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The predominant narrative among education activists is that school segregation has gotten worse in the past several decades. It's an argument backed by data - one I've stressed in my own work. And earlier this year, a New York Times op-ed also made this argument and cited that same data.

But there's now a handful of pundits pushing back on this notion, like the National Review's Robert VerBruggen. In response to the Times piece, he wrote that changing demographics makes the data misleading - and that ultimately, "we're not going in reverse" when it comes to segregation. Prominent journalists, like New York magazine's Jonathan Chait and my colleague Matt Yglesias, shared VerBruggen's post on Twitter.

The National Review piece isn't coming out of the blue. The idea that changing demographics - the US becoming less white - makes it harder to integrate schools is something that has picked up steam in recent years. In Connecticut, Gov. Dannel Malloy has pushed for more leniency in standards set by a court-ordered desegregation case.

So how could two sides look at the data and come to two different conclusions about school segregation trends?

On the surface, this is an argument about how we measure school segregation trends. But ultimately, it's a disagreement over how we should be thinking about school segregation.

Is school segregation not actually getting worse? It depends on how you measure it.

The core disagreement comes down to federal government data that was highlighted by the UCLA Civil Rights Project on the 60th anniversary of Brown v. Boar d of Education, the Supreme Court case that ruled segregated schools were unconstitutional.

The data shows that black students in the South are less likely to attend a school that is majority white than about 50 years ago:

National Review's VerBruggen sees this chart and argues that a smaller portion of black students are attending majority-white schools because the US is just less white than it was 40 or 50 years ago:

Both arguments are the products of some messy data work.

On one hand, if we're measuring segregation by how many children attend majority-white schools, then it's worth acknowledging that white people are now a smaller percentage of the US population. This is something I've admittedly left out of my work when presenting this data.

On the other hand, VerBruggen uses this flaw to argue that school segregation actually isn't getting worse - even though it's virtually impossible to make this argument from this data alone. VerBruggen does cite a study by Stanford sociologist Sean Reardon and USC sociologist Ann Owens that says school segregation hasn't changed that much in the past few decades. But Reardon and Owens specifically write that there are two ways they measure segregation:

1. Exposure or isolation, which looks at whether students attend schools with a high or low proportion of a given racial group

2. Unevenness, which measures how evenly distributed students of a given racial group are

Reardon and Owens write, "The debate about whether the last two decades can be characterized as a period of resegregation largely hinges on whether one uses exposure or unevenness measures of segregation."

The VerBruggen argument adopts the "unevenness" frame: School segregation hasn't gotten worse because students are just as unevenly distributed now as they were in the 1980s.

Reardon and Owens give this example:

... Consider a school district in which 90% of students are black. If all schools in the district had enrollments that were 90% black, we would have low unevenness but high black isolation (or, equivalently, low black-white exposure) because the average black student would attend a predominantly black school. Conversely, in a school district with very few black students, isolation might be low even if students were very unevenly distributed by race.

But if you care about more equity in education, this is an odd argument. It's essentially saying: Hey, we haven't made school segregation worse - and it's because of Asian and Hispanic immigrants.

This leads to the reason why people who care about equity balance it with the other measure: isolation.

A reason to measure racial isolation, not just unevenness

Let's just state this for the record: Racial segregation in schools was caused by white America's policies that kept schools and neighborhoods white-only. For black families, this meant their country engineered for them a second-class experience - one that put them in poor, segregated ghettos and poor, segregated schools.

And that's not getting better. Black children are now more likely to grow up in poor neighborhoods than they were 50 years ago.

This is important because a large body of research shows that growing up in heavily segregated, poor neighborhoods affects everything from your education level, your future earnings, and your happiness to your health and, ultimately, your life span.

But in many of these areas, where you live determines where you go to school. So when we see students who are racially isolated, it's describing both underlying residential segregation and how little school districts do to ameliorate that segregation.

As it turns out, things have been getting worse since the 1980s when we look at segregation using this isolation frame:

As Reardon and Owens point out, indices of exposure show black-white segregation have actually gotten worse since the 1970s:

This has caused a growing number of our schools to be predominantly black or Hispanic with a higher concentration of students in poverty:

This isn't even considering the growing charter school movement. An increasing number of charter schools are high-poverty and are predominantly black or Hispanic. Meanwhile, a growing number of charter schools are also low-poverty and predominantly white and Asian:

So, yes, there is a portion of America that is getting more diverse. And overall, the "unevenness" measure of segregation shows we're racially distributing students about as well as we were a few decades ago.

But we are also increasingly isolating the most vulnerable students in America. Things haven't been steady; they are getting worse.

Focusing on what's holding steady pushes a misleading narrative

VerBruggen is pushing back against a narrative that most experts agree with, which says that America went through a period of desegregation from the 1950s through the 1980s but then backslid in the decades since. VerBruggen is arguing that as immigration policies have diversified America in recent decades, our schools diversified as well.

But research by Cornell sociologist Daniel Lichter shows that segregation between white families and nonwhite families has actually changed very little since the 1980s. In fact, while segregation within cities has gotten slightly better, segregation between municipalities has gotten worse.

In other words, there is probably less segregation within the neighborhoods of your town. But there is probably more segregation in comparing your town and a neighboring one.

So if broader segregation has increased, it might be reflected in our schools, as school attendance zones are often drawn based on where you live.

This is partially what has entrenched the heavily segregated school attendance zones in virtually every American city:

But school boards can draw school attendance boundaries to lessen that segregation - to send kids to less racially segregated schools. We don't have to send kids to the nearest school, especially because it ends up recreating the underlying residential segregation:

But most school districts don't do anything to ameliorate this situation. We continue to recreate the residential segregation. (Here's an interactive that lets you look up your own district.)

In addition, research from Southern Methodist University's Meredith Richards shows that when neighborhoods don't experience much demographic change, they tend to draw school attendance zones that resegregate. Also, when neighborhoods experience a lot of demographic change, they defensively draw attendance zones that further segregate:

So let's rehash here:

We are increasingly isolating poor black and Hispanic children in segregated schools, both public and charter.

Residential segregation between cities is getting worse, and the Supreme Court in the 1974 case Milliken v. Bradley said surrounding cities could not be forced into school integration plans.

Meanwhile, segregation within cities is about the same as in the 1980s. It's still extremely high.

School districts are doing very little to ameliorate that segregation.

And when neighborhoods don't change or drastically change, school districts actually tend to make even more segregative attendance zones.

Yes, we can find metrics that show school segregation isn't getting worse; we can find metrics that show our schools are not any more segregated now than they were 30 years ago. These metrics are important, and they describe significant ways our schools are changing.

