How can we fight medical racism?

A friend of mine recently shared her experience seeking medical attention for a broken ankle. The break was so bad that it required emergency surgery to fix, yet she spent much of the evaluation simply trying to convince the examiners that something was wrong and that she was in pain. It wasn’t until “a Black nurse intervened and pushed her coworker aside because she believed me” that my friend, who is also Black, received any sort of diagnosis.

Unfortunately, my friend is not alone in her experience. Although healthcare professionals take required oaths to treat all patients equally, it is becoming widely realized that “blacks and other minority groups in the U.S. experience more illness, worse outcomes, and premature death compared with whites.”

Structural racism in the United States assures that the lives of people of color are less healthy in a multitude of ways –

• Neighborhoods of color are less likely to be protected from pollution, causing Black and Hispanic populations to be disproportionately exposed to air and water pollution and their health impacts.

• African Americans are more likely to be uninsured or under-insured – the average cost for health care premiums is nearly 20 percent of the average household income for African Americans – making them less likely to have access to healthcare resources.

•  Black and Hispanic neighborhoods are more likely to have limited access to healthy food or face food insecurity.

• Black and Latino workers are more likely to work jobs that cannot be done remotely and less likely to be in living situations that allow for sick days or quarantine.

• Racial and ethnic minorities are more likely to suffer from toxic stress – prolonged activation of the body’s “fight-or-flight” response – due to perceived discrimination in day-to-day activities, long-term lower economic status, constant expectations to assimilate into the dominant white culture, and other race-related factors.

This same inherently racist system makes implicit bias incredibly difficult to address with  medical staff themselves, resulting in “disparate outcomes for different races despite the best efforts of individual health care professionals”. Studies have shown that nearly 50% of white medical students hold “false beliefs about biological differences between blacks and whites” – for example, that a black person’s skin is thicker than a white person’s skin – and that those who hold these beliefs both record lower pain levels and provide less accurate treatment for black patients.

Bias has been particularly notable in pregnancy-related care, where black women are more than three times more likely to die during childbirth than white women, and the infant mortality rate is 2.3 times higher for African American babies than white babies. These statistics change, however, when the doctor providing care is also Black. A recent study of 1.8 million hospital births showed that in the care of Black physicians, the mortality rate of Black newborns drops by 39-58 percent, while the mortality rate of white babies remains unchanged based on the doctor’s race.

And it’s not just medical personnel guilty of racial disparities in patient treatment. A recent study published in the New England Journal of Medicine illustrates that algorithms commonly used to help determine a patient’s treatment propagate outdated assessments of “race-based medicine [that] guide decisions in ways that may direct more attention or resources to white patients than to members of racial and ethnic minorities.” Another recent study shows that pulse oximeters (particularly important nowadays in monitoring blood oxygen levels for COVID-19 patients) overestimate oxygen levels for Black patients nearly 12% of the time, likely because the device is not designed to accommodate the different way in which its infrared light is absorbed by darker skin pigments.

In 2020, unsurprisingly, statistics for the COVID-19 pandemic also reflect racial and ethnic disparities. The COVID Racial Data Tracker, a collaboration between the COVID Tracking Project and the Boston University Center for Antiracist Research, aims to continually compile and publish race and ethnicity data on COVID-19 in the United States. Their analysis shows that, with the data currently available, Black people are dying from COVID-19 at twice the rate as white people, accounting for 19 percent of COVID-19 deaths where race is known. In July, the New York Times reported that Black and Latino workers are three times as likely to become infected with COVID-19 as their white neighbors, and nearly twice as likely to die if infected with the virus. In Delaware, the disparity is greatest among those of Hispanic or Latino ethnicity; while constituting only nine percent of the state’s population, they represent 21 percent of COVID-19 cases.

It’s important to note, however, that statistics like these can only be as accurate as the data available to analyze. While 51 of the 56 U.S. states and territories report race or ethnicity data for COVID-19 cases, much of this data is incomplete – many states report statistics for only about 65-90 percent of cases, with some states reporting as low as five percent (we’re looking at you, Texas). Delaware currently reports race and ethnicity data for about 94 percent of COVID cases, but does not require hospitals to report data on patient race or share this aggregate data publicly.

What can be done to address and rectify medical racism in our community? ChristianaCare, Delaware’s largest health care system, is currently piloting a platform called Unite Delaware that aims to provide more holistic care for historically marginalized communities. Understanding that societal factors such as housing, food security, safety, and literacy affect a person’s physical and mental health, this platform is designed to improve patient health by connecting people to community resources that can assist with relevant social stressors.

To support mental health of Black and brown communities, Delaware licensed professional therapist Crysta Harris has created Black Brown Delaware Therapists, a directory “to connect Black and Latinx Delaware residents to competent, culturally sensitive, licensed  mental health providers that look like them”. Research has shown that finding a therapist with a similar racial or ethnic background increases a person’s probability of staying in treatment and reaching treatment goals.
 
Delaware resources:

• Unite Delaware, sponsored by ChristianaCare: https://christianacare.org/services/communityhealth/unite-delaware

• Black Brown Delaware Therapists: https://www.blackbrowndelawaretherapists.com

• Come prepared, speak up, take notes: How to advocate for yourself at the doctor's office

 
Read more:

• The Century Foundation: Racism, Inequality, and Health Care for African Americans

• World Economic Forum: A brief history of racism in healthcare

• New England Journal of Medicine: Structural Racism and Supporting Black Lives — The Role of Health Professionals

• American Psychological Association: How does implicit bias by physicians affect patients' health care?

• USA Today: America's history of racism was a preexisting condition for COVID-19

• Delaware News Journal: Hear from Black women about what they've experienced while seeking health care

• Delaware News Journal: Finding a doctor who looks like you - Delaware health care providers take aim at disparities