Frequently, we look at someone with a chronic disease or someone who is in a particular situation and think that they should have done something differently to avoid that fate. If only, we think. If only they ate better. If only they took better care of themselves. If only they didn’t live in that neighborhood.

In a perfect world, those thoughts might have some validity. But our world is far from perfect.

We live in a world where the zip code you are born in can predict how long you will live. We live in a world where the color of your skin can determine which care you get when you go to the hospital. In a world where your chance of getting a good-paying job still varies by race and ethnicity. This is a world where the personal decisions you make may not forestall tragedy. This is a world where you might not even be able to make decisions that can protect your health.

For many Philadelphians, racism is not just horrible words and crossing the street. Racism also exists on a higher level. Systemic racism is racism that is baked into the fabric of our society and affects each of us in ways that we cannot even see. Systemic racism predisposes Black and Brown Philadelphians to shorter lives, worse outcomes from chronic health conditions, and a higher likelihood of being in traumatic situations.

We know systemic racism as red-lining, but we also know that it exists in medical decision-making charts that assume that Black people can tolerate more pain than White people. We know that industrial plants and factories are situated near communities of color, and we know that even the tree canopy that helps protect us on hot summer days has less coverage in predominantly Black and Brown neighborhoods. All these things, and so many more are what determine the course of our lives, without us even being aware of them.

During Black History Month, the Health Department strives to highlight public health conditions that are driven by systemic racism.

Hypertension and Diabetes in the African American Community

The prevalence of high blood pressure (HBP) among Black people in the United States is among the highest in the world. Your blood pressure is one of the most important markers of health. High blood pressure (also known as “hypertension”) is very common in people with diabetes. In fact, the two conditions often go hand-in-hand because they can both result from the same factors that are impacted by social determinants of health.

COVID-19 illness and high rates of death in Black communities put a spotlight on this issue as we found that hypertension and diabetes were leading risk factors. Black adults are dying at twice the rate of their White adult counterparts. About 55 percent of Black adults have high blood pressure. Black people also have disproportionately high rates of more severe HBP and it develops earlier in life.

Many factors contribute to health inequities

Historical and systemic factors play a major role in health outcomes. Among them are adverse social determinants of health, the conditions in which a person is born and lives contributes widely from high levels of stress to poor healthy options. The determinants include lack of access to care and medication and lack of access to healthy foods. Societal issues include education, geography, occupation, housing conditions. Institutional racism exacerbates all these barriers. Another contributing factor is African Americans have a cultural distrust of health care systems based on historical discrimination.

The concept of personal responsibility in health care is that, if we follow healthy lifestyles (exercising, maintaining a healthy weight, not smoking) and are good patients (keeping our appointments and heeding our physicians’ advice), we will be rewarded by better health while spending less money. This antiquated concept often ignores the barriers that contribute to poor health and poor habits that are outside the control of patients. For example, African Americans in low-income neighborhoods may find themselves living in a food desert — an area where access to healthy foods is limited. Then comes the issue of the cost of healthy food. With less options and limited resources, it is much easier to purchase fries than fruit.

Changing the health trajectory

Though some problems require broader, societal interventions, we are hopeful that individuals can take steps to reverse the trends. Sadly, we’ve been in this toxic system with poor health outcomes for so long that too many look at the outcomes as natural because they are not aware they are abnormal. But, there is growing awareness that better outcomes are possible. Our job at the Health Department is to be a catalyst for change and to support Philadelphia residents. This is a long journey that will not be solved by the Health Department or any one entity but through a collaboration of the Philadelphia community coming together as we learn and work together.

Focus on the basics. Don’t underestimate the power of diet and exercise.

We want and have encouraged better awareness and behavior for better health outcomes, such as exercise, access to more fruits and vegetables, and lowering consumption of fried and rich foods that may be culturally significant but unhealthy.

Some of our efforts include:

Access to high-quality medical care.  Greater focus on prevention and access to primary care is a major priority. Our Primary Care Finder identifies free and low-cost medical care in Philadelphia.  The finder allows searching for providers based on geography, service and language: https://www.phila.gov/primary-care/.

Learn more about our FoodFitPhilly initative