And, to be fair, VerBruggen writes in his piece that "this doesn't mean that this country's racial problems are over or that there's nothing we can do to spur further integration."

But using those metrics to paint a picture in which school segregation isn't getting worse misses the point of why we talk about school segregation. The American education system has vestiges of engineered inequities, and those inequities have created unequal opportunities for a huge chunk of black Americans. When we query the data using this framework, the answer is clear: We are going in reverse.

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The data proves that school segregation is getting worse

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This is ultimately a disagreement over how we talk about school segregation.

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What You Should Know

Of the more than 20 million people who have gained coverage under the ACA, 2.8 million of them are African-American-and yet, this population is still more likely to be uninsured than white Americans.

The average American family spends around 11 percent of household income on health care premiums and out-of-pocket costs, but that amount approaches 20 percent for African American households.

Because African Americans tend to be poorer than other demographic groups on average, public health insurance programs such as Medicaid are vital to ensure affordable health care and healthier outcomes-yet fourteen states have resisted Medicaid expansion, mostly in the South.

Even with improved access to medical care under the ACA, the disparities in health outcomes between African Americans and whites are stark. African-American women are three times more likely to die of pregnancy-related causes than white women, for example, and the African-American infant mortality rate is twice the rate for white infants.

Certain social determinants of health, such as poverty, income inequality, wealth inequality, food insecurity, and the lack of safe, affordable housing have important implications for health risk and the ability to attain health insurance coverage for African Americans.

Another important social factor leading to poor health outcomes and economic disadvantage among African Americans is racism, because not only is it a stressor, leading to wear and tear on the body, but it also impacts who gets what in America, particularly health care.

The nation is at a moment when more progressive health care reform might be possible; any health care reform needs to take these inequities into account in recreating a health care system that will serve all Americans.

The American health care system is beset with inequalities that have a disproportionate impact on people of color and other marginalized groups. These inequalities contribute to gaps in health insurance coverage, uneven access to services, and poorer health outcomes among certain populations. African Americans bear the brunt of these health care challenges.

African Americans comprise 13.4 percent of the U.S. population. Over the span of several decades, namely since the Civil Rights Acts of 1964 and 1968, they have been able to make notable strides in American society. According to the Economic Policy Institute, educational attainment has greatly increased, with more than 90 percent of African Americans aged 25-29 having graduated from high school. College graduation rates have also improved among African Americans. When it comes to income, gains have been made as well, but African Americans are still paid less than white Americans for the same jobs and lag significantly behind when it comes to accumulating wealth. And as for home ownership, just over 40 percent of African Americans own a home-a rate virtually unchanged since 1968.

African Americans are also living longer, and the majority of them have some form of health insurance coverage. However, African Americans still experience illness and infirmity at extremely high rates and have lower life expectancy than other racial and ethnic groups. They are also one of the most economically disadvantaged demographics in this country.

This report will examine the state of health care coverage for African Americans and shed a light on important social factors that uniquely impact their health outcomes. In an effort to draw implications from leading health care reform plans, recommendations are made for the way forward in ensuring that the physiological and social impacts of racism are not omitted in efforts to secure truly universal health care coverage in America. African Americans are one of the most politically engaged demographics in this country. Addressing their unique challenges and perspectives, including the pervasive impacts of racism, must be included in health reform efforts.

Coverage Gains-and Obstacles-for African Americans Under the ACA

The Affordable Care Act (ACA) has helped to ensure health care coverage for millions of Americans. The uninsured rate among African Americans declined after the law was implemented: of the more than 20 million people who have gained coverage under the ACA, 2.8 million of them are African-American. Yet, this population is still more likely to be uninsured than white Americans: as of 2018, the uninsured rate among African Americans was 9.7 percent, while it was just 5.4 percent among whites. African Americans were more likely to be covered through employer-sponsored or private health insurance: 55 percent of African Americans used private health insurance in 2018, while 41.2 percent were enrolled in Medicaid or some other type of public health insurance.

While coverage expansions under the ACA have hastened the progress toward universal coverage, the continued high cost of many coverage options means that access to affordable health care is still a challenge for many Americans-particularly African Americans.

The average family spends $8,200 (or 11 percent of family income) per year on health care premiums, and out-of-pocket costs for things such as office visit copays, prescription drugs, and surprise or out of plan medical bills continue to wreak havoc on the financial security of families. For African Americans, the average annual cost for health care premiums is almost 20 percent of the average household income-a major cost to bear, when taking into account income inequality and other economic challenges for this demographic.

The high cost of coverage has kept the number of uninsured and underinsured unacceptably high: of the 27.5 million people that still lack health insurance coverage, 45 percent cite cost as the reason for being uninsured. Furthermore, the Commonwealth Fund estimates that an additional 87 million people (adults aged 19 to 64) are underinsured; that is, they have coverage, but their plan leads to unusually high out-of-pocket costs relative to income that can lead to a strain on personal finances or even debt. Of these underinsured adults, 18 percent are African-American.

Systemic Health Care Challenges That Reform Must Address

Despite coverage gains, remaining health care challenges exist that have a disproportionate impact on African Americans. The lack of Medicaid expansion in key states, health disparities, and health care provider shortages make it incredibly hard to address America's health care needs in a comprehensive way. And while these challenges are factors that touch many Americans in various parts of the country, the gravity of them is uniquely seen in the South, and among the African-American population.

The South's Stubborn Approach to Medicaid Expansion

The Medicaid program has been a lifeline for low-income Americans, pregnant people, the elderly, and people with disabilities. It is jointly funded by states and the federal government, and has been operating for fifty-four years. As of August 2019, the program covered 68 million people, with African Americans making up about 20 percent of Medicaid enrollees. Because African Americans tend to be poorer than other demographic groups on average, public health insurance programs such as Medicaid are vital to ensure affordable health care and healthier outcomes. In states that have not expanded Medicaid under the Affordable Care Act (ACA), African Americans and other people of color are most likely to fall within a coverage gap -meaning they earn too much to qualify for the traditional Medicaid program, yet not enough to be eligible for premium tax credits under marketplace plans.

The states that have not expanded Medicaid are largely concentrated in the southern region of the United States.

Under the ACA, Medicaid eligibility was expanded for adults with incomes up to 138 percent of the federal poverty level (FPL). This expansion was originally written into the ACA as a requirement for all states, but due to a 2012 Supreme Court ruling in National Federation of Independent Business v. Sebelius, it is now just an option for states. To date, thirty-seven states (including the District of Columbia) have expanded Medicaid, either through traditional means or the Section 1115 waiver process. The states that have not expanded Medicaid are largely concentrated in the southern region of the United States. (See Map 1.)

Map 1

In the South, African Americans are disproportionately represented. According to the U.S. Department of Health and Human Services Office of Minority Health, 58 percent of the African-American population lived in the South as of 2017. They are also more likely to be uninsured, with Texas, Florida, and Georgia being home to the largest shares of uninsured African Americans. Some states have also proposed draconian work requirements as a condition for the participation in the Medicaid program. These requirements can only serve to stigmatize enrollees, deny coverage, and discourage low-income people from the support they desperately need. In Arkansas-one of nine states to date with 1115 waivers approved by the Trump administration allowing fully implemented work requirements- 18,000 low-income people lost health care coverage as a result. This coverage loss comes as no surprise, because the use of work requirements for other safety-net programs, including Temporary Assistance for Needy Families (TANF), has proven them to be ineffective in their stated goal-promoting employment-yet highly effective in reducing program eligibility. Medicaid work requirements for three states have been struck down by the courts. Due to the failure to expand Medicaid, the South is now home to the nation's sickest people, and is where health disparities between whites and people of color are the most pronounced.

Disparities in Health Outcomes

Increases in health insurance coverage under the ACA have improved access to medical care and have been linked to better outcomes for African Americans, such as earlier diagnosis and treatment of certain cancers. However, disparities still exist across health conditions when comparing African Americans and whites, including maternal mortality, infant mortality, heart disease, diabetes, cancer, and other health issues. Social factors, including economic disadvantage, inequities in education, and lack of access to health care, impact a person's ability to lead a healthy and productive life. For people in American society that experience racism and inequality in their daily lives, and throughout the lifespan, the impact of social factors on health are the most grave.

Even with improved access to medical care under the ACA, the disparities in health outcomes between African Americans and whites are stark. African-American women are three times more likely to die of pregnancy-related causes than white women (see Figure 1). The African-American infant mortality rate is twice the rate for white infants (see Figure 2). African Americans are more likely to die from cancer and heart disease than whites, and are at greater risk for the onset of diabetes. However, death rates for African Americans with cancer and heart disease did drop over a fifteen year period. Across many chronic illnesses, however, African Americans are still more likely to die compared to other racial and ethnic groups. Homicides are also a leading cause of death for African Americans. In fact, African American children are ten times more likely to die by gun violence than white children (see Figure 3).

Figure 1

Figure 2

Figure 3

Health Care Provider Shortages

Due to residential segregation, majority African-American and Hispanic areas are more likely to lack hospitals and other health care providers. Therefore, place matters. When health care providers are located within majority African-American and Hispanic neighborhoods, they tend to offer lower-quality care. Often, people of color find themselves relying heavily on community health centers, emergency rooms or outpatient care, and community-based providers due to the lack of available primary care and mental health providers in a given geographic area. Traveling outside of the immediate geographic area to access health care may be an option for some people, yet this can be a challenge due to lack of access to transportation for those with limited incomes or for those living in rural areas.

It is not difficult to locate where-and for whom-provider shortages are a serious concern. The Health Resources and Services Administration (HRSA) defines Health Professional Shortage Areas (HPSAs) as geographic, population, or facility-based designations that are indicative of health care provider shortages. Designations are made by the following health disciplines: primary care, dental health, and mental health. Federal regulations dictate the threshold for shortages by calculating the ratio of population to provider in order to identify high need areas. In 2018, there were 17,657 geographic areas, populations, and facilities identified by HRSA as not having enough health care providers. Mental health and primary care were the disciplines in the shortest supply.

Medically Underserved Areas and Populations (MUA/Ps) are another designation by HRSA. They are geographic areas and populations that lack adequate access to primary care providers. MUA/Ps identify specific populations that are likely to experience barriers to health care including the homeless, low-income people, people eligible for Medicaid, Native Americans, and migrant farmworkers. Designations are made by calculating the population-to-provider ratio, percent of population below the federal poverty level, percent of population over the age of 65, and the infant mortality rate.

Important Considerations for Health Care Specific to African Americans

Certain social factors, also referred to as social determinants of health, have important implications for health risk and the ability to attain health insurance coverage. Poverty, income inequality, wealth inequality, food insecurity, and the lack of safe, affordable housing are just a few. Another important social factor leading to poor health outcomes and economic disadvantage among African Americans is racism, because not only is it a stressor, but it impacts who gets what in America, particularly health care.

Racism's Wear and Tear on African Americans

African Americans have endured racism within American society for hundreds of years. Studies conducted over time have been consistent in proving that racism not only impacts social stratification, but also the ability of African Americans to be healthy-both mentally and physically. This burden-a burden that is indeed inescapable for black and brown people in this country-causes African Americans to die prematurely and experience chronic illnesses and mental health challenges at higher rates than white Americans.

According to a study published in the journal of Psychoneuroendocrinology, racist experiences bring on an increase in inflammation in African Americans. This increase in inflammation raises the risk of becoming chronically ill. The researchers of the study assert that, because the body's response to stressors-such as the adversity of racism-results in compromising systems that are critical in fending off disease, exposure to racism over long periods of time caused the health of African Americans to suffer greatly with chronic illness as the body's defenses were down due to inflammation. Chronic illnesses associated with experiencing racism include heart attack, neurodegenerative disease, and metastatic cancer. The study participants had similar socioeconomic backgrounds, which eliminated poverty as a stressor-a social factor that has also been linked to the onset of illness.

Similar findings were yielded in some of the earliest studies looking at the impact of racism on the health of African Americans by University of Michigan public health researcher Arline Geronimous. After looking at biological factors associated with exposure to stressors, Geronimous hypothesized, in what is also referred to as the weathering hypothesis, that African Americans experienced health deterioration because of those stressors. Geronimous examined the allostatic load scores-that is, the cumulative wear and tear on the body's system brought on by the repeated adaptation to stressors-for adults aged 18-64. African Americans were found to have higher scores than white Americans. Once again, poverty was ruled out as a factor, due to the fact that the higher allostatic loads existed among African Americans of various socioeconomic backgrounds. Geronimous concluded that racism, and the burden of coping with it across the lifespan, leads to differences in health among African Americans and white Americans-including the onset of chronic illness and premature death.

In addition to instigating poor health outcomes among African Americans, racism also creates barriers to economic opportunity and uneven access to health care. Even the health care system itself perpetuates racism and bias toward African Americans. This has been well documented with examples, including differences in pain management and treatment of African Americans when compared to whites experiencing the same health conditions, use of African Americans' bodies in medical experimentation, and racial bias in health algorithms for the purpose of guiding health decisions and assessing health care costs. Actions like these have led to a general distrust of the health care system within the African American community. Racism cannot be divorced from the other social factors outlined in this report, which give reason to the fact that African Americans are disproportionately affected by them.

