Pause and pondr
RACIAL DISPARITIES PERSIST IN HEALTH CARE
Seven out of ten Black Americans say they’re treated unfairly by the health care system and over half say they distrust it.
DID YOU KNOW?
African Americans are two times more likely to die of Covid-19 than people who identify as white, non-Hispanic and are almost three times more likely to be hospitalized.
WHAT YOU’LL LEARN
Deconstruct both statistics and the personal stories of healthcare inequities
Identify how unconscious bias may impact medical diagnoses
Recognize how racism has a direct impact on health and well-being
How has Covid-19 magnified the health equity gap for Black Americans?
Health disparities among racial and ethnic groups are nothing new. But the Covid-19 pandemic magnified their impact on African Americans. Black Americans were dying from Covid-19 at nearly twice the rate of whites, according to the Centers for Disease Control and Prevention.
Diabetes, heart disease and other pre-existing conditions put Black Americans more at risk. Sickle cell disease, HIV and obesity — all conditions more common among Black Americans — put an additional burden on vulnerable immune systems.
Some factors of health inequities in America, such as poverty, food insecurities and limited access to affordable housing, transportation and healthcare contribute to health disparities, says Jamila Taylor, Director of Healthcare Reform and Senior Fellow at The Century Foundation. But the root cause is systemic: “In the end, it all comes back to one thing: racism,” she says.
Why has there been a surge in CDO hires?
How have historical racial injustices bred mistrust?
The American healthcare system has a long history of mistreating Black Americans whose bodies were repeatedly used without consent to advance medicine. One of the most notorious examples was the Tuskegee syphilis experiment in which the U.S. Public Health Service together with the Tuskegee Institute used Black men to study and track the progression of untreated syphilis without patients’ consent.
Enslaved Black women’s bodies were used in invasive gynecological surgeries without anesthesia to advance scientific study — for white women, Taylor says.
There are plenty of historical wrongs linked to health disparities, but we don’t have to go back too far to find them, said Tiffany Green, assistant professor of population health science at the University of Wisconsin–Madison.
In an October 2020 poll by ESPN’s The Undefeated and the Kaiser Family Foundation, 7 out of 10 Black Americans say they’re treated unfairly by the healthcare system and over half say they distrust it.
Racism itself causes physical changes that make people sick, leading to a higher rate of hypertension, cardiovascular disease and cancer among Black Americans, says Dr. Samuel Cykert, professor of medicine at the University of North Carolina School of Medicine in Chapel Hill.
“Blacks have the highest risk for lung cancer and yet they are the least screened,” says Cykert. A lack of insurance plays a big part. In addition, clinics, hospitals and pharmacies are not located in neighborhoods where they are easily accessible.
What can be done to improve health care?
The medical workforce needs to be diversified. Just 5% of physicians in the U.S. identify as Black, according to the Association of Medical Colleges.
“We do need more Black healthcare providers,” Taylor says. “But we also need to train all doctors on how to offer care in ways that are compassionate and value all people.”
Experts say that educating medical professionals and would-be doctors on their unconscious bias and the history of medical abuse and exploitation could help, and some medical schools are responding to this need. Medical Apartheid, a 2007 book about the history of medical experimentation on African Americans is required reading for incoming students at the University of North Carolina School of Medicine.
More representation in leadership positions is also needed. Studies suggest diversity in healthcare leadership can enhance quality of care, community relationships, and quality of life in the workplace, according to the American College of Healthcare Executives. Yet in 2019, 89% of all hospital CEOs were white.
“We need to have folks who are directly impacted by health disparities more involved,” Taylor says.
Pondr This
What have your experiences been like going to the doctor throughout your life?
Have you ever had an experience with a medical professional that has been compassionate and understanding?
How about an experience with a medical professional that has been challenging? What assumptions did they make about you?
In your opinion, what are some ways that the healthcare field can be improved to be more inclusive?
FOR LEADERS
How do you think health disparities affect life for the people around you?
What health care struggles have you yourself or your family experienced?
What has health care made possible for you? And how has the health care system fallen short for you?
Explore The Stories
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Racial disparities plague healthcare in the United States
When giving birth becomes a matter of life and death
Topic in Review
Racial and ethnic health disparities in the U.S affect Black Americans, in particular, who have high rates of diabetes, heart disease and hypertension. In this Pause and Pondr, we looked at how factors such as poverty, food insecurities and limited access to affordable housing, transportation and health care all play a role — and that historical and present-day racism and discrimination are at the root of these inequities.
A recent analysis of health care spending, published in JAMA, found that non-Hispanic white Americans received up to 72% of the $2.4 trillion spent on ambulatory, inpatient and emergency care, nursing facilities, prescribed pharmaceuticals, and dental care. That’s opposed to what other racial and ethnic groups received: African Americans, 11%; Hispanics, 11%; Asian, Native Hawaiian and Pacific Islanders, 3%; and American Indians and Native Alaskans, 1%.
The researchers noted that some of the differences were due to factors such as “how physicians respond to patients … bias that exists in the algorithms that assess health needs and determine appropriate interventions … and … residential segregation that precludes easy access to health care services."
The study had found that African Americans accounted for 26% less spending on outpatient care per person than average, but 12% more spending on emergency department — suggesting that Black Americans have less access to routine, preventative care, and as the authors pointed out, “reinforces previous research showing unequal access to primary care.” Comparatively, non-Hispanic white Americans made up 15% more spending per person for outpatient care.
Experts say that addressing existing health disparities is gaining more attention in recent years. In an interview with U.S. News, Alisahah Jackson, system vice president of population health innovation and policy at CommonSpirit Health, said that though health disparities have “been around forever,” there’s been a more intentional interest by health systems to address them. More hospitals are creating positions geared toward health equity.
A recent book titled “Unequal Cities: Structural Racism and the Death Gap in America’s Largest Cities” is a collection of essays that examines life expectancy, mortality and Black-white inequities for the biggest 30 cities in the country. According to the co-editor Fernando De Maio, “There's anger about the data, the inequality, the injustice, but there's also hope that it can stimulate action and recognition that things could be different. “We tend to think of health inequities as big, monolithic, deeply entrenched problems, but they vary from place to place and vary over time.”
And that the data that’s been uncovered can also show that the inequities are not inevitable.