This week we are talking about racism and discrimination within the healthcare system, with a particular focus on how it impacts Black people. The intersections of racial inequality and its effects are evident when it comes to the coronavirus pandemic — one in four coronavirus deaths in the United States are Black Americans, who have a death rate that is 2.4 times greater than that of white Americans. The complex, vast, and numerous systems of inequality in U.S. healthcare demonstrate the tangible impacts of discrimination within our society.
Much of the inequity seen within the medical system can be directly traced to other systems of discrimination. In terms of health and well-being, factors such as residential segregation have led Black Americans on average to live in places with higher levels of air pollution and more limited accessibility to healthy foods (‘food deserts’), leading to higher rates of conditions such as asthma and obesity. Additionally, it has been scientifically proven that the daily discrimination faced by people of color has quantifiable health detrements. In terms of coronavirus, both obesity and asthma put patients at an increased risk of mortality.
In addition to all of these external factors, the healthcare industry itself has had a long history of perpetuating racism. From its inception, the medical community within the U.S. has exploited, violated, and abused Black bodies for scientific gain. James Sims, deemed the “father of modern gynaecology”, tested and perfected surgeries on female slaves without anesthesia or their consent. Medical students in Virginia dug up Black bodies to be used as cadavers, and disposed of the bodies in the city’s sewers. In 1932, 600 Black men were unknowingly injected with Syphilis (a disease which had no cure at the time), and left under study for 40 years in order to determine the disease’s impacts on the human body. 28 died of syphilis, and 100 others from related complications.
Our current healthcare industry continues the history of racism, both in access to care and the quality of care received. 14% of Black adults are uninsured (in comparison with 9% of white adults), and are also less likely to receive a proper diagnosis and treatment. Black people are more likely to be covered by Medicaid, which places them at a disadvantage to people on private insurance. Because doctors are paid more to see patients with private insurance, patients on Medicaid face longer wait times and fewer options in physicians; a 2015 survey found only 68% of family practice physicians accepted new Medicaid patients, compared with 91% of those with private insurance. Additionally, factors such as clinic location, staffing, and funding within black communities can impact access to timely and quality care.
One major step the federal government can take is to provide health insurance when states do not. The disproportionate number of uninsured minorities means that from the start there is unequal access to healthcare (a problem only made worse by the increased unemployment taking away people’s company sponsored insurance). The 15 states that opted out of increasing Medicaid eligibility have 46% of the country’s Black working-age adult population, leaving them tremendously vulnerable. By federalizing Medicaid, the government can greatly reduce the racial health-insurance gap. Additionally, the government should increase the amount Medicaid pays doctors so that they are received equally by doctors compared to people on medicare or private insurance.
Although physicians have taken an oath to provide equal care to all, in practice, racial bias has a significant impact on how doctors assess their patients, whether intentional or not. This is particularly evident in pain analysis, which is entirely up to the physician’s discretion. Here, notions of Black patients being more able to tolerate pain are evident, with Black children experiencing acute appendicitis and being in severe pain being ⅕ as likely as white children to receive opioids. Problematic views on Black people are pervasive, impacting anything from cancer analysis to how pregnancy is handled. Properly diagnosing and treating conditions and complications, particularly in vulnerable populations such pregnant women, is extremely difficult if doctors do not believe their patients. As a result, Black babies are more than 230% more likely to die than white babies, with Black mothers also being 4 to 5 times more likely to die than white women. With inaccurate and improper handling of diagnosis and the underlying factors that put Black people at increased risk, it becomes clear to see how many gaping racial disparities, like those in infant and maternal mortality, are possible.
In order to reduce racial disparities, hospitals must acknowledge that a community’s health is influenced by certain social factors (for example the higher rates of asthma within Black communities). By addressing these social factors rather than just reacting to their negative health impacts, hospitals can reduce readmissions, ER visits, missed school days/work days, and save money in the long run. Additionally, hospitals need to have more diversity in their physician and nursing staff. An experiment showed that increasing the involvement of Black doctors could reduce the gap in mortality rate due to cardiovascular complications between Black and white men by 19%, yet only 5% of physicians are Black (Latinxs and Indigenous people are also underrepresented), a gap that can be largely explained by the economic and social barriers that impede minority students form pursuing a medical degree. Finally, the curriculum taught in medical schools must acknowledge the bias and historical racism in the medical system.
From text books that mostly use white skin tones to students who hold false beliefs about race-based physiological differences, there is clearly a gap that needs to be addressed in medical education. In light of the pandemic and calls to racial justice, many medical institutions have started to take steps towards establishing racial equity, but there is much more work to be done.