Poverty

Across economic indicators, vast disparities exist between African Americans and whites that mirror the proportions seen in health disparities. Due to structural barriers, African Americans are more likely to be poor than white Americans and are less likely to have a full-time worker in the household. The poverty rate among African Americans was 20.8 percent in 2018, higher than for any other racial or ethnic group in the United States, and more than twice the poverty rate of white Americans. Growing up in poverty is also associated with toxic stress, of which the impact can reach crisis levels when a person is also grappling with the toxic stress brought on by racism. When African Americans are able to attain work, they are more likely to work in low-paying jobs that lack important benefits, including health insurance and paid leave. The African-American poverty rate also shows how critical public programs such as Medicaid are to helping ensure access to health care for this population. Because of these factors, Medicaid expansion helps more African Americans gain coverage than any other group.

Household Income Inequality

African-American households have significantly lower household income than white households. The average household income for African Americans in 2018 was $41,361, while it was $70,642 for white households. (See Figure 4.) African Americans tend to make less than whites for the same jobs, pointing to unequal pay as a contributing factor in the gap in household income. Even when taking into account similar education levels, workers of color are consistently paid less than white workers.

Income is a major factor in a family's ability to access health care, which can make up a significant share of household spending in terms of insurance premium costs and out-of-pocket costs.

Figure 4

The Wealth Gap

When it comes to accumulating wealth, the numbers are even more grim-white families now have approximately ten times the wealth of African-American families, on average. (See Figure 5.) Research shows that the wealth gap impacts African Americans across the income and education spectrum, making it harder for them to own homes or build retirement savings. And while African Americans on average have less total debt than whites, the wealth gap means they are more likely to have costly, high-interest debt obligations. High health care costs and surprise medical bills can negatively affect an African-American family's ability to reduce or eliminate debt, and ultimately the ability to create wealth-which could impact a family for generations.

Figure 5

Food Insecurity

Food insecurity is also an issue affecting many African Americans and has important implications for health outcomes and economic well-being. Food insecurity occurs when a household or family lacks access to adequate nutritious food. This happens due to the lack of financial means to purchase healthy food or by living in impoverished geographic areas void of grocery stores with whole, fresh foods. Neighborhoods that lack access to nutritious foods are also referred to as food deserts. The ten U.S. counties with the highest food insecurity rates are all at least 60 percent African-American. African Americans experience hunger at twice the rate of white Americans, including one in four African-American children. Hunger can also lead to chronic illness and has been associated with low-birth weight, diabetes, cancer, pregnancy complications, and mental distress.

The Lack of Safe and Affordable Housing

Housing and neighborhood safety are also important economic indicators that can impact health. Unfortunately, far too many African Americans have to grapple with neighborhood violence and environmental factors (such as a lack of clean water, exposure to lead paint, and pollution) that can negatively impact both their mental and physical health. Additionally, a relative lack of affordable housing options and home ownership continues to plague the African-American community, largely due to longstanding racist practices such as redlining and subprime mortgages. The lack of affordable housing puts a financial strain on families and can pull resources away from necessities like food and medical care. For homeless and transient communities, it can be almost impossible to access health care or maintain adequate health regimens. Despite comprising just 13.4 percent of the total U.S. population, African Americans make up 40 percent of the homeless population, and are an overrepresented part of this group in every state.

Overview of Health Care Reform Plans

Several health care reform proposals have been introduced by members of U.S. Congress and by 2020 presidential candidates. In this section, the most widely known and promising plans that have gained traction and media coverage in recent months are highlighted.

Medicare for All

Medicare for All is a signature single-payer plan originally authored by Senator Bernie Sanders, setting forth a vision for major structural change of the health insurance system. It has since been endorsed and supported by Representative Pramila Jayapal (who introduced the House version of the legislation), Representative Alexandria Ocasio-Cortez, Senator Elizabeth Warren, Senator Kamala Harris, Senator Cory Booker, and a host of other progressive policymakers. It calls for a single federal program with comprehensive benefits for all U.S. residents that would replace all private insurance, Medicaid, Medicare, and the Children's Health Insurance Program (CHIP). The plan would be financed by taxes and eliminate premiums and cost-sharing or out-of-pocket costs, leading to major cost-savings for consumers in the long run. Taking into account the vast economic challenges for African Americans, savings in health care costs could help lead to better economic outcomes. In turn, health outcomes could also improve due to more comprehensive coverage available to all.

Comprehensive health benefits under Medicare for All include medically necessary services in thirteen benefit categories, including home and community-based long-term care, dental care, hearing, vision care, comprehensive reproductive health care (including abortion services), and transportation to health care appointments for people with disabilities and low-income people. Drug prices would be negotiated annually and a formulary would be established. Medicare for All would also prohibit balance billing, also known as surprise billing, which happens when health providers bill patients for the difference in the total cost of a health care service and the amount paid by an insurer.

Public Insurance Option

Public option plans call for a federal insurance option. These plans essentially build upon the ACA by adding a new option available to those seeking coverage. Former vice president Joe Biden has been an advocate for this plan and has included it in his platform as a 2020 presidential candidate. There are several versions of the public option-some that would leave the marketplace subsidy structure unchanged, and others that would enhance it for all plan participants. Some public option proposals even go so far as to eliminate individual heath insurance plans created by the ACA. A key difference in the Biden plan, when compared with Medicare for All, is that it retains current public and private insurance sources. For people who like or prefer their private insurance, they can maintain it under the Biden plan.

The Biden plan would retain major components of the ACA including protections for people with pre-existing conditions, premium subsidies, and Medicaid expansion, along with offering public insurance as an option to anyone who wants it. A public insurance option was initially part of the ACA as introduced in Congress but was taken out of the legislation later in the negotiations process. Biden's public option plan also aims to reduce the cost of prescription drugs by allowing importation of them from other countries, empowering Medicare to negotiate drug prices, and supporting the development of generic drugs. It would also offer tax credits to middle class families to help lower the cost of health insurance and eliminate the 400 percent federal poverty level income cap. The plan would eliminate balanced billing and be financed through capital gains taxes on rich individuals. Biden's plan also includes protecting access to contraception and abortion rights, as well as the promise to adopt California's strategy of public-private partnerships nationwide in addressing the U.S. maternal mortality crisis as major steps in building upon the ACA. Various versions of public insurance option legislation have also been introduced in Congress by Senator Ben Cardin, Representative Cedric Richmond, Senator Tim Kaine, Representative Jan Schakowsky, and others.

