduring than formal legal changes would suggest. Living in segregated neighborhoods has blocked Black Americans from the educational opportunities mentioned in the section above, jobs, and wealth building necessary to access well-resourced neighborhoods, while generations of white families have benefited from the structural advantages of the opportunity-rich neighborhoods in which they live. And neighborhoods occupied by Black American often lack the quality services and housing stock necessary to appeal to white homeseekers, who may have many other options. As a result, many Black Americans remain locked in disinvested neighborhoods, while predominantly white neighborhoods grow and prosper more readily.

Employment, and Social Support Networks:

According to Statistica, In 2021, 8.6 percent of the Black or African-American population in the United States were unemployed, the highest unemployment rate of any ethnicity. In 2021, the national unemployment rate stood at 5.3 percent. Even with Black Americans that achieve and Bachelor’s or higher, they still fall short of closing the income gap amongst Whites and Asians. According to the National Funds for Workforce Solutions, Blacks with a BA degree or higher between the ages of 25-64 represent 32% of their racial group however, their average income is about $26 an hour juxtaposed to AAPI at $38 per hour and whites at $34 per hour. According to a Duke University Study released in 2017, What we get wrong about the racial wealth gap, White American wealth was still approximately 15,000 dollars higher without a high school diploma as opposed to Black Wealth with a BA or higher. 

Historically, Black American Social Support Systems were primarily the Church, the Family and Schools. According to Pew, Black Americans still have the highest percentage of Christians in the nation but you do have a higher percentage of them leaving the church. The “falling away” comes amidst scandals, and the rise of skepticism especially amongst Millenials and Gen Z.  Pew also says Black Americans show about almost 20% of Blacks consider themselves irreligious. The family structure has also suffered the most under institutional and structural barriers often prevent them from being able to realize valued romantic partnerships, marriage, and children., particularly for those who have low incomes.From 1987 to 2017, the rates of cohabitation among Black women ages 19 to 44 increased from 36 percent to 62 percent, a rate similar to that seen among women from other racial groups. The percentage of Black women ever married, however, is lower than those who have cohabitated, at 37 percent. While there are many explanations for lower levels of marriage among Black women, an overwhelming number of theories focus on economics—specifically, the earning potential and availability of Black men.For instance, a lack of employment opportunities for Black men, higher workforce participation among Black women than among Black men, a lack of wage parity between Black women and Black men, and the disproportionate representation of Black men (particularly from low-income backgrounds) in the criminal justice system may result in a lack of marriageable partners (e.g., men who are perceived by women as attractive marriage prospects because of their financial or social standing). Importantly, each of these theories—implicitly, and sometimes explicitly—acknowledges the potential role of systemic racism and its impact on the marriage rate of Black Americans.(child trends, 2021)

Health Care:

Health Equity is also a topic that is prevalent amongst Black Americans but still not achieved. In my Covid-19, Vaccines, and Black America. Is there a Nefarious Correlation?, I wrote:

Black Americans have a major distrust of the Medical Industry. Their distrust is not unwarranted. Unfortunately, Black people in America have experienced a number of malpractice mishaps.  James Marion Sims is considered the ‘Father of Modern Gynecology’ who pioneered tools and surgical techniques related to women’s reproductive health. Although he was very groundbreaking in this field, he developed his techniques by conducting research on enslaved Black women without anesthesia. He operated under a false and racist notion that Black people did not feel pain. Today, we know three of the names of the female fistula patients from Sims’s own records—Lucy, Anarcha, and Betsey. The first one he operated on was 18-year-old Lucy, who had given birth a few months prior and hadn’t been able to control her bladder since. During the procedure, patients were completely naked and asked to perch on their knees and bend forward onto their elbows so their heads rested on their hands. Lucy endured an hour-long surgery, screaming and crying out in pain, as nearly a dozen other doctors watched. As Sims later wrote, “Lucy’s agony was extreme.” She became extremely ill due to his controversial use of a sponge to drain the urine away from the bladder, which led her to contract blood poisoning. “I thought she was going to die…it took Lucy two or three months to recover entirely from the effects of the operation,”

Sims’s racist beliefs affected more than his gynecological experiments. Before and after his gynecological experiments, he also tested surgical treatments on enslaved Black children in an effort to treat “trismus nascentium” (neonatal tetanus)—with little to no success. Sims also believed that Black Americans were less intelligent than white people, and thought it was because their skulls grew too quickly around their brain. He would operate on Black children using a shoemaker’s tool to pry their bones apart and loosen their skulls.

