The murder of George Floyd brings our nation’s racial injustices back to the fore. But structural racism is not only found in the criminal justice system.

As the COVID-19 pandemic lays bare, racism also has pernicious effects on our health care here at home. Black North Carolinians make up 22% of the population, but 38% of cases and 35% of deaths. However, these effects are not limited to COVID-19. Black North Carolinians are far more likely to live with -- and die from -- diabetes, high blood pressure and other chronic diseases.

In North Carolina, these disparities start early. Black babies are 2.4 times more likely to die than white babies. These inequities continue through life, as African-Americans are 2.3 times more likely to die from diabetes and kidney disease than their white counterparts. Differences in access to quality care and health insurance often underpin these statistics: only 60% of Black North Carolinians have consistent access to prenatal care when pregnant, compared to 74% of their white counterparts.

Even more jarring: these health inequities have historic roots, as the parts of North Carolina that had the highest concentration of slaves before the Civil War now have the highest rates of amputations because of peripheral artery disease.

Beyond highlighting these disparities, policymakers can take immediate steps to begin to redress them.

First, Medicaid expansion must become a renewed priority, despite legislative gridlock. Experts estimate that expansion would provide health insurance to 550,000 North Carolinians -- especially helping Black and Hispanic North Carolinians who disproportionately work in low-wage essential jobs. The federal government can help alleviate fears that it will relent on its 90% matching guarantee by increasing the match rate during the pandemic and guaranteeing the 90% match in the long-term.

Second, both federal and state governments should better support essential workers, who are disproportionately Black. Meatpacking plants, where workers are 30% Black, should be required by regulators to report outbreaks in their facilities. This issue is particularly important here in North Carolina, which has one of the largest pork plants nationally.

Third, in the rapid transition to telehealth, the state should invest in broadband access and digital literacy to ensure that minority communities are not left behind. In North Carolina, about 24% of households lack access to broadband internet service that allows video streaming. In majority-minority rural counties like Robeson County, over 50% of households face this barrier.

Finally, the state should immediately resume its Healthy Opportunities pilot, which enables Medicaid to address issues of housing and food insecurity. One of us, Dr. Agbafe-Mosley, recently saw a patient who could benefit from the effective deployment of this program. The young woman had uncontrolled diabetes and she was not taking her prescribed medication.

Why? She was hungry.

After being referred to a local Catholic Charities unit, the patient was able to get the food she needed, which led her to be more engaged and successful with her diabetes care. Programs like Healthy Opportunities will more robustly address disparities in reliable access to healthy food and advance health for some of North Carolina’s most vulnerable.

The roadmap to address the structural racism plaguing our health is complex. The necessity of those investments, though, has never been more clear. The federal government has abandoned any good faith efforts to expand access to care and failed to adequately support states in COVID-19 relief efforts. On both ends, Black North Carolinians have disproportionately suffered.

As North Carolina works to cement its status as the center of a new and more racially progressive south, alleviating Black health disparities is key to turning this hope into reality.

Dr. Agbafe-Mosley is a family physician in Wilmington and works with the local NAACP chapter on health equity. Victor Agbafe is her son and an incoming medical student at University of Michigan Medical School.

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