Sixty-one percent of white respondents in a November 2019 Gallup poll prefer the private health insurance system, whereas 57 percent of nonwhite respondents prefer government-run insurance. The cost of health care is still of major concern for those people with private health insurance, more so than for those with public insurance sources.

Ensuring Health Care Access and Affordable Coverage for African Americans

The single payer and public option insurance plans outlined in this report were developed in a way to help fill coverage gaps and get as many people insured as possible. The plans aim to do this by emphasizing affordability-addressing the high cost of insurance premiums and limiting out-of-pocket costs, including surprise medical bills, prescription drugs, and fees for direct health care services. Unfortunately, current health reform plans fall short in adequately addressing racism in the health care system. This stands in the way of ensuring health equity, namely full insurance coverage and quality health care access for African Americans.

Cost to the individual is certainly an important factor in the conversation about health coverage and ensuring that people can access the health care services they need. However, in order for African Americans to attain meaningful insurance coverage and access to quality health care, the health care system must be transformed to better address the unique social factors that cause African Americans to remain in the coverage gap and how racism plays a role in their health outcomes. Furthermore, the economic challenges African Americans face serve as barriers to sustaining comprehensive coverage which can lead to poor health outcomes. It is simply not enough for insurance coverage to be affordable or even "free"-it must also serve as a tool in progress toward systemic change and equity that will help African Americans get ahead.

To do this, getting to universal health care coverage will require that the following steps be taken:

Promote health equity by adequately addressing racism, bias, discrimination, and other systemic barriers within the health care system. To do this, policymakers must acknowledge the historical foundations of racism and ensure that health care providers, personnel and staff are substantively trained to recognize and eliminate all forms of bias in the health care system. Accountability measures at both the individual and systems levels should be in place, including measures that link payment, professional certification, and licensure to quality of care.

Incorporate evidence-based tools to adequately address health disparities that focus on quality of care that extend beyond health insurance coverage, including the impact of racism on the health of African Americans throughout the life course. In health reform efforts, policymakers must take into account the social determinants and address how they impact health by working across sectors, including social support agencies and community-based providers with patient-centered approaches to care. Racist practices, such as those in the treatment and pain management of African Americans, should be eliminated.

Protect and expanding access to insurance coverage and comprehensive benefits and bolstering the ACA benefit provisions and nondiscrimination guarantees. These efforts should include preserving coverage for people with pre-existing conditions by further codifying protections that ensure benefit inclusion and design decisions that do not result in limiting access to care. Policymakers should also build on the essential health benefits package to include important health care services currently omitted, such as long-term care and dental care.

Protect the integrity of Medicaid, an important health insurance source for African Americans, by denying state efforts to impose draconian stipulations on coverage for enrollees such as work requirements. In order to close the coverage gap among African Americans, policymakers must also implement targeted strategies to incentivize and ensure Medicaid expansion in all southern states.

Ensure access to quality providers and addressing provider shortages and hospital closures by anticipating increases in demand and working with HRSA to implement concrete strategies to close gaps in health care access for medically underserved areas/populations and health professional shortage areas. Strategies should include plans to not only increase the health care workforce, but also diversify it and offer technical support and training to minority-serving hospitals.

Support the development of a robust, diverse, and culturally competent health care workforce by encouraging and facilitating diversity throughout the health care system and care teams, and adequately training all staff to be culturally sensitive. Payment rates and coverage guidelines for health care coverage should be developed in a way that supports fair, living wages and pay equity in the health care professions and jobs.

Limit the cost of premiums and out-of-pocket costs, helping to make health insurance more affordable for individuals and families across the income spectrum. This should include limiting deductibles, prescription drug costs and other point-of-service charges, and completely eliminating surprise medical bills. All of these costs are major barriers to health care access, particularly for individuals and families with limited incomes.

Strengthen access to trusted community-based providers currently available through safety-net programs, such as Medicaid, Medicare, and the Children's Health Insurance Program (CHIP). These programs are often lifelines for marginalized communities and they disproportionately serve people of color. Policymakers should develop health reform plans that are intentional in ensuring continued access to these vital sources of care, as well as seamless coordination with health insurance payers for people with coverage seeking care from community-based providers.

African Americans stand to make significant gains if health reform is done right. The statistics outlined in this report paint a grim picture. Regardless of the progress made in recent decades, far too many African Americans still struggle to lead healthy and economically secure lives. This is due to the long-standing effects of racism, which touches all African Americans, regardless of socioeconomic status. These effects can be reversed, but it will take real commitment and systemic change. Health care reform must be part of the effort.

Tags: health care, income inequality, wealth inequality, racism, racial inequality, African americans

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Racism, Inequality, and Health Care for African Americans

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What You Should Know Of the more than 20 million people who have gained coverage under the ACA, 2.8 million of them are African-American-and yet, this population is still more likely to be uninsured than white Americans.

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Is It OK to Attend Protests for Marginalized Groups If I’m Not Affected?

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We paired with Amnesty International USA to answer.

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Alicia Garza, Patrisse Cullors and Opal Tometi

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An interview with the founders of Black Lives Matter

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Born out of a social media post, the Black Lives Matter movement has sparked discussion about race and inequality across the world. In this spirited conversation with Mia Birdsong, the movement’s three founders share what they’ve learned about leadership and what provides them with hope and inspiration in the face of painful realities. Their advice on how to participate in ensuring freedom for everybody: join something, start something and “sharpen each other, so that we all can rise.”

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Is It OK to Attend Protests for Marginalized Groups If I’m Not Affected?

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We paired with Amnesty International USA to answer.

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In 1954, the Supreme Court ruled in Brown v. Board of Education that segregated public schools are unconstitutional.

In 2018, on the 64th anniversary of that ruling, a lawsuit filed in New Jersey claimed that state's schools are some of the most segregated in the nation. That's because, the lawsuit alleged, New Jersey school district borders are drawn along municipality lines that reflect years of residential segregation.

The idea that school district borders carry years of history is the premise of a new report from the nonprofit EdBuild, which studies the ways schools are funded in the U.S.

The report starts with a number: $23 billion. According to EdBuild, that's how much more funding predominantly white school districts receive compared with districts that serve mostly students of color.

"For every student enrolled, the average nonwhite school district receives $2,226 less than a white school district," the report says.

EdBuild singles out 21 states - including California, New Jersey and New York - in which mostly white districts get more funding than districts composed primarily of students of color.

