Students shifted the tone of the question-and-answer portion of a talk on racial health disparities by President Christina Paxson P’19 Monday night, posing questions and concerns about institutional racism. Paxson’s talk was followed by a speech by Nicole Alexander-Scott MPH’11, assistant professor of pediatrics and medicine at the Alpert Medical School and director of the Rhode Island Department of Health, as part of the 2015 Paul Levinger Health Care Reform Roundtable Series.
Around 200 undergraduates, graduate students and faculty members crowded into Sayles Hall for the talk, with some standing in doorways because seats were unavailable. Paxson’s lecture centered on analyzing the existence and causes of health disparities along racial lines.
Many students used the Q&A to express discontent with the University’s health insurance costs and their contribution to racial disparities on campus.
Noah Ezer ’19 asked Paxson why financial aid packages do not cover health insurance, while another student noted that the health insurance fee “is not a direct fee calculated into the cost of attending.” A back-and-forth discussion ensued, in which Paxson said health insurance is guaranteed by University financial aid, while the student noted the bureaucratic difficulties that students of color encounter when trying to receive medical attention with insurance.
Paxson encouraged students to attend her office hours to discuss any perceived problems with health insurance. “I don’t want to give you misinformation,” she said.
Mae Verano ’17, a public health concentrator, said Paxson’s “neo-imperialist” speech framed people of color as subjects of research without names or faces. She asked how the administration plans to address health care problems facing staff members and students who have experienced racial disparities.
“We really want to create a community where people who work here are well-supported,” Paxson said, noting that staff members receive wages that are “pretty good relative to peers and the market” as well as grants to help their children attend college.
Verano also said she had never encountered a professor who identified as a person of color in the Department of Public Health and suggested that the University offer a public health class on racial disparities.
In response, Terrie Wetle, dean of the School of Public Health and professor health services, policy and practice, went onstage and said, “I don’t believe that only underrepresented minorities can answer questions related to racial disparities.” A “deliberate effort” to integrate racial disparities into all courses and programs would be more effective in addressing race in public health than a single course, she added.
Another student said all the classes she has taken about racial health disparities have been taught by white professors, noting the number of “white faces” in the room. In response, Paxson reiterated her goal of doubling the number of underrepresented minority faculty members.
Paxson opened her talk by introducing the Grossman model of 1972, which “posited the idea of health as a stock — something individuals invest in and which evolves over time.” She then described race as “a social construct that defines groups of people and which is associated with a cluster of social and economic opportunities and experiences.”
“Now when this nation is so focused on structures of discrimination, it seems important to give a new perspective on the study of disparities in health,” she said.
Statistics on wealth and health show huge gaps between blacks and whites, Paxson said, citing a recent report by Pew Research Center showing that the average white family has $141,900 and the average black family has $11,000 in wealth — a figure that includes assets as well as income.
These gaps in wealth contribute to inequality in health, and poor health in turn reduces earnings, Paxson said. People of color are shown to have higher rates of morbidity and mortality, affecting their ability to earn wages, she said.
Like wealth, higher education is also associated with higher rates of income, employment and health behaviors, as well as lower rates of mortality and morbidity, Paxson said. But while statistics show that blacks currently have lower education levels than whites on average, education is not the only cause of health disparities. Early life circumstances and the geographic area in which a person is raised can also help to explain racial gaps in health.
Health insurance alone will not reduce the health disparities between races, Paxson said. What will help are focuses on interventions early in life and in mid-life, as well a “focus on integrated, high-quality care” for all, she said.
Paxson concluded that the problem of racial disparities in health will not be solved until “we dismantle structural barriers to economic and social opportunities” for people of color.
During the Q&A, a student said these barriers are due to the “white supremacy and racism” that are also present on the University’s campus and asked how the administration aims to address racial disparities. Paxson said administrators have been holding discussions to “ensure that black and Latinx and Native American students know that they are full and valued members of this community.” She cited a community-wide email she sent Monday, which stated that the University will provide a working draft of a plan for diversity and inclusion and solicit student feedback to address issues of racial inequality.
Nancy Ghanian P’17 spoke up to say that though she is from the Middle East, her daughter has never encountered any racial profiling. “I am here to thank you and all your staff for the great opportunities,” she said to Paxson.
In her speech following Paxson’s talk, Alexander-Scott addressed measures the state is taking to alleviate racial disparities. Rhode Island’s first priority is to address the social and environmental determinants of health by fostering an expanded understanding of how patients’ communities and opportunities affect their health, she said.
The Ocean State’s second priority is to eliminate the disparity of health and to promote health equity, Alexander-Scott said. Its third priority is to ensure access to quality health services for all residents, including vulnerable populations, she said.
“The United States by far spends the most on total expenditure on health per capita compared to every other developed country” and yet does not have comparable health with countries that spend less, Alexander-Scott said. This is because the United States does not have high enough social service expenditures, leading to poor health, particularly among communities of color.
“It is painful to discuss that no matter the disease, there are higher rates among African Americans and people of color,” she said. “A key element in addressing those concerns is doing what we are doing today: having a discussion, raising awareness.”
Sam Rubinstein ’17 asked Alexander-Scott what Rhode Island is doing to stop health insurance companies from excluding transgender people from health care that is necessary for the transition process. Alexander-Scott replied that the Medicaid office recently made adjustments to services covered for trans people, though she added that there is still room for improvement.
Alexander-Scott praised the students in the audience for speaking up during the Q&A to “raise awareness and form partnerships to make an impactful difference.”
“I am encouraged that you have a president like Dr. Paxson and the dean in the front row who are listening,” she said.
The event went about a half hour longer than planned, concluding with shouts of “let black students speak!” and boos when it was announced that there was no time for further questions. Paxson said her office hours are available for students who wish to further express their concerns.