Racial Disparities in Health and Healthcare
According to the Medical News Today newsletter of October 2020, racial
discrimination permeates the healthcare systems of many countries, including the
United States. The COVID-19 pandemic draws attention to this. A May 2020 study
estimated that in the U.S., Black people were 3.57 times more likely to die from
COVID-19 than white people. In 2015, the U.S. Department of Health and Human
Services found numerous examples of health inequity for Black, Indigenous, and
People of Color, including lower life expectancy, higher blood pressure, and lower
rates of flu vaccination.
Some of these conditions are the result of racial inequality that exists
outside of the healthcare system, such as economic disparities that make it more
difficult for some to get health insurance, which prevents people from getting
healthcare. However, racism also exists within healthcare itself and can lead
doctors to neglect, disbelieve, or actively discriminate against patients.
These articles and whitepapers provide more detailed information on
health inequities, and suggest changes to medical education, healthcare systems,
and society as a whole that would make it possible to move toward equitable
access and treatment for people of color.
Stories about the consequences of inadequate treatment:
A Black doctor died of Covid-19 weeks after accusing hospital staff of racist treatment
https://www.cnn.com/2020/12/24/us/black-doctor-susan-moore-covid-19/index.html
‘All you want is to be believed’: the impacts of unconscious bias in health care
https://piedmontexedra.com/2020/10/all-you-want-is-to-be-believed-the-impacts-of-unconscious-biasin-health-care
Details of Racism in healthcare:
Some definitions
- Social determinants of health: Defined by the World Health Organization (WHO) as “the circumstances in which people are born, grow up, live, work and age, and the systems put in place to deal with These circumstances are in turn shaped by a wider set of forces: economics, social policies, and politics.”13
- Health equity: To define health equity, we turn to the work of Professor Margaret Whitehead, head of the WHO Collaborating Centre for Policy Research on the Social Determinants of Health. Most countries use the term “inequalities” to refer to socioeconomic differences in health — that is, health differences “which are unnecessary and avoidable but, in addition, are also considered unfair and unjust.” Whitehead goes on to state that, when there is equity in health, “ideally everyone should have a fair opportunity to attain their full health potential and, more pragmatically, no one should be disadvantaged from achieving this potential, if it can be avoided.”14 This is the definition IHI uses to guide our work on improving health
- Health disparity and health inequity: Health disparity is defined as the difference in health outcomes between groups within a population. While the terms may seem interchangeable, “health disparity” is different from “health inequity.” “Health disparity” denotes differences, whether unjust or not. “Health inequity,” on the other hand, denotes differences in health outcomes that are systematic, avoidable, and
- Health care disparity: Defined by the Institute of Medicine as “racial or ethnic differences in the quality of health care that are not due to access-related factors or clinical needs, preferences, and appropriateness of ”15 This white paper focuses on disparities in health outcomes rather than the provision of health care; however, the equitable provision of health care is essential to reducing disparities in health outcomes.
MEDICAL NEW TODAY -Racism in healthcare: What you need to know
https://www.medicalnewstoday.com/newsletter
Racial discrimination permeates the healthcare systems of many countries, including the United States. This has negative consequences for both patients and healthcare workers, leading to higher risks of illness and, in some cases, lower standards of care for people of color (POC).
The COVID-19 pandemic draws attention to this. A May 2020 study estimates that in the U. S., Black people were 3.57 times more likely to die from COVID-19 than white people. Similarly, the risk of death within the Latinx population was nearly twice that of the white population.
Data from other countries reveal the same problem. A 2020 report from Public Health England found that in England, COVID-19 death rates were higher among Black and Asian people than white people.
The report also found that healthcare workers from marginalized groups felt unable to voice their concerns about the lack of personal protective equipment and COVID-19 testing in the pandemic’s early stages.
This article explores how racism affects various aspects of U.S. healthcare, including pregnancy, emergency treatment, mental health treatment, and more.
How racism impacts health
Racism has a profound impact on mental and physical health, and can make it more difficult for people to access healthcare services.
In 2015, the U. S. Department of Health and Human Services (HHS) found numerous examples of health inequity for POC in the U.S., including:
- Lower life expectancy: In 2014, Black males and females had lower average life expectancies than white males and females.
- Higher blood pressure: Between 2013 and 2014, 42.4% of Black males had high blood pressure, compared to 30.2% in white males. During the same period, 44% of Black females also had this condition compared to 28% in white females.
- Lower rates of influenza (flu) vaccination: Flu vaccines can save lives. However, in 2014, only 60% of Black and Latinx people aged 65 or over got a vaccination, compared to 70% of white and Asian people of the same age.
- Strain on mental health: A 2015 review found that racism was strongly associated with mental health difficulties, contributing to stress, anxiety, and depression. This was especially true for Asian American and Latinx groups.
Some of these findings are influenced by racial inequality that exists outside of the healthcare system. For example, economic disparities between racial groups make it more difficult for some to get health insurance, preventing people from getting medical care.
In 2014, around 20% of Black adults could not access health insurance compared to 10% in white and Asian adults. For Latinx adults, this figure was 35%. A 2012 study also found that predominantly Black zip codes were 67% more likely to have a shortage of primary care physicians (PCPs).
