What is Medical Racism?

Racial discrimination has saturated healthcare systems around the world. Disparities in care have led to negative consequences for people of color and other marginalized groups.  Some of these consequences include gaps or lack of access to health insurance, limited access to services and high-quality physicians, and poorer health outcomes among certain populations.  

Over the last year, disparities in the United States healthcare system have come to the fold due to the COVID-19 pandemic. The Center of Disease Control reports that racial and ethnic minority groups are and have been unequally affected by economic, social, and secondary health consequences of the pandemic. 

Of the case data collected, African Americans have the highest percentage (13.8%) of a positive test result. Data also shows that non-Hispanic American Indians or Alaska Natives have the highest rate of hospitalization due to the disease, while 34% of deaths were among African Americans.  

While these numbers are just a glimpse into public health data, it shines a light on racial health disparities, policies, and practices that have been an integral part of medical history. 

What is Medical Racism? 

Medical racism is defined as the systemic, widespread prejudice or discrimination against people of color, ethnicity, or culture within the health care system. It allocates certain resources in a way that unfairly disadvantages some, while without reason, rewards another.   

As a systemic issue, racism permits the establishment of certain patterns, procedures, practices, and policies within medical organizations that consistently penalizes and exploits people due to their race, color, culture, or ethnic origin.  

In health care, this is usually carried out by means of:  

  • Gaps in health insurance 
  • Lack of access to health insurance 
  • Limited access to qualified medical professionals 
  • Poorer treatment from medical professionals (gaslighting, restricted testing etc.) 

These differences often result in poorer health outcomes. Data shows that racial and ethnic minority groups across the United States experience higher rates of illness and death among a wide range of health conditions compared to their white counterparts. In addition, life expectancy of non-Hispanic Black Americans is four years lower than White Americans.  

History of Medical Racism 

Medical racism stretches back centuries, all the way to the 1700s, that created a system of belief and practice that people of color have inferior bodies compared to whites. This idea allowed doctors to place blame on people based on their race or ethnicity for having poorer health outcomes than White people.  

The first signs of medical racism emerged in 1793, during the yellow fever outbreak in Philadelphia. Benjamin Rush, a respected physician and signer of the Declaration of Independence, was convinced that Black people were immune to yellow fever. He requested members of the African Society to care for the sick, predominately white population. Two brave, free Black men, Absalom Jones and Richard Allen, volunteered to care for the sick and dying, accompanied by hundreds of other African Americans. Weeks later, Rush was proven wrong and Black people began to die from yellow fever at an even faster rate than whites.  The epidemic killed 5,000 Philadelphians, 10% of those were Blacks even though they only made up 6% of the city’s population.  

Black racism continued into the 1800s. Samuel Cartwright’s spirometer, a medical instrument used to assess lung capacity, found that Black people had a lower lung capacity compared to White people. Like many other physicians, Cartwright believed that this provided evidence that people of color were biologically inferior. What he failed to consider, was that living quarters where many Black people lived during this era had little to no ventilation or insulation from the weather. These conditions put people at higher risk for respiratory conditions and deficiencies.  

In the 19th century, Dr. J. Marion Sims, controversially known as the “father of American gynecology”, used enslaved women of African descent for his surgical experiments. Dr. Sims was a brