Racial Disparities in Healthcare

Written by: Ashley Tibebe

Image Source: Michelle D'Urbano

The organized, nationwide United States healthcare system functioning today was initially created to cover military personnel in the event of injury or death (Griffin et al., 2020). Since its founding, the United States healthcare system has evolved to include elderly, disabled, unemployed, and low-income individuals. However, many early healthcare programs often excluded large demographics of American minorities, including African Americans, Native Americans, and Hispanics (Blake, 2022). Because of these historical racial disparities and biases interwoven into the systems and structures of the modern healthcare system, racial discrimination within the healthcare system is still persistent today. Currently, racial minorities face harmful, false racial myths and stereotypes, including a widespread belief among medical professionals that African Americans have fewer pain receptors and thus do not feel pain at the same rate as their white counterparts, which results in diminished medical care (Foden-Vencil, 2019). Within this system, minorities are often disregarded and mistreated based on socioeconomic factors, such as their health insurance status and English-speaking proficiency. In addition, previous government legislation regarding the segregation of poor African American neighborhoods put medical services out of reach for minority communities today (Essien, 2020). Although the United States healthcare system has improved in racial inclusivity over decades, racial minorities continuously experience racial disparities in the healthcare system due to racial myths and stereotypes, socioeconomic factors, and historical legislation.

Dating back to slavery, racial myths and stereotypes formed in early American history significantly shaped the attitudes of many toward African Americans at the time and are still

apparent in the healthcare system today (Foden-Vencil, 2019). While some racial myths and stereotypes are based on false, race-based differences in physiology, others are rooted in preconceived notions regarding minority cultures. To demonstrate the existence of racial myths in medical care, a survey conducted at the University of Virginia asked medical students “whether they thought African Americans have fewer pain receptors than whites,” and an overwhelming majority of students said, “Yes, that’s true” (Foden-Vencil, 2019). In the same survey, medical professionals revealed that they believe the blood of African Americans clots faster (Foden-Vencil, 2019). In addition to exposing the lack of race education provided for medical professionals, this study illustrates the detrimental effects myths, without any supporting science, can have on minority patients. The widespread belief among medical professionals that African Americans have a higher pain tolerance results in undue pain and suffering and inferior medical care for African Americans. Furthermore, in a study conducted by Westat, Inc., where participants discussed their personal experiences with racism in healthcare, a Hispanic participant recalled an instance where they stated their common Hispanic surname to a medical professional over the phone and were met with “a lack of respect” and felt that the doctor treated them without any professional courtesy because the doctor assumed the patient was “another dumb Mexican” (Grady and Edgar, 2003). These experiences of disrespect and stereotyping affect the quality of medical care, causing discomfort and a negative emotional impact on minority patients.

Similarly, in many cases, the quality of medical care received by minorities is affected by their socioeconomic status. For example, researchers at the University of California, Berkeley, discovered a hospital algorithm from Optum UnitedHealth Group Inc prioritized healthier white patients and allowed them to receive treatment over sicker Black patients with one more chronic illness and poorer vital and laboratory results (Evans, 2019). The reason behind the algorithm's racial bias is its use of cost to rank patients' need for medical attention, which disproportionately affects minority patients who historically spend less money on healthcare than white patients (Evans, 2019). With the growing use of technology in healthcare, similar algorithms cause economically disadvantaged minorities to experience medical neglect, which results in worsened conditions from untreated ailments or wrongful death. Moreover, the English-speaking proficiency of minority patients often dictates the attitudes and treatment they receive from medical professionals. For instance, non-English speaking participants in a series of interviews conducted by Westat, Inc. explained how they regularly encountered healthcare staff who “ignored” and “avoided trying to help them” as well as treated them disrespectfully because they spoke little to no English (Grady and Edgar, 2003). Healthcare organizations and professionals being unaccommodating to language barriers can result in inadequate or unsatisfactory medical care services and misunderstood health information received by minority patients, which can have fatal consequences.

Lastly, historical legislation that dictated where minorities resided in the past affects their access to medical care today. During segregation, the United States practiced a federal law known as redlining, which forced African Americans to live in poor, segregated neighborhoods with low-quality businesses (Essien, 2020). Due to this discriminatory practice that contributed to structural racism, many minority communities have limited availability of essential medical resources and poor hospital quality. This barrier to healthcare access can lead to a disproportionate rate of poor health outcomes, such as preventable death due to delayed care. Additionally, a recent study in the Annals of Surgery journal discovered that formerly ‘redlined’ communities, or groups who were victims of a discriminatory practice in which services, like purchasing a home, were withheld from them because their communities were deemed “hazardous” to investors, corresponded with a higher rate of postoperative mortality and complications (Garber, 2021). This finding exemplifies the dangerous legacy of previous United States legislation on health outcomes for disadvantaged minority communities, including causing undue deaths and medical complications.