Moving to another event in Medical Apartheid history, one cannot also forget the Tuskegee Experiment which was an infamous study on Syphilis.  The Tuskegee experiment began in 1932, at a time when there was no known treatment for syphilis. After being recruited by the promise of free medical care, 600 men originally were enrolled in the project. The participants were primarily sharecroppers, and many had never before visited a doctor. Doctors from the U.S. Public Health Service (PHS), which was running the study, informed the participants—399 men with latent syphilis and a control group of 201 others who were free of the disease—they were being treated for bad blood, a term commonly used in the area at the time to refer to a variety of ailments.In order to track the disease’s full progression, researchers provided no effective care as the men died, went blind or insane or experienced other severe health problems due to their untreated syphilis.

Cases like these and others like the unfortunate story of Henrietta Lacks whose cells from her cervix were bought, sold, packaged, and shipped by the trillions to laboratories around the world, would absolutely warrant any Black American who descends from Chattel Slavery to run screaming from any medical professional coming within ten feet of them. Even in the 21st century, Black Americans are still experiencing adverse disparities in healthcare driven by lack of health resources in our communities and also implicit biases that health care professionals possess. In an NCBI article entitled Health Disparities: Gaps in Access, Quality and Affordability of Medical Care, Wayne J. Riley MD, MPH, MBA, MACP writes,

“…analysis revealed even more objective evidence of major differences and raised the specter of the role of bias and discrimination with regard to populations with equal access to healthcare. Underscoring the resultant discrepant quality of care experienced by populations as manifested in the appropriateness of clinical care and patient preferences, and the often confusing and challenging nature of the healthcare system and its legal and regulatory environment, are the roles of bias, discrimination, and uncertainty.”

Going back to Neighborhoods and Built Environments, Black Americans disproportionately deal with crime and violence that has brought to light a public health crisis. In my article: The Epidemic of Violence in Freedmen Communities, I wrote:

…it is important to note where the most violence occurs in these cities and have a tendency to be the poorest. Looking at Chicago, the most reported violent neighborhood is West Garfield Park, which is located on the city’s West Side. According to https://www.cmap.illinois.gov/, the largest population by race that occupies this area is Black, non-Hispanic which is around 15,888. White non-Hispanic is 358, Hispanic or Latino is 447, and Asian non-Hispanic is 55. According to CMAP, Black non-Hispanic hold about 93% of the population. The Median Income is $24,591 and about 2,706 households have an income less than 25,000 a year. About 18% of the total population is unemployed and 43% of the population live under the federal poverty line.

I would argue that the demographics like these are reflected in the most violent neighborhoods in America. This leads me to believe that high unemployment and rampant poverty is a recipe for unbridled violence.

At the mark of King’s death until today, we still are living under systemic threats to Black Americans Social Determinants of Health. King was more than aware of the disparities that existed for Black Americans and sought with other Civil Rights leaders to stop the bleeding and force a 180 degree turn in our position. Although landmark legislation that lifted the tides of all Americans, evidence shows that Black Positionality has made very little progress. In actuality, our progress in some cases has shown to be regressive. King was well aware of this. During his “Where do we go from Here” Speech, King said:

With all the struggle and all the achievements, we must face the fact, however, that the Negro still lives in the basement of the Great Society. He is still at the bottom, despite the few who have penetrated to slightly higher levels. Even where the door has been forced partially open, mobility for the Negro is still sharply restricted. There is often no bottom at which to start, and when there is there’s almost no room at the top. In consequence, Negroes are still impoverished aliens in an affluent society. They are too poor even to rise with the society, too impoverished by the ages to be able to ascend by using their own resources. And the Negro did not do this himself; it was done to him. For more than half of his American history, he was enslaved. Yet, he built the spanning bridges and the grand mansions, the sturdy docks and stout factories of the South. His unpaid labor made cotton “King” and established America as a significant nation in international commerce. Even after his release from chattel slavery, the nation grew over him, submerging him. It became the richest, most powerful society in the history of man, but it left the Negro far behind.

And so we still have a long, long way to go before we reach the promised land of freedom. Yes, we have left the dusty soils of Egypt, and we have crossed a Red Sea that had for years been hardened by a long and piercing winter of massive resistance, but before we reach the majestic shores of the promised land, there will still be gigantic mountains of opposition ahead and prodigious hilltops of injustice. (Yes, That’s right) We still need some Paul Revere of conscience to alert every hamlet and every village of America that revolution is still at hand. Yes, we need a chart; we need a compass; indeed, we need some North Star to guide us into a future shrouded with impenetrable uncertainties.

Now, in order to answer the question, “Where do we go from here?” which is our theme, we must first honestly recognize where we are now. When the Constitution was written, a strange formula to determine taxes and representation declared that the Negro was sixty percent of a person. Today another curious formula seems to declare he is fifty percent of a person. Of the good things in life, the Negro has approximately one half those of whites. Of the bad things of life, he has twice those of whites. Thus, half of all Negroes live in substandard housing. And Negroes have half the income of whites. When we turn to the negative experiences of life, the Negro has a double share: There are twice as many unemployed; the rate of infant mortality among Negroes is double that of whites; and there are twice as many Negroes dying in Vietnam as whites in proportion to their size in the population. (Yes) [applause]

In other spheres, the figures are equally alarming. In elementary schools, Negroes lag one to three years behind whites, and their segregated schools (Yeah) receive substantially less money per student than the white schools. (Those schools) One-twentieth as many Negroes as whites attend college. Of employed Negroes, seventy-five percent hold menial jobs. This is where we are.

Where do we go from here? First, we must massively assert our dignity and worth. We must stand up amid a system that still oppresses us and develop an unassailable and majestic sense of values. We must no longer be ashamed of being black. (All right) The job of arousing manhood within a people that have been taught for so many centuries that they are nobody is not easy.

He went on the say:

And so I say to you today, my friends, that you may be able to speak with the tongues of men and angels (All right); you may have the eloquence of articulate speech; but if you have not love, it means nothing. (That’s right) Yes, you may have the gift of prophecy; you may have the gift of scientific prediction (Yes sir) and understand the behavior of molecules (All right); you may break into the storehouse of nature (Yes sir) and bring forth many new insights; yes, you may ascend to the heights of academic achievement (Yes sir) so that you have all knowledge (Yes sir, Yes); and you may boast of your great institutions of learning and the boundless extent of your degrees; but if you have not love, all of these mean absolutely nothing. (Yes) You may even give your goods to feed the poor (Yes sir); you may bestow great gifts to charity (Speak); and you may tower high in philanthropy; but if you have not love, your charity means nothing. (Yes sir) You may even give your body to be burned and die the death of a martyr, and your spilt blood may be a symbol of honor for generations yet unborn, and thousands may praise you as one of history’s greatest heroes; but if you have not love (Yes, All right), your blood was spilt in vain. What I’m trying to get you to see this morning is that a man may be self-centered in his self-denial and self-righteous in his self-sacrifice. His generosity may feed his ego, and his piety may feed his pride. (Speak) So without love, benevolence becomes egotism, and martyrdom becomes spiritual pride.

I want to say to you as I move to my conclusion, as we talk about “Where do we go from here?” that we must honestly face the fact that the movement must address itself to the question of restructuring the whole of American society. (Yes) There are forty million poor people here, and one day we must ask the question, “Why are there forty million poor people in America?” And when you begin to ask that question, you are raising a question about the economic system, about a broader distribution of wealth. When you ask that question, you begin to question the capitalistic economy. (Yes) And I’m simply saying that more and more, we’ve got to begin to ask questions about the whole society. We are called upon to help the discouraged beggars in life’s marketplace. (Yes) But one day we must come to see that an edifice which produces beggars needs restructuring. (All right) It means that questions must be raised. And you see, my friends, when you deal with this you begin to ask the question, “Who owns the oil?” (Yes) You begin to ask the question, “Who owns the iron ore?” (Yes) You begin to ask the question, “Why is it that people have to pay water bills in a world that’s two-thirds water?” (All right) These are words that must be said. (All right)

King’s Legacy is much more than a dream, a judgment of the content of character, or marching. King’s legacy, and other martyrs of Black Struggle, is about how we see ourselves as a nation. With Critical Race Theory being attacked, which is really an attack on teaching actual history, too many are concerned about little white children feeling the guilt of America’s maleficence. The guilt will only be alleviated with America acknowledging their crimes against their first citizens, Addressing the disparities Black Americans that descend from Chattel Slavery still face, and exact repair. The question is not the ability to do this. The question is the WILL do to this. Will they?

Only if WE THE PEOPLE FIGHT FOR REPAIR

Happy Birthday Dr. King. We are still fighting. 

  • Cynthia McDonald Political and Health Advocate
Dr. Martin Luther King, Jr. | Where Do We Go From Here | We Need FULL Economic Inclusion PERIOD! By the People Media

Published by Cynthia McDonald

Hi There! I am a Social Worker certified in Community Health. I currently write a blog concerning the social determinants of health that primarily affect Black Americans that are descended from American chattel slavery,

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