How can we recognize and prevent racial discrimination in healthcare?

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INTRODUCTION

OVERVIEW

Medical care in America has evolved significantly since the early 1900s. However, one significant aspect still lingers from Jim Crow America: minority patients consistently receive substandard care in comparison to white patients as a result of racial bias and systemic racism. When a patient first enters a healthcare setting, the color of their skin may drastically alter how medical workers will handle their case. A doctor may assume information, such as past illnesses, drug use, financial status, or trustworthiness based on the race of the patient. These assumptions are very common in a setting that requires decisive action, but decisions based on stereotypes and biases can and have put many lives in danger. An analysis of data from 2006 to 2010 discovered that “nonwhite patients presenting with abdominal pain were 22% to 30% less likely to receive analgesic medication and 17% to 30% less likely to receive narcotic analgesics compared to white patients” (Dehon, Erin, et al.). The study also found that people of color had, on average, longer wait times and lower admission rates (Dehon, Erin, et al.). This clear disparity between treatments is a display of the effects of stereotypes held by medical providers. Racist beliefs concerning pain tolerance, trustworthiness, and other medical factors can prevent people of color from receiving necessary care, and puts them at a greater risk.

HISTORY

In the 1896 supreme court case Plessy v. Ferguson, it was decided by the court that segregation was not a violation of the 14th amendment, establishing the precedent of “separate but equal” in Jim Crow America (“Plessy v. Ferguson.”). This ruling made it clear to lawmakers that segregation would be an acceptable practice to implement in public areas, and opened the door to inequality on a grand scale. Laws were introduced across the country that prevented African Americans from receiving the same treatment as white people. These measures set the foundation for a healthcare system rooted in racial discrimination.

COVID-19

The coronavirus pandemic has brought many alarming statistics surrounding infection and mortality rates by race to light, especially for Black Americans. Across the country, COVID-19 hospitalization and mortality rates for Black Americans are alarmingly high. A Washington Post analysis found that majority-black counties had infection rates three times the rate of majority-white counties, and a CDC analysis of hospitalization data revealed that a third of COVID-19 patients were black people, who only make up 18% of the population surveyed (Thebault, Reis, et al.). In Oakland, the death rate for black patients with the coronavirus has consistently been around twice as high as the death rate for white patients (Schaaf et al.).

However, the response to the inequalities has, in general, not been one of calls for change and equality. Instead, racist rhetoric has consumed many of the discussions around this topic. Many share the belief that the blame for high rates of infection in black patients lies within the black community, rather than flaws within our healthcare system.

“When it comes to black people, whenever Americans see a black individual acting in a self-destructive manner, they see black people acting in a self-destructive manner. Whenever Americans see a black individual not social distancing, they see black people not social distancing … Black individuals are all, always, stand-ins for their race, never individuals”

Ibram X. Kendi, director of the Boston University Center for Antiracist Research

FOR NOW

To begin reversing the effects of racial bias in the US healthcare system, changes need to be made, both in the way that medical professionals treat minority patients, as well as how we, as a society, recognize and treat racial bias.

Individual level – it is important to be aware of the racial biases and stereotypes that affect the daily lives of people of color, especially in ways that might not seem harmful or targeted. When unconfronted, stereotypes and racist beliefs evolve to create situations like the ones described earlier, where biases held by medical providers put lives at risk. Everyone, especially those belonging to majority groups, has a responsibility to call out discriminatory behaviors to prevent future harm. In addition to this, those who have power in today’s society, whose voices hold the most weight, need to be a voice for those who have been harmed by discriminatory practices in healthcare or similar settings.

Larger scale – many changes could be made to the healthcare system to prevent future instances of discrimination. To fully document past incidents where patients were discriminated against, hospitals could implement a system for reporting them. Additionally, there needs to be more legislation concerning medical discrimination in order for physicians who endanger minority patients to be held accountable. However, to prevent these incidents, there also needs to be further education for medical providers on treating people of color. This could range from anti-bias training to communicating across cultural and language barriers.

WHAT CAN I DO?

Other than the individual-level changes I suggested earlier, I’d like to ask those who read this page to answer a few questions in the comments:

  • Have you or anyone you know ever encountered instances of discrimination in a medical setting?
  • What are any ideas you have for preventing racial discrimination in the US healthcare system on a micro or macro level?

I would also appreciate any feedback you have for me in the comments. Thank you for reading!

 

Click here for this page’s bibliography: https://docs.google.com/document/d/1ee0PF0eZ4pRgBlmDNTMYSCle06yqN3X8f-3AzyRb4Lw/edit

 

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