Healthcare discrimination is literally a life or death topic. It has been shown that discrimination in healthcare settings may occur due to race/ethnicity, immigrant status, language proficiency, and insurance status. Racial healthcare discrimination is when people of color receive less, and often worse, health care services than that of White people.
So what does this diminished care actually look like? Medical professionals may be more dismissive of the concerns of Black patients. Patients may receive fewer explanations of diagnoses and treatment options. Black patients are less likely to be prescribed drugs for pain management. During the opioid epidemic, doctors often opted not to prescribe opioids to Black patients because they wrongly believed they were more likely to become addicted to the drugs, would be more likely to sell the drugs, and had a higher pain threshold than White people because they were biologically different. This incidentally is why there wasn’t a higher Black death toll during the opioid epidemic; however, Black individuals in pain still suffered due to their doctor’s implicit biases and incorrect assumptions.
There is a historical basis for Black people’s distrust of the healthcare system. The Tuskegee Syphilis Study, one of the most infamous epidemiological studies that ultimately led to the implication of informed consent in research protocols, took place from 1932-1972. Over these 40 years, researchers wanted to study the natural course of syphilis in Black men; however, the patients were not given full disclosure about their rights as participants and the true nature of the study. When treatment for syphilis became available in 1947, researchers withheld the treatment from those in the study, leading to the unnecessary suffering of the individual participants. Fast forward to the 1990s, the Baltimore Lead Paint Study once again forged ahead with a lack of informed consent to study the effect of lead paint on children in low income, largely Black Baltimore neighborhoods. Due to the high amount of lead exposure, the children ended up with neurological disabilities, among other negative health effects. This demonstrated a lack of respect towards the Black community as they were still being taken advantage of well after Tuskegee, causing even more mistrust towards healthcare professionals and researchers. Finally, there was, and still is, the non-consensual or coerced sterilization of women of color. From the 1930s to the 1970s, ⅓ of Puerto Rican women of childbearing age were sterilized. In the 1960 and 70s, thousands of Native American women were sterilized without consent. Then, there is the forced and coerced sterilization of imprisoned women of color that was still happening in the 2010s. These are only three examples of when medical professionals have devalued the lives of Black people and POC. There are MANY more examples. Is it any wonder that people of color have a hard time trusting a system that has consistently told them that their lives and the lives of their children are worth less than those of White people?
Modern Black perspectives on healthcare reflect the historic and inherent racism in such systems. Studies indicate that Black people experience many microaggressions while being treated within healthcare institutions in the US. A study done involving focus groups from the Midwest indicated that Black patients perceive that physicians communicate with non-Black patients in a way that is less dismissive and more courteous. In addition, Black Americans perceive the language used in healthcare settings to be more disrespectful when targeted towards them. Black Americans were also shown to perceive healthcare professionals to always assume the worst when compared to their White-counterparts. This includes assumptions about being incompetent, using illegal drugs, being sexually promiscuous, not having health insurance, etc. While these are often not overtly racist remarks, subtle differences in treatment can negatively impact the way Black patients feel in these settings. These perspectives on top of the historical maltreatment of people of color contribute to a general mistrust of the healthcare system.
Healthcare discrimination has a larger impact on an individual’s physical well-being than mere disrespectful comments and microaggressions. Patients may choose to only seek help if it is “urgent” and may avoid seeking preventative care from health care providers as a result of deep-rooted mistrust. A lack of proper empathetic interpersonal care towards Black Americans has been shown to contribute to “lower levels of patient engagement and recommended treatment”, as stated by Ross and colleagues in a study done on racial discrimination in healthcare. This means that when patients DO come in, they may still not get the care that they need or follow the medical professional’s treatment plan because they don’t feel like the doctor or nurse actually cares. These actions can also cause patients to delay or even avoid treatment, and in some instances cause preventable or treatable diseases to become life-threatening.
The CDC’s 2015 report on Health in the US showed that Black people have lower life expectancy than White people. BIPOC have higher infant mortality, that is to say, infants that die before their first birthday, and higher rates of preterm births. Black and Latinx populations are more likely to have childhood obesity than White or API populations, which puts them at higher risk for developing diabetes and heart disease later in life. Black men and women are much more likely to have hypertension (high blood pressure) than White people or other POC. This leads to an increased risk of heart disease and other major health concerns.
In order for healthcare discrimination to improve, medical professionals need to recognize how their own implicit biases play a role in exacerbating healthcare disparities and understand that they are operating in an inherently racist system. In addition, we need more Black doctors and nurses, as a recent study found that “care for Black patients is better when they see Black doctors.” This change alone would increase the likelihood that Black patients perceive the care that they are getting to be more personal and respectful. Ethically, doctors must model respect and open-mindedness towards all groups of people. The medical world needs to redefine what normal is- we must stop looking at patients of color through a White-centric lens, which may mislead diagnoses and treatment. These points must be emphasized and added to the curriculum of medical education for all healthcare professionals.
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