More than half of students in the U.S. go to segregated or "racially concentrated" schools, according to the report. Those are schools in which more than three-quarters of students are white, or more than three-quarters are nonwhite.

Researchers found that high-poverty districts serving mostly students of color receive about $1,600 less per student than the national average. That's while school districts that are predominately white and poor receive about $130 less.
What's causing the disparity?
As Rebecca Sibilia, founder and CEO of EdBuild, explains, a school district's resources often come down to how wealthy an area is and how much residents pay in taxes.

"We have built a school funding system that is reliant on geography, and therefore the school funding system has inherited all of the historical ills of where we have forced and incentivized people to live," she says.

Public schools are primarily funded by local and state sources - the federal government pays for less than 10 percent,on average, of K-12 education. States sometimes step in to provide extra funding for districts that need it most. But not all states have been able to keep up with that demand.
The relationship between funding and teacher strikes
In some of the states with the worst funding disparities, teachers have gone on strike in the past year. In Arizona, poor, primarily white school districts get about $19,000 per student - while high-poverty, nonwhite districts get about $8,000, according to EdBuild.

That means high-poverty districts made up of mostly students of color - about a third of the school districts in the state - receive almost $11,000 less per student than the state's high-poverty, predominantly white districts.

Sibilia also points to the #RedForEd movements in Oklahoma and Colorado. Because those states have placed limits on their taxes, she says, they simply don't have the income to step in and fund the school districts that need it most.
Why funding in Southern states looks more equal
According to EdBuild researchers, predominantly white districts are often smaller than districts with mostly students of color: The former serves an average of just over 1,500 students, and the latter over 10,000, or three times the national average.

That size disparity matters. Sibilia says districts serving mostly students of color "rely more on the decisions that are being made at the state level, but there are fewer voices representing them. And that's where you really start to see the shift in power."

This power dynamic looks different in the South, where school district lines are often drawn along county lines, making districts larger across the board. Researchers found that funding looks more equal in states like Georgia and Alabama.

"This confirms a theory that we've had, which is that the larger the tax base - the larger the actual geography of the school districts - the more you can actually balance out the difference between a wealthy white suburb and a less wealthy rural or urban area," Sibilia says.

EdBuild researchers looked at data from a variety of sources - including the Education Department and the U.S. Census Bureau - to find school system demographics and district funding levels. They compared the funding across districts after taking cost of living into account.

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Why White School Districts Have So Much More Money

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According to a new report, predominantly white school districts receive $23 billion more than districts that serve mostly students of color in the U.S.

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WASHINGTON - Black boys as young as 10 may not be viewed in the same light of childhood innocence as their white peers, but are instead more likely to be mistaken as older, be perceived as guilty and face police violence if accused of a crime, according to new research published by the American Psychological Association.

"Children in most societies are considered to be in a distinct group with characteristics such as innocence and the need for protection. Our research found that black boys can be seen as responsible for their actions at an age when white boys still benefit from the assumption that children are essentially innocent," said author Phillip Atiba Goff, PhD, of the University of California, Los Angeles. The study was published online in APA's Journal of Personality and Social Psychology®.

Researchers tested 176 police officers, mostly white males, average age 37, in large urban areas, to determine their levels of two distinct types of bias - prejudice and unconscious dehumanization of black people by comparing them to apes. To test for prejudice, researchers had officers complete a widely used psychological questionnaire with statements such as "It is likely that blacks will bring violence to neighborhoods when they move in." To determine officers' dehumanization of blacks, the researchers gave them a psychological task in which they paired blacks and whites with large cats, such as lions, or with apes. Researchers reviewed police officers' personnel records to determine use of force while on duty and found that those who dehumanized blacks were more likely to have used force against a black child in custody than officers who did not dehumanize blacks. The study described use of force as takedown or wrist lock; kicking or punching; striking with a blunt object; using a police dog, restraints or hobbling; or using tear gas, electric shock or killing. Only dehumanization and not police officers' prejudice against blacks - conscious or not - was linked to violent encounters with black children in custody, according to the study.

The authors noted that police officers' unconscious dehumanization of blacks could have been the result of negative interactions with black children, rather than the cause of using force with black children. "We found evidence that overestimating age and culpability based on racial differences was linked to dehumanizing stereotypes, but future research should try to clarify the relationship between dehumanization and racial disparities in police use of force," Goff said.

The study also involved 264 mostly white, female undergraduate students from large public U.S. universities. In one experiment, students rated the innocence of people ranging from infants to 25-year-olds who were black, white or an unidentified race. The students judged children up to 9 years old as equally innocent regardless of race, but considered black children significantly less innocent than other children in every age group beginning at age 10, the researchers found.

The students were also shown photographs alongside descriptions of various crimes and asked to assess the age and innocence of white, black or Latino boys ages 10 to 17. The students overestimated the age of blacks by an average of 4.5 years and found them more culpable than whites or Latinos, particularly when the boys were matched with serious crimes, the study found. Researchers used questionnaires to assess the participants' prejudice and dehumanization of blacks. They found that participants who implicitly associated blacks with apes thought the black children were older and less innocent.

In another experiment, students first viewed either a photo of an ape or a large cat and then rated black and white youngsters in terms of perceived innocence and need for protection as children. Those who looked at the ape photo gave black children lower ratings and estimated that black children were significantly older than their actual ages, particularly if the child had been accused of a felony rather than a misdemeanor.

"The evidence shows that perceptions of the essential nature of children can be affected by race, and for black children, this can mean they lose the protection afforded by assumed childhood innocence well before they become adults," said co-author Matthew Jackson, PhD, also of UCLA. "With the average age overestimation for black boys exceeding four-and-a-half years, in some cases, black children may be viewed as adults when they are just 13 years old."

Article: "The Essence of Innocence: Consequences of Dehumanizing Black Children," Journal of Personality and Social Psychology, published online Feb. 24, 2014; Phillip Atiba Goff, PhD, and Matthew Christian Jackson, PhD; University of California, Los Angeles; Brooke Allison, PhD, and Lewis Di Leone, PhD, National Center for Post-Traumatic Stress Disorder, Boston; Carmen Marie Culotta, PhD, Pennsylvania State University; and Natalie Ann DiTomasso, JD, University of Pennsylvania.

Phillip Atiba Goff, PhD, can be contacted by phone at (310) 206-8614 (preferred) or by email. If Goff is unavailable, contact Matthew Christian Jackson, PhD, by phone at (814) 574-9781 or by email.

