The second paragraph of the Declaration of Independence states clearly: "all men are created equal." But does this hold true for all people in 2020?

Yes, Americans can legally vote in elections, go to school or assemble in groups to peacefully protest. However, true equality goes beyond laws and policies. From inadequate access to fresh food and clean water, to screening in early stages of disease or the inability to rent an apartment because of discriminatory housing practices, these long standing systemic inequities for some Black Americans can have long lasting effects on health.

Michigan Medicine researchers have been studying racial disparities in the health care system for years, in hopes of gaining a better understanding of how the complex issue of institutional racism, among other factors, create differing health outcomes for Black and white Americans.

Researchers continue investigating these issues in hopes of shedding light on the problem and to prompt systemic changes. Here are ten of their studies from the last few years:

1. Racial Disparities in the Time of COVID-19

A startling and disproportionate death rate among Black Americans around the country from COVID-19 is revealing persistent inequities and the need for solutions to address them.

While it's true that Black Americans have higher rates of hypertension, diabetes and obesity, all risk factors for worse outcomes from COVID-19, "I think public health practitioners would say it's not the fact that they have these diseases that's causing the higher death rate because people of all races, classes and creed have these diseases," says Melissa Creary, Ph.D., assistant professor of health management and policy at the U-M School of Public Health.

"It's the fact that we see an undeniable burden of disease in the Black population. It's this disproportionate amount that is worrisome. The underlying issue to why we see so many is actually attributed to structural inequity."

2. Study Explores Why Prostate Cancer Mortality is Higher in Black Men

The largest study of its kind finds societal factors and access to quality care, rather than genetics, contributes to a 2.5 times higher prostate cancer mortality rates for Black men, compared to non-Hispanic white men.

"(Black men) generally get fewer PSA screenings, are more likely to be diagnosed with later stage cancer, are less likely to have health insurance, have less access to high-quality care and other disparities that can be linked to a lower overall socioeconomic status," says study co-senior author Daniel Spratt, M.D., co-Chair of Genitourinary Clinical Research at U-M.

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Spratt adds, "While our job is to treat cancer, we know that these other factors are in play, so as doctors we need to make sure we focus on the health of the entire patient and, as a society, on addressing racial inequities."

3. Minority Patients Benefit From Having Minority Doctors, But That's a Hard Match to Make

Ryan Huetro, M.D., a family medicine physician at Michigan Medicine, wrote an op-ed about his work studying health disparities for Black and Indigenous people and how increasing the probability that minorities see doctors of their race or ethnicity can improve health care delivery.

"Black patients, for instance, may feel warier with a white doctor than a Black doctor, and white doctors may feel less comfortable caring for minoritized patients," he says. "Mounting evidence suggests when physicians and patients share the same race or ethnicity, this improves time spent together, medication adherence, shared decision-making, wait times for treatment, cholesterol screening, patient understanding of cancer risk, and patient perceptions of treatment decisions. Not surprisingly, implicit bias from the physician is decreased."

4. Racial and Ethnic Disparities in Insurance Access Impact Maternal-Infant Health

Earlier this year, a study showed nearly half of all Black, Hispanic and Indigenous women had discontinuous insurance coverage between pre-conception and after delivering their babies compared to approximately a fourth of white women.

"Racial and ethnic disparities in maternal and child health outcomes are a national public health crisis," says senior author and obstetrician-gynecologist at Michigan Medicine Von Voigtlander Women's Hospital, Lindsay Admon, M.D., M.Sc. "In the United States, insurance coverage is an important prerequisite for accessing healthcare. Throughout the most critical periods of pregnancy, we identified wide racial–ethnic disparities related to women's ability to access to preconception, prenatal, and postpartum care."

5. Young African Americans with Colon Cancer Fare Worse

Racial disparities in treatment outcomes for young colon cancer patients appear at every stage of the disease, suggesting screening access isn't all that matters.

"We need to look at tumors that develop in young people and in African Americans to see if they have molecular differences compared to the typical colorectal cancer seen in older adults," says study author Elena Stoffel, M.D., director of the Cancer Genetics Clinic at the U-M Cancer Center.

6. Why Does Dying Cost More for People of Color?

Medicare pays thousands more for the end-of-life care of Black and Hispanic people than for white people. But why? A U-M team found that the last six months of life is $7,100 more expensive to the Medicare system for Black people, and $6,100 more expensive for Hispanics, compared with white people. 

"We need to look harder for the causes of disparities in end-of-life care costs, and look at factors on the provider level and health system level, including family dynamics, that may come into play," says Elena Byhoff, M.D., M.Sc., who led the study as a Robert Wood Johnson Clinical Scholar at U-M's Institute for Healthcare Policy and Innovation.

7. Blood Pressure Associated with Racial Differences in Cognitive Decline

Michigan Medicine researchers have targeted blood pressure in a quest to understand and reduce racial disparities in dementia development. The new analysis identifies long-term hypertension as a possible explanation for why Black people are more likely than white people to develop dementia later in life.

They compared participants' blood pressure levels, along with three cognitive measures: global cognition, memory and executive function. Black individuals had faster declines in global cognition and memory than white individuals, differences that were equivalent to 2.5 to 4 years of cognitive aging, researchers say.

8. Study Reveals Blind Spot in Coverage of Low Vision Devices

Technology can enrich the lives of those with low vision, but Medicare doesn't cover the cost of these devices. Compared to white adults age 65 and older, the odds of using a low vision device were 17% lower in Black adults.

"Low vision services can improve quality of life and the ability of patients to do important everyday activities. However, ensuring equitable access to these services is a major challenge,"  says senior study author Joshua Ehrlich, M.D., MPH, an ophthalmologist at Kellogg Eye Center and eye policy researcher at the U-M Institute for Healthcare Policy and Innovation.

9. ACA Helped Make Health Insurance Access More Equal, But Racial and Ethnic Gaps Remain

Although the Affordable Care Act has narrowed racial and ethnic gaps in access to health insurance and care, Black and Hispanic Americans are still less likely than whites to have health coverage, and more likely to avoid care because of cost.

"This is a glass half full, glass half empty story," says Thomas Buchmueller, Ph.D., one of two U-M health economists who authored the study. "The half full aspect is that coverage increased and disparities declined, and those with the greatest need tended to benefit. But we still have large disparities, particularly for Hispanic non-citizens. And lack of insurance means lower access to care and poorer health outcomes."

10. Even Before COVID-19, Many Adults Lacked Stable Food Supply

Results from the National Poll on Healthy Aging showed food insecurity disparities by age, health status, race, ethnicity and education, potentially worsened by the pandemic.

"Access to nutritious food and health status are closely linked, yet this poll reveals major disparities in that access," says Preeti Malani, M.D., the poll's director and a professor of internal medicine at Michigan Medicine. "Even as we focus on preventing the spread of coronavirus, we must also ensure that older adults can get food that aligns with any health conditions they have, so we don't exacerbate diabetes, hypertension, digestive disorders and other conditions further."

Visit Michigan Medicine's Office for Health Equity and Inclusion for anti-racism support and tools.

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