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Racism, oppression and discrimination against black people underlie every institution in the United States, and they kill people. The health care system – by definition designed to promote well-being – is no exception, from the disproportionate impact of COVID-19 on the black community to police brutality.
The first lines: The impact of racism in health care is evident in statistics on the health of blacks in all areas:
- Black women are 22% more likely die from heart disease and 71% more likely to die from cervical cancer than white women
- Black people giving birth are 243% more likely die during pregnancy or childbirth and black infants are twice as likely die before the age of one compared to whites
- People of color experience higher rates of otherwise preventable or manageable conditions, including diabetes, stroke, heart disease and cancer – blacks are 77% more likely be diagnosed with diabetes than whites
Systemic anti-black #racism is an obvious public health crisis in many ways, including police violence, denial of health care, lower rates of disease screening and reduced access to mental health services. Our action statement should be NOW: https://t.co/bafE9OFErq #ONhealth #BlackLivesMatter pic.twitter.com/yVB1cMNMsQ
– Alliance for Healthier Communities (@AllianceON) June 3, 2020
Here are some examples of how racism in health care works:
1. Harmful stereotypes
Some common stereotypes have followed black people in making decisions about their health care. Powerful contributor Kelly Oglesby pointed out how the stereotype of the “strong black woman” has led to mistreatment of her migraines or damage when doctors assume that every health problem is weight related. Read more:
2. Exclusive research practices
Medical research and clinical trials are often conducted with predominantly white participants – less than 10% of people enrolled in clinical trials are people of color. As a result, treatments and diagnostic criteria do not take into account differences for people of different races or ethnicities.
Rochaun Meadows-Fernandez pointed out this can lead to misdiagnosis or even medication – like albuterol inhalers for asthma – to be less effective. The result is abuse or no treatment. Read more:
3. Lack of black practitioners
The health system, from surgeons and doctors to therapists and psychiatrists, lacks black practitioners.
This means that most people of color see a white practitioner, which can lead to ill-treatment due to lack of understanding or racist treatment. And in the case of mental health, having a therapist who is not black becomes an obstacle, as Mighty contributor A Porter wrote:
Yesterday I called my white therapist for an emergency call because I didn’t know how to manage my grief and my PTSD, but she can only say so much and I can only say the same. She will never understand my fate and cannot relate to racism.
4. Racism of practitioners
Arrested by hospital security at the entrance while a white classmate in front of me was let through, without I.D. 4/9
– Samuel Kebede, MD MPhil (@KebedeMD) June 3, 2020
Racism among predominantly white practitioners towards co-workers and patients is also rampant. It occurs during medical training, as Samuel Kebede, MD, described in a Twitter feed. And this happens in the doctor’s office by ignoring the concerns of patients or by not providing the same level of care to black patients.
- A study found that doctors with an implicit pro-white bias were less likely to prescribe pain relievers after surgery to black patients
- Liz Dwyer reported 2016 study found mental health therapists less likely to call potential clients if they appeared black or had a low income history
- A systematic review of studies of implicit biases among healthcare providers indicated 31 of 37 studies reviewed suggested evidence of bias towards black and brown people
5. “Treating” mental health in prison
Public health includes treatment through the education, housing and criminal justice systems.
-2.17 times more likely to be arrested and 5 times 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
Rather than receiving the care they need, black people with mental illness are criminalized – black people with severe mental illness are five times more likely be sent to jail as people with the privilege of skin color. Patrisse Cullors, co-founder of Black Lives Matter, shared in the documentary “Bedlam” that her brother Monte had been diagnosed with a mental illness in prison.
6. Toxic stress of racism
The hypertensive body that carries eight generations of white racist violence as hypertension is blamed for being hypertensive when this racist violence fulfills its eight generation old destiny when a knee crushes the trachea of the hypertensive body. A damn plague.
– Tressie McMillan Cottom (@tressiemcphd) May 29, 2020
Blacks must navigate daily in a white supremacist and racist society, ranging from micro-aggression to overt racist violence and discrimination, to tokenization and traumatic interactions in daily activities. Collectively, this trauma leads to toxic stress, which has a major negative impact on health.
7. Socioeconomic disparities
How to be healthy
Do yoga / buy my supplement / keep a gratitude journal / detox
Have the privilege of an education, a good income, a support network, absence of racism / sexism / any prejudice, accessible health care, political stability, winning the genetic lottery
– Dr Nikki Stamp FRACS (@drnikkistamp) May 31, 2020
Health is not limited to what goes on in a doctor’s office – it includes income, housing, food security, community support, access to health insuranceand other socio-economic factors. Blacks are more likely to struggle in all of these areas because of systemic racism, which Bonnie Castillo, executive director of National Nurses United, pointed out is already a risk factor in a for-profit healthcare system:
In a profit and ability to pay medical system, racial disparity translates into the ability to pay the high cost of premiums, deductibles and copays which disproportionately discourages African Americans from seeking medical care. required. This problem is exacerbated when business decisions about healthcare are based solely on reducing healthcare costs.
8. Biased health algorithms
The same racist biases manifested by practitioners have also been programmed into the systems that decide who should receive care. To 2019 study published in Science studied the algorithm used by health systems and insurers to determine which patients with chronic illnesses needed additional care. Here’s what the researchers found:
- The algorithm identified only 18% of black patients as needing more care compared to about 82% of whites, even if their disease levels were similar
- As a result, the algorithm failed to “account for a set of nearly 50,000 chronic conditions experienced by black patients”, according to STAT, who then did not receive adequate care
More useful reflection: Learn more about the impact of racism on health care in the black community with these articles:
Header image via Lordn / Getty Images
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