However, racism also exists within healthcare itself and can lead doctors to neglect, disbelieve, or actively discriminate against patients. The following sections look at specific ways of how this manifests.
Health inequities affect all of us differently..
Pain treatment
A 2016 study found many white medical students wrongly believe Black people have a higher pain tolerance than white people. Of all the participants, 73% held at least one false belief about the biological differences between races.
Examples of these beliefs include Black people having thicker skin, less sensitive nerve endings, or stronger immune systems. The researchers note these beliefs are centuries old, and that some 19th-century doctors used them to justify the inhumane treatment of slaves.
These myths still have an impact today. In a previous study, Black children with appendicitis were less likely to receive appropriate pain medication than white children. The same was true in research on people with recurring cancer.
Emergency care
In addition to the limited access to trauma centers that people in predominantly Black areas have, evidence suggests racial bias may prevent POC from receiving emergency care.
For example, according to Frontiers in Pediatrics, doctors in emergency departments (EDs) are less likely to:
- Classify Black and Latinx children as requiring emergency care compared to White or Asian children
- Admit Black or Latinx children to the hospital after visiting the ED
- Order blood tests, CT scans, or X-rays for Black, Latinx, or Asian children compared to White children
This study did not look at the cause of these differences. However, the researchers say they cannot be explained by social, economic, or clinical factors that would change how doctors treat POC in emergencies.
Differences in emergency care also apply to adults. A 2020 study shows that between 2005 and 2016, medical professionals were 10% less likely to admit Black patients to the hospital than white patients. It also suggests Black people were 1.26 times more likely to die in the ED or hospital.
Pregnancy
Racial disparities also affect the medical care of pregnant people and newborn babies.
The term “infant mortality” refers to the proportion of babies who die below the age of one compared to those that live. Organizations often use infant mortality to measure the success of postnatal healthcare.
Between 1999–2013, infant mortality tended to decrease in the U.S. However, there were still disparities between racial groups. The following 2013 data comes from the HHS:
|
Group |
Infant mortality |
|
Black |
11 in 1,000 |
|
Indigenous |
8 in 1,000 |
|
White and Latinx |
5 in 1,000 |
|
Asian or Pacific Islander |
4 in 1,000 |
Black people also face higher risks during pregnancy. According to a 2019 study, they are 3–4 times more likely to die from pregnancy-related causes than white people in the U.S.
Chronic illness
Chronic illnesses are long-term health conditions that can severely impact someone’s quality of life. Sometimes, they can cause disability and require ongoing medical care.
A 2019 study found that Black people aged 51–55 were 28% more likely to already have a chronic illness compared to white people of the same age. The study also found that Latinx people of the same age accumulated chronic diseases faster than white people.
The researchers note numerous factors may affect this, such as chronic stress, chronic inflammation, lower rates of insurance coverage, and less access to quality healthcare or PCPs.
Mental health
According to Mental Health America (MHA), mental illness rates are roughly equivalent between some marginalized groups and white people. However, there are some significant areas of difference, such as:
Disability
Overall, Black people experience a disproportionate amount of disability from mental health conditions compared to white people. Depression in Black and Latinx people is also more likely to be persistent.
Schizophrenia
Black males are four times more likely to receive a schizophrenia diagnosis than white males. MHA suggests this is because clinicians can overlook the symptoms of depression and focus more on psychotic symptoms when treating Black people.
Addiction
Native and Indigenous Americans have the highest alcohol dependence rates out of any marginalized group. Conversely, Asian Americans may be under-diagnosed.
A 2016 study suggests doctors are less likely to diagnose alcohol addiction in Asian Americans compared to white people, despite having the same symptoms.
This may occur due to the “model minority” stereotype, which frames Asian Americans as successful and self-reliant. The implicit bias this creates may lead doctors to overlook signs that Asian American patients require help.
Summary
Many studies reveal racial disparities in how marginalized groups access and receive healthcare in the U.S. Sometimes, these disparities are related to socioeconomic inequality.
However, biases and stereotypes also have a serious impact on how doctors treat POC. This can lead to over- or under-diagnosis of certain conditions, a lack of proper pain management, and increased health risks, even when economic status is not a factor.
Toward the Science and Practice of Anti-Racism: Launching a National Campaign Against Racism:
Strategies to Address Health Disparities Among Black/African American Women in Connecticut
Perspective: strategies for achieving health equity: concern about the Whole Plus concern about the hole
file:///C:/Users/George/AppData/Local/Temp/Strategies_for_Achieving_Health_Equity_Concern_abo.pdf
Just in TIME: Trauma-Informed Medical Education
https://pubmed.ncbi.nlm.nih.gov/33006111/
Video Resources:
TEDTalks: David R. Williams, "How Racism Makes Us Sick"
https://www.youtube.com/watch?v=VzyjDR_AWzE
The Problem with Race Based Medicine, Dorothy Roberts
https://www.youtube.com/watch?v=KxLMjn4WPBY
Achieving Health Equity: Tools for a National Campaign Against Racism: Camara Jones: