Mistrust in Physicians does not Explain Black-white Disparities in Primary Care and Emergency Department Utilization: The Importance of Socialization During the Jim Crow era

Abstract

Mistrust in physicians does not explain black-white disparities in PC or ED utilization. Blacks under-utilize PC services compared to whites, net of predisposing, need, and enabling factors, but this is especially apparent among blacks who were raised in the U.S. south during the Jim Crow era and continue to reside in the South. Blacks greatly over-utilize ED services compared to whites, but this is greatest among those raised in the south during the Jim Crow era and/or those currently residing in the South.

Economic Strain Deteriorates While Education Fails to Protect Black Older Adults Against Depressive Symptoms, Pain, Self-rated Health, Chronic Disease, and Sick Days

“…Due to some historical reasons, Blacks have extremely low levels of wealth. Slavery, redlining, Jim Crow laws, discriminatory lending, mass incarceration, war on crime, and many other policies have kept average Blacks poor [177][178][179][180][181][182][183] . Given such historical injustice, most Black families have not been able to accumulate wealth over time.…”

Lessons Learned from Health Disparities in Coronavirus Disease-2019 in the United States

“…Racial health disparities are rooted in the Jim Crow Laws (e.g., a collection of state and local statutes that legalized racial discrimination, starting after the Civil War, and continuing until 1965), when healthcare institutions were segregated by law. Following the Civil Rights Act of 1964 34 , 35 Medicare mandated that US hospitals receiving federal funding were racially integrated, yet today many hospitals in predominantly Black communities still operate with lower revenues because of charity care, limiting resources for staffing, training, and quality improvement initiatives, and reducing their capacity to respond to increased care needs. All this likely led to worse COVID-19 outcomes among Black communities in the U.S. Southeast.…”

Mechanisms for Community Health Worker Action on Patient-, Institutional-, and Community-Level Barriers to Primary Care in a Safety-Net Setting

“…M EDICALLY AND SOCIALLY complex patients, who have a high disease burden, multiple comorbidities, and high levels of social need, often face multiple barriers to effective engagement in primary care (Freed et al, 2013;Hudon et al, 2016), contributing to poor health outcomes (Shi et al, 2002(Shi et al, , 2003Starfield, 2012). Strategies for reducing barriers to primary care engagement include improving access to linguistically and culturally concordant providers, expanding shared decision-making, and addressing social determinants of health (Davis et al, 2005;Hua et al, 2018;Mitchell et al, 2019). Community health workers (CHWs) help reduce these barriers, as they serve as brokers between the patient and health or social service systems and work to deliver needed support and information to those they serve while building trust in populations disproportionally affected by health inequities (please see 2009-1 APHA policy statement for the nationally recognized CHW definition [American Public Health Association, 2009;Sabo et al, 2017]).…”