On the other hand, some would argue that African Americans and their deep distrust of the United States healthcare system is the reason for racial health disparities (Foden-Vencil, 2019). In a segment with National Public Radio, Hortensia Gooding, an African American resident of Harlem, New York, explained there is "a lot of deep, deep-seated fear and concern that…the medical community really will harm people of African descent on purpose" (Stein, 2017). While the existence of this fear is accurate, as research has found that African Americans are more likely to be wary of the medical community, it is unreasonable to assume African Americans and their suspicions of the healthcare system are responsible for the diminished care and disparities they experience (Foden-Vencil, 2019). Firstly, this thinking is shortsighted because it fails to consider the historical view of health disparities and how the fear in African American communities developed, which was through continuous experiences of racism due to a combination of the previously mentioned factors, including racial myths and stereotypes and their socioeconomic status (Stein, 2017). This constant cycle of disrespect unsurprisingly leads to less confidence in the healthcare system. Additionally, this belief suggests that African Americans are to blame for the health inequities they endure, which hinders progress in combating these disparities. Thus, the distrust of the healthcare system present in African American communities is not a cause of racial health disparities; instead, it is a direct effect.

In conclusion, the United States healthcare system has come a long way since segregation, yet it still fails to achieve medical care equality for racial minorities. Through the prevalence of racial myths and stereotypes, which cause undue pain and discomfort for minorities; discrimination based on socioeconomic factors, which results in racial profiling and inadequate medical care; and racist historical legislation that caused minority communities to become underfunded in medical fields, minorities are severely disadvantaged compared to their white counterparts. Therefore, the United States government has the responsibility to acknowledge these disparities and actively strive to reduce them, thus, making medical care more enjoyable and accessible to all its citizens.

References:

Blake, Asha. "The Journey of the Underrepresented: The History of Exclusion in the Health Care Field." Northeast Ohio Medical University, 22 Aug. 2022, www.neomed.edu/news/the-journey-of-the-underrepresented-the-history-of-exclusion-in-the-health-care-field/. Accessed 18 Mar. 2023.

Essien UR, Venkataramani A. Data and Policy Solutions to Address Racial and Ethnic Disparities in the COVID-19 Pandemic. JAMA Health Forum. 2020;1(4):e200535. doi:10.1001/jamahealthforum.2020.0535

Evans, Melanie. "Researchers Find Racial Bias in Hospital Algorithm." Wall Street Journal Online, 24 Oct. 2019. SIRS Issues Researcher, explore.proquest.com/sirsissuesresearcher/document/2308698231?accountid=11329.

Foden-vencil, Kristian. "Emergency Medical Responders Confront Racial Bias." Kaiser Health News, 11 Jan. 2019. SIRS Issues Researcher, explore.proquest.com/sirsissuesresearcher/document/2265934530?accountid=11329.

Garber, Judith. "Racist Redlining Policies Still Have an Impact on Health." Lown Institute, 6 Sept. 2021, lowninstitute.org/racist-redlining-policies-still-have-an-impact-on-health/. Accessed 19 Mar. 2023.

Grady, Meredith and Edgar, Tim/ Institute of Medicine (US) Committee on Understanding and Eliminating Racial and Ethnic Disparities in Health Care; Smedley BD, Stith AY, Nelson AR, editors. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. Washington (DC): National Academies Press (US); 2003. Appendix D, Racial Disparities in Health Care: Highlights From Focus Group Findings. Available from: https://www.ncbi.nlm.nih.gov/books/NBK220347/

Griffin, Jeff, et al. "The History of Medicine and Organized Healthcare in America." JP Griffin Group, HUB International, 27 Mar. 2020, www.griffinbenefits.com/blog/history-of-healthcare. Accessed 13 Mar. 2023.

Stein, Rob. "Troubling History in Medical Research Still Fresh for Black Americans." National Public Radio, 25 Oct. 2017, www.npr.org/sections/health-shots/2017/10/25/556673640/scientists-work-to-overcome-l egacy-of-tuskegee-study-henrietta-lacks. Accessed 20 Mar. 2023.

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