Many celebrated Sunday as Kára McCullough won the Miss USA crown. The black nuclear chemist who wore her natural hair was poised to be a source of pride.
But for many, that came to a halt after she offered her political views during the question-and-answer portion of the pageant.
“Do you think affordable health care for all U.S. citizen is a right or a privilege?” co-host Julianne Hough asked.
“I’m definitely going to say it’s a privilege,” said McCullough. “As a government employee, I am granted health care, and I see firsthand that for one to have health care, you have to have jobs. So, therefore, we need to continue to cultivate this environment that we’re given the opportunity to have health care as well as jobs to all American citizens worldwide.”
She has since clarified her views, stating, “I am privileged to have health care, and I do believe it should be a right.”
It is possible that McCullough misunderstood the question and confused her personal privilege with a privilege that is more along the lines of an advantage given to a select few. From her response, we can only assume that she meant, as a government employee, she is privileged to have high-quality health care, but for those who are not as privileged as she is, affordable health care should still be a right.
While many in the black community were let down by this graduate of a historically black university, South Carolina State, it’s worth noting that McCullough has never said she is specifically representing the African-American community. (She did want D.C. to win “back to back” crowns, she said, making a Drake reference.)
It’s no secret that black Americans face worse health outcomes than the general population. Nearly 40 percent of African-Americans surveyed reported fair or poor health, according to recent statistics from the U.S. Centers for Disease Control and Prevention. Black Americans and other people of color are less likely to be insured than white Americans due to fewer employment-based insurance options, like the one McCullough has.
This lack of access to insurance coverage combined with poorer treatment outcomes contribute to shorter life expectancies for black Americans and other people of color.
Here are the realities of receiving health care while black that McCullough might want to consider:
1. Black Americans are proportionally more likely to fall into ‘the coverage gap.’
Many Americans make too much money to qualify for Medicaid but too little to qualify for the Affordable Care Act’s marketplace assistance. This puts them in a precarious position with little or no health insurance. This circumstance is most prevalent in the South, where 91 percent of people who fall within the coverage gap live (thanks to state governments that refused Medicaid expansions, according to an analysis released in October by the Kaiser Family Foundation).
But 31 percent of this uninsured group are black, though the black population nationally is 12 percent.
The reduced access to affordable health care means more people use high-cost emergency room services rather than a primary care physician. This also costs taxpayers, hospitals and privately insured patients.
2. Black Americans are less likely to seek mental health care.
Black Americans have some of the lowest rates of mental health treatment, though some research indicates they may be 20 percent more likely to suffer from serious mental health issues than the rest of the population. According to the National Alliance on Mental Illness, only about one-quarter of African-Americans seek mental health treatment, compared with 40 percent of whites.
While the exact cause for this is unclear, cultural stigma and lack of access to services due to insurance barriers are components.
“Historically, mental health has primarily been seen as ‘white people’s problems,’” said Monique Mort, a licensed professional counselor. “The thing is, those struggles have always been there. They are just going unlabeled and untreated. I believe so many people of color do not seek help for their mental health due to the negative stigma and lack of education regarding mental health.”
3. Poor care for even wealthy black women is driving the rise in maternal mortality in the U.S.
The maternal mortality rate for black women is more than four times the national average. There is an average of 12.1 deaths per 100,000 live births for white women and 40.4 deaths per 100,000 live births for black women, according to the CDC.
These disparities remain across financial classes for black women. Lack of quality health care services is certainly a factor, but in many ways, it’s just the result of systemic and institutional racism.
On a holistic level, having a birth support person was listed by the World Health Organization as a way to combat maternal mortality, but lack of coverage from insurance companies limits access to these services, which in turn disproportionately affects black mothers.
“Most insurance companies, both public and private, do not cover doula services, which could improve the chances of survival for mothers and oftentimes infants because their presence decreases stress levels and improves comfort,” said Christin Farmer, executive director and professional birth worker at Birthing Beautiful Communities, an organization devoted to combating infant mortality in Cleveland.
4. Inequality in health care for black Americans begins at birth
Black mothers aren’t the only ones dying. The infant mortality rate for black newborns is more than twice the national average.
But the national average disguises some areas where the disparity is profound. In cities such as Cleveland, this rate is 22 infant deaths per 1,000 born.
Black infants have 1.5 times the risk of preterm birth than white babies, and the most frequent cause of infant mortality is preterm delivery, according to the CDC.
“Our stress levels are off the charts, and that directly impacts the fetus. It contributes directly to prematurity,” said Farmer.
Stress combined with all of the above factors ― poverty, location and lack of access to jobs that provide employee insurance ― result in increased obstacles for pregnant women and new moms, which directly affects infants.
Many were surprised to hear a graduate of a historically black university provide a response to a question that neglects to address issues that deeply plague the black community. Hough’s question to McCullough was about much more than “a right to health care.” For many Americans, it’s about a right to live.