Racism in Health Care


The subtler ways racism impacts health—and why that’s everyone’s problem to solve

Structural racism persists in America throughout our social, economic and political systems. It is deeply rooted in our history, culture, institutions, policies, practices and norms. People of color, particularly Black Americans, face discrimination and experience disparities in income, housing, schooling, social services and health care.

Black Americans experience poorer access to and lower quality of care compared to white Americans. Access to care may be limited because of unemployment, lack of health insurance, or insufficient coverage for needed specialists—as well as logistical burdens like lack of childcare or transportation options. Providers may knowingly or unknowingly contribute to these access barriers by not making changes to operating hours or insurance policies.

In addition, misinformation, stereotypes, and health care providers’ unconscious attitudes contribute to disparities in patient care. Implicit biases fuel differential treatment of minorities. The statistics paint a grim picture—Black Americans are also more likely to die from cancer and heart disease, are at greater risk for the onset of diabetes, and have a higher prevalence of glaucoma. While the novel coronavirus was anticipated by some to be the “great equalizer,” recent data on COVID-19’s impact shows Black Americans are dying at three times the rate of white Americans.

Eliminating this inequity in healthcare begins with acknowledging structural racism as well as individual biases. We have to actively confront these issues—through education and dialogue—to dismantle existing policies and practices and enact equitable and anti-racist structures in their place.

Read our post originally published in December 2017.

How poverty and race affect health

It’s no secret that minorities fare worse than whites when it comes to their health. They have higher rates of heart disease and mortality. Black Americans are almost twice as likely to be diagnosed with diabetes as non-Hispanic whites, and more likely to suffer from complications.

Both poverty and race matter when it comes to accessing healthy food and health care.

Socioeconomic factors certainly play a role. Poor, urban areas tend to be “food deserts”—areas where residents do not have easy access to affordable, healthy food. But race factors in as well. Compared to white communities with similar poverty rates, “Black and Hispanic neighborhoods have fewer large supermarkets and more small grocery stores” offering more junk food and less fresh produce, reported Johns Hopkins Magazine. “Both poverty and race matter when it comes to having healthy food options.”

And it’s not just minorities who live in inner cities who struggle to stay healthy. A recent CDC report found that rural white populations have better access to health providers than minorities. More rural racial/ethnic minority populations (compared with non-Hispanic whites) “reported their health as fair or poor, that they had obesity, and that they were unable to see a physician in the past 12 months because of cost,” according to the report.

Shocking statistics show minorities receive lower quality care

Even accounting for geographic and socioeconomic differences, however, “racial bias and discrimination in health care as well as outside of medicine contribute to poor health for Black patients and other racial and ethnic minorities,” stated an article in U.S. News & World Report.

“Across virtually every medical intervention, from the most simple medical treatments to the most complicated treatments, blacks and other minorities receive poorer-quality care than whites,” NPR reported, in a segment titled, “Racism Is Literally Bad For Your Health.”

Black Americans and Latinos are less likely to be given pain medication, and some studies have shown racial differences in cardiac care and delays in kidney transplantation rates, according to U.S. News.

A Black woman in the U.S. is 243 percent more likely to die from pregnancy- or childbirth-related causes than a white woman.

A shocking article in ProPublica found that Black women in the U.S. die in pregnancy and childbirth at rates similar to women in countries such as Mexico and Uzbekistan. “A Black woman is 22 percent more likely to die from heart disease than a white woman, 71 percent more likely to perish from cervical cancer, but 243 percent more likely to die from pregnancy- or childbirth-related causes,” stated the article.

ProPublica and NPR researchers reported that in over 200 stories of Black mothers they collected over the course of a year, “the feeling of being devalued and disrespected by medical providers was a constant theme.”

It’s important to note that doctors disrespecting patients is not the only way discrimination shows up in medicine. On KevinMD.com, an Iranian-born U.S. doctor wrote about his experiences with patients who have threatened him with deportation and made openly racist remarks to him.

The physical effects of discrimination over time

There’s another subtler but more pervasive factor that hurts minorities. As NPR put it: “the day-to-day little indignities affect health: being treated with less courtesy than others, being treated with less respect than others, receiving poorer service at restaurants or stores.”

People who experience ongoing discrimination report worse sleep, higher rates of stroke and asthma, even lower birth weight in babies.

Research finds that in people who experience these things over time, there is a real, measurable, negative impact on their health—everything from worse sleep, more asthma, higher rates of stroke, and even lower birth weight in babies born to pregnant women who reported high levels of discrimination.

“Individually these incidents seem benign,” said Roberto Montenegro, M.D., who wrote about his experience of being mistaken for a Latino valet in JAMA. “But cumulatively I believe that they act like sort of low-grade microtraumas that can end up hurting you and your biology. It’s not just having your feelings hurt. It’s having your biology hurt as well.”

Arline Geronimus, a professor at the University of Michigan School of Public Health, coined the term “weathering” for how this continuous stress wears away at the body, according to ProPublica.

Research is growing on the impact of discrimination on physical and mental health, and whether these experiences could contribute to health disparities among different U.S. populations. The next step is looking at what can be done to reduce these negative effects on health.

Hope that awareness will affect change

The first step is awareness. “Experts emphasize that health organizations as well as individual health providers and professionals should seek to raise awareness of unconscious biases, embrace diversity, and work to be more sensitive to patients of different races,” stated U.S. News.

This goes beyond simply portraying people of color in your patient education and marketing materials. Studies have shown that doctors’ nonverbal communication varied between Black versus White patients. Are you looking all your patients in the eye and showing empathy and respect? Are your arms crossed or are you facing your EHR? These are all things to pay attention to.

Ron Wyatt, M.D., who experienced this type of discrimination as a patient, told U.S. News that he hopes that increased recognition in health care and society overall of these subtle biases, and efforts to overcome those biases, will make a significant difference. “I’m optimistic. I think we’re further down the road on this than we’ve ever been,” he said, but added, “There has to be systematic change.”

This post was originally published on December 22, 2017.

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