The American Psychological Association, in Washington, D.C., is the largest scientific and professional organization representing psychology in the United States. APA's membership includes more than 134,000 researchers, educators, clinicians, consultants and students. Through its divisions in 54 subfields of psychology and affiliations with 60 state, territorial and Canadian provincial associations, APA works to advance the creation, communication and application of psychological knowledge to benefit society and improve people's lives.

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Black boys viewed as older, less innocent than Whites, research finds

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Black boys as young as 10 may not be viewed in the same light of childhood innocence as their white peers, but are instead more likely to be mistaken as older, be perceived as guilty and face police violence if accused of a crime.

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116th Congress by Party, Race, Gender, and Religion

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The 116th Congress has the most women and people of color than ever before.

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The Statista "Chart of the Day" currently focuses on two sectors: "Media and Technology", updated daily and featuring the latest statistics from the media, internet, telecommunications and consumer electronics industries; and "Economy and Society", which current data from the United States and around the world relating to economic and political issues as well as sports and entertainment.

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Infographic: How Diverse is U.S. Congress?

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The Statista "Chart of the Day" currently focuses on two sectors: "Media and Technology", updated daily and featuring the latest statistics from the media, internet, telecommunications and consumer electronics industries; and "Economy and Society", which current data from the United States and around the world relating to economic and political issues as well as sports and entertainment.

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This week, millions of students and teachers are taking part in Read Across America, a national literacy program celebrated annually around the birthday of Theodor Geisel, better known as Dr. Seuss. For over 20 years, teachers and students have donned costumes - often the Cat in the Hat's iconic red and white striped hat - and devoured books like Green Eggs and Ham.

But some of Seuss' classics have been criticized for the way they portray people of color. In And To Think That I Saw It On Mulberry Street, for example, a character described as Chinese has two lines for eyes, carries chopsticks and a bowl of rice, and wears traditional Japanese-style shoes. In If I Ran the Zoo, two men said to be from Africa are shown shirtless, shoeless and wearing grass skirts as they carry an exotic animal. Outside of his books, the author's personal legacy has come into question, too - Seuss wrote an entire minstrel show in high school and performed as the main character in full blackface.

In light of this, the National Education Association rebranded Read Across America in 2017, backing away from Seuss' books and Seuss-themed activities. It introduced a new theme of "celebrating a nation of diverse readers." Its website now highlights works by and about people of color.

But in many schools and libraries, the week is still synonymous with all things Seuss. Classrooms are decorated in colorful red and blue fish and children dress up as their favorite iconic characters, like Thing 1 and Thing 2, dreaming of the places they'll go.

That tension between Seuss and Seuss-free classrooms is emblematic of a bigger debate playing out across the country - should we continue to teach classic books that may be problematic, or eschew them in favor of works that more positively represent people of color?

Part of the reason this debate is so complicated is the staying power of classic books. Think back to the works lining your school bookshelves.In Adventures of Huckleberry Finn, the N-word appears more than 200 times. But for generations, people have argued that the book is vital to understanding race relations in America in the late 1800s. And the trope of Jews as greedy and money-hungry is pretty clear in The Merchant of Venice. Yet Shakespeare is hailed for his keen understanding of human nature that continues to be relevant today.

Jaya Saxena, a writer whose work examines inclusivity in young adult literature, is in favor of revamping the canon. But she understands why teachers might continue to teach it. She says when she was in high school, her teachers used the classics to teach literary devices and styles of writing, not necessarily to prioritize certain narratives or worldviews. The Merchant of Venice, for example, is a prime example of allegory.

"The point was, here's what this book does well," Saxena says. "Maybe they weren't everybody's favorite books, but they were good examples of ... the craft of writing."

And when planning lessons from year to year, it's easier for teachers to prioritize books they're already familiar with. But when these books include offensive stereotypes, teachers have to decide whether to continue teaching them and how.

"Not engaging [with problematic texts] at all runs too great a risk of not learning or understanding where the problems lie," says Larissa Pahomov, who teaches English at a high school in Philadelphia. "I believe there is a way to look at material that is stereotypical [and] racist and identify it for what it is, and then hopefully, in doing so, neutralize its effect."

When Pahomov read One Flew Over the Cuckoo's Nest with her seniors last fall, she was careful to teach students how to read the work through a critical lens that took the author's background into account. In class discussions, she made sure to emphasize that context to her students as they examined the work.

"What resources did he draw from to write this book, and this character? What has been the Native American reaction to this book specifically? What was the reaction of the psychiatric treatment community? How do we look at it now? What's the treatment of women? There were so many angles to discussing it," she says.

Pahomov notes that because her students are teenagers, having these conversations is possible. But books geared toward younger kids? Those discussions can get a lot more complicated.

Which brings us back to Dr. Seuss.

In a study published earlier this month in Research on Diversity in Youth Literature, researchers Katie Ishizuka and Ramon Stephens found that only 2 percent of the human characters in Seuss' books were people of color. And all of those characters, they say, were "depicted through racist caricatures."

Those caricatures have a potent effect, even at an early age. Research shows that even at the age of 3, children begin to form racial biases, and by the age of 7, those biases become fixed.

"One of the reasons for that is the images and experiences that they're exposed to regarding marginalized groups and people of color," Stephens says. "And so [Seuss' books] being mainstream, and being spread out all over the world, has large implications."

If kids open books and "the images they see [of themselves] are distorted, negative [or] laughable, they learn a powerful lesson about how they are devalued in the society in which they are a part," Rudine Sims Bishop, a scholar of children's literature, wrote in a 1990 article.

But when they see themselves represented in a positive way, it can have a similarly powerful effect.

That's one of the reasons first-grade teacher Emily Petersen says she won't be reading Dr. Seuss with her students this week, or ever.

"If I'm looking at a 6-year-old and choosing what story [I'm] going to teach them how to read through, I'm definitely going to choose the one that affirms and celebrates identities in a new way," she says.

For other teachers who want to help students affirm their identities, the NEA is offering grants and resources to help schools highlight literary works by and about people of color.

But the forces that have kept Dr. Seuss on the bookshelf for decades are strong. Often, schools plan their Read Across America events months in advance. Costumes, books and activities from previous years are ready to go. It can be difficult for teachers to deviate from these plans, especially when they have celebrated in the same way year after year after year. And with over 650 million of his books in circulation worldwide, just like his infamous cat, it looks like Dr. Seuss will keep coming back.

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Dr. Seuss Books Can Be Racist, But Students Keep Reading Them

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A recent study found that Dr. Seuss books can be pretty racist. It's highlighted a growing debate: Should schools teach classic books that may be problematic or trade them for socially conscious ones?

