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Healthcare is a right for all Americans, not something that has to be earned as some have argued, said HHS Secretary Xavier Becerra during a Health Affairs briefing on racism in healthcare on Tuesday afternoon.

Becerra, who has been chided by Biden administration officials regarding his leadership during the COVID-19 pandemic, cited a couple of accomplishments during his year-plus tenure. For example, the "significant gap" in COVID vaccination rates between Black and Brown Americans versus white Americans has undergone a "dramatic change" so far this year, he said.

HHS has also expanded postpartum Medicaid coverage, which should benefit about 700,000 mothers, he noted.

During the briefing, several researchers and healthcare leaders addressed issues stemming from systemic racism within American healthcare, including the need to improve the quality of services for Black and Brown Americans, and problems with data collection and quality undermining perceptions of racial inequities.

A history of racism within the healthcare system spans generations, said Richard Besser, MD, CEO of the Robert Wood Johnson Foundation.

The broad research policies implemented were not "colorblind," argued Ruth Enid Zambrana, PhD, professor in the Harriet Tubman Department of Women, Gender, and Sexuality Studies at the University of Maryland. They were "intentionally and strategically" developed, often excluding the voices of marginalized communities, including minority ethnic groups. She called for interventions to yield different, more comprehensive outcomes.

"I just cannot support the idea that we need more [similar] research," Zambrana said. Instead, she suggested incorporating the lived experiences of these groups into scientific spaces.

Socioeconomic factors have clearly influenced health outcomes, she added, noting that there have been improvements in this area, but there is still "a ways to go."

Paula Braveman, MD, director of the Center on Social Disparities in Health at the University of California San Francisco, compared racism within healthcare to an iceberg; the laws and policies intrinsically driving racist outcomes lurk just below the surface in large form. Scholars and public health officials focus too much "on individuals behaving badly," rather than the structures that drive such behavior, she said.

"We're missing the mark," she noted, adding that policymakers have "centuries of evidence" about the role economics have played in influencing health disparities.

When states expand Medicaid, those decisions are often made by white officials and do not benefit ethnic minorities to the extent they could, argued José Figueroa, MD, MPH, of the Harvard T.H. Chan School of Public Health. If minority communities do not gain political power, they cannot affect the change they need, he added.

Janette Dill, PhD, of the University of Minnesota, cited healthcare workforce issues. Wages need to be raised overall, she said, including the federal minimum wage -- especially in healthcare homes.

"We need to address the cultural assumptions about who should be providing care," and attack the "feminization" of care, Dill urged.

She suggested offering more and better training to nurse assistants to help them earn RN degrees. This in turn would raise their salaries and career prospects, and lead to more racial justice within healthcare organizations, she said.

The labor market is now undergoing "an enormous correction" among the lowest wage groups "after decades of stagnant and declining wages" relative to other salaries, she added. "And I hope it continues."

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