Racism, oppression and discrimination toward Black people underlies every institution in the United States, and it kills people. The health care system — by definition designed to promote wellness — is no exception, from COVID-19’s disproportionate impact on the Black community to police brutality.
The frontlines: The impact of health care racism is evident in statistics about Black health across the board:
- Black women are 22% more likely to die from heart disease and 71% percent more likely to die from cervical cancer than White women
- Black people who give birth are 243% more likely to die during pregnancy or childbirth and Black infants are twice as likely to die before they turn 1 year old compared to White people
- People of color experience higher rates of otherwise preventable or manageable conditions, including diabetes, stroke, heart disease and cancer — Black people are 77% more likely to be diagnosed with diabetes than White people
Systemic anti-Black #racism is a public health crisis evident in many ways, incl. police violence, denial of health care, lower disease screening rates & less access to mental health services. Our statement on action needed NOW: https://t.co/bafE9OFErq #ONhealth #BlackLivesMatter pic.twitter.com/yVB1cMNMsQ
— Alliance for Healthier Communities (@AllianceON) June 3, 2020
Here are just a few examples of how health care racism plays out:
1. Harmful Stereotypes
Some common stereotypes have followed Black people into decisions about their health care. Mighty contributor Kelly Oglesby highlighted how the “strong Black woman” stereotype led to poor treatment for her migraines or the harm caused when doctors assume that every health issue is weight-related. Read more:
- When the ‘Strong Black Woman’ Stereotype Follows You Into the Doctor’s Office
- ‘Insecure’ Made an Important Point About Black Women and Pain
- 10 ‘Harmless’ Comments People of Color Are Tired of Hearing About Mental Health
2. Exclusionary Research Practices
Medical research and clinical trials are often conducted among predominantly White participants — less than 10% of those enrolled in clinical trials are people of color. As a result, treatments and diagnostic criteria don’t take into account differences for people of different races or ethnicities.
Rochaun Meadows-Fernandez pointed out this can lead to misdiagnosis or even medications — like albuterol inhalers for asthma — to be less effective. The result is poor treatment or no treatment at all. Read more:
- Black Participants Are Sorely Absent from Medical Research
- More Minorities Needed in Clinical Trials to Make Research Relevant to All
3. Lack of Black Practitioners
The health care system, from surgeons and doctors to therapists and psychiatrists, lacks Black practitioners.
- More than half of active physicians in the United States are White, and only 5% of physicians are Black
- As of 2015, only 4% of psychologists in the workforce were Black
This means most people of color see a White practitioner, which can lead to poor treatment due to a lack of understanding or racist treatment. And in the case of mental health, having a therapist who isn’t Black becomes a barrier, as Mighty contributor A Porter wrote:
Yesterday I called my white therapist to have an emergency call because I was at a loss on how to deal with my grief and PTSD, but she can only say so much and only I can say so much to her. She will never understand my plight and cannot relate to racism.
4. Practitioner Racism
Stopped by hospital security at the entrance while a white classmate in front of me was let through, sans I.D. 4/9
— Samuel Kebede, MD MPhil (@KebedeMD) June 3, 2020
Racism among mostly White practitioners toward colleagues and patients also runs rampant. It occurs during medical training, as Samuel Kebede, MD, described in a Twitter thread. And it occurs in the doctor’s office by dismissing patient concerns or not offering Black patients the same standard of care.
- One study found that doctors with an implicit pro-White bias were less likely to prescribe pain medications following surgery to Black patients
- Liz Dwyer reported that a 2016 study found mental health therapists were less likely to call back prospective clients if they sounded Black or like they had a lower-income background
- A systematic review of studies on implicit bias among health care providers indicated 31 of the 37 studies reviewed suggested evidence of bias toward black and brown people
5. ‘Treating’ Mental Health in Jail
Public health includes treatment by the education, housing & criminal justice system.
-2.17x more likely to be arrested & 5x more likely to be imprisoned
-Whites in the criminal justice system are more likely to be identified as having a mitigating mental illness 9/
— Andy Slavitt @ ???? (@ASlavitt) June 2, 2020
Instead of getting the care they need, Black people with mental illness are criminalized — Black people with a serious mental illness are five times more likely to be sent to jail than people with skin color privilege. Patrisse Cullors, a co-founder of Black Lives Matter, shared in the documentary “Bedlam” that her brother Monte was diagnosed with a mental illness in jail.
[Monte] was diagnosed in the jails and so we were distrustful of the diagnosis because of the place that came from. — Patrisse Cullors
6. Toxic Stress of Racism
The hypertensive body that carries eight generations of white racist violence as hypertension is being blamed for being hypertensive when that racist violence fulfills its eight-generations-old destiny as a knee thay crushes the hypertensive body’s windpipe. A gotdamn scourge.
— Tressie McMillan Cottom (@tressiemcphd) May 29, 2020
Black people must navigate a white supremacist, racist society every day, from microaggressions to overtly racist violence and discrimination, tokenization and traumatic interactions in everyday activities. Collectively, this trauma leads to toxic stress, which has a major negative impact on health.
- Adiaha Spinks-Franklin wrote that toxic stress leads to worse health outcomes over time, such as a lowered immune response and higher rates of mother and infant mortality rates
- Toxic stress is also compounded, as Tressie McMillan Cottom shared on Twitter, by generations of racism, violence and oppression
7. Socioeconomic Disparities
How to be healthy
Do yoga/buy my supplement/keep a gratitude journal/do a detox
Have the privilege of an education, a good income, a support network, absence of racism/sexism/any bias, accessible health care, political stability, win the genetic lottery
— Dr Nikki Stamp FRACS (@drnikkistamp) May 31, 2020
Health isn’t just about what happens in a doctor’s office — it includes income, housing, food security, community support, access to health insurance, and other socioeconomic factors. Black people are more likely to struggle in all of these areas due to systemic racism, which Bonnie Castillo, executive director of National Nurses United, highlighted is already a risk factor in a for-profit health care system:
In a medical system premised on profits and ability to pay, racial disparity presents in ability to afford the high cost of premiums, deductibles, and copays that disproportionately discourages African Americans from getting needed medical care. That problem is exacerbated when corporate health care decisions are premised solely on reducing costs for care.
8. Biased Health Algorithms
The same racist biases exhibited by practitioners have also been programmed into the systems that decide who should get care. A 2019 study published in Science investigated the algorithm used by health systems and insurers to determine which patients with chronic conditions needed extra care. Here’s what researchers found:
- The algorithm only identified 18% of Black patients as needing more care compared to about 82% of White people, even though their levels of sickness were similar
- As a result, the algorithm failed “to account for a collective nearly 50,000 chronic conditions experienced by black patients,” according to STAT, who then didn’t receive adequate care
More helpful thinking: Read more on how racism impacts health care in the Black community with these articles:
- Racism, Inequality, and Health Care for African Americans
- The Racism That’s Pervaded the U.S. Health System for Years Is Even Deadlier Now
- Racism and Health: Evidence and Needed Research
- Healthcare in America Is Structural Racism. Didn’t They Teach You That in Medical School?