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Kwame Alexander: Take a Knee - ESPN Video

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The Newbery Medal winning poet delivers a new piece for The Undefeated

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You may know what race you are, but how would you prove it if someone disagreed with you? The fact is, race is a social and political construct that has evolved in fascinating and often confusing ways over the centuries.

Race is a social construct

With the 1776 edition of his book, On the Natural Variety of Mankind, German scientist Johan Friedrich Blumenbach is credited with creating one of the first race-based classifications. He decided on five categories: "Caucasian, the white race; Mongolian, the yellow race; Malayan, the brown race, Ethiopian, the black race, and American, the red race." Each race was ranked, and he put "Caucasian" at the top. This seemingly arbitrary ranking was the impetus for centuries of discrimination and inequality.

The US Census proves race is subjective

The evolution of race in the US Census illustrates just how hard it is to categorize people in a way that is inclusive and accurate. For example, in 1929, people who were of Mexican birth or ancestry in the United States were considered white. In 1930, they were considered non-white. In 1942, they were switched back to white. These dates are interesting because they align directly with the shifting political and economic agendas of the time.

Racial categories are not backed by science

Dorothy Roberts, the author of Fatal Invention: How Science, Politics, and Big Business Re-create Race in the Twenty-first Century explains that when the medical community links race to health outcomes, it's really just using race as a proxy for other factors such as where your ancestors came from, access to healthcare, and socioeconomic status. Sickle-cell anemia is a prime example of this. Commonly linked to race, this adaption is actually a product of environments where Malaria is prevalent, including some parts of Europe and Asia, in addition to Africa.

Although race isn't real, racism certainly is

The racial categories to which we're assigned, based on how we look to others or how we identify ourselves, can determine real-life experiences, inspire hate, drive political outcomes, and make the difference between life and death. But these important consequences are a result of a relatively new idea that was based on shaky reasoning and shady motivations.
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First, advertising dollars go up and down with the economy. We often only know a few months out what our advertising revenue will be, which makes it hard to plan ahead.

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You may know what race you are, but how would you prove it if somebody disagreed with you? Jenée Desmond Harris explains.

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By Chelsea Bailey BBC News, Washington

One thing Americans find hard to talk about

February was Black History Month in the US, a time typically set aside to recognise African Americans and their contributions to the country.

This year's commemoration ended with insults and accusations of racism on the floor of Congress, at a televised hearing broadcast into millions of homes. But that exchange, between a Democrat and Republican, was hardly an isolated incident.

The month began with calls for Virginia's governor to resign after a photo emerged of him in blackface. And it ended with President Donald Trump - who himself has been accused of racism - saying Academy Award winner Spike Lee was being racist after the film director urged Americans to "do the right thing" and choose love over hate by helping to thwart Mr Trump's re-election hopes.

The flood of racially-charged headlines underlined a feeling shared by many - that 400 years after the first slaves were brought to the US, Americans still struggle to have meaningful conversations about race.

"We can't even have a productive conversation if people aren't open to looking in the mirror," said Ibram Kendi, director of the Antiracist Research and Policy Center at American University.

"Denial is essentially the heartbeat of racism in this country and every time you are not open to what you could be doing in the moment, you are living and breathing racism itself."

African Americans in New Orleans on the state of race relations

He says the first step to dismantling racism in the US is recognising that we can all shift between being racist and anti-racist.

"When someone is charged with doing something that's racist, instead of getting upset and lashing out, they should consider the evidence."

Conversations about race typically devolve into arguments because Americans have come to view the word "racist" a permanent label and not a description of an action, says Mr Kendi.

He now advocates for redefining the word "racist" as a reflection of both our beliefs and behaviours and not merely as an insult.

"A racist supports, by their action or inaction, policies that reproduce racial inequality. An anti-racist supports, with their actions, policies that reduce or eliminate racial inequality," says Mr Kendi.

"What you're doing and what you're saying is an expression of who you are in that moment."

Much of this discussion was sparked by the argument on the floor of the House of Representatives, which began when after Rashida Tlaib, a Democratic freshman, accused the Republican veteran congressman Mark Meadows of racism and using a black woman as a "prop".

Mr Meadows had asked Lynne Patton, a long-time employee of the Trump Organization, to attend the Michael Cohen hearing to refute accusations that President Trump was racist.

Speaking for Ms Patton, Mr Meadows said "as the daughter of a man born in Birmingham, Alabama, there is no way she would work for a man who is racist".

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When Ms Tlaib said that simply having a friend or employee who's a minority does not prohibit someone from being racist, the hearing quickly dissolved into a very heated row.

Social psychologist Daniel Effron, who studies morality and race, said there's a reason people often resort to the "black friend" defence when charged with racism.

Mr Effron said his research shows that whenever a person is accused of racism or their moral identity is challenged, they instinctively search for any example to bolster their "non-racist credentials", which can be a low bar.

"When people are motivated to find evidence that they're not prejudiced, they're more likely to think having a black friend is really strong evidence," he said.

Getty Images

Spike Lee never mentioned President Trump by name in his speech but it was interpreted as a message to vote him out

"We make a mountain of morality out of a molehill of virtue."

But even people with good intentions can face criticism when it comes to discussing race in America, as the director of the Oscar-winning movie Green Book discovered.

Set against the backdrop of the segregated South in the 1960s, the film follows the unlikely friendship between a black classical and jazz musician and his white chauffeur.

Critics accused the film of whitewashing history and furthering the "white saviour" trope in Hollywood.

More on race in the US

Racism in the US: Is there a single step that can bring equality?

Author and anti-racism activist Tim Wise said he thinks we need to reframe the way we teach race in America, shifting the emphasis away from an individual's actions and looking at the system as a whole.

"When we think about the way Americans teach racism historically, it is a story about individuals who did or did not own slaves, individuals who did or did not own segregated businesses. It's a lot harder to see systems of inequality," he said, adding that this can absolve people from reflecting on their own actions.

Mr Wise explores his own struggles with reconciling white privilege and racism in his autobiography White Like Me and has made a career out of navigating difficult conversations about racism.

He said he thinks Americans have been conditioned to believe certain racial stereotypes and unlearning those prejudices begins with recognising they exist in the first place. Until then, he said, we will continue to have circular arguments about race without making progress toward dismantling racism.

"It would be ridiculous to say, 'I don't have a racist bone in my body'... you grew up in America," he says.

"It's about saying, 'Look, I'm going to be humble enough to admit my weaknesses. Not because I want you to beat me up and not because I want to beat myself up, but because I know that I'm capable of better.'"

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A series of very public arguments over race blighted Black History Month and reminded us of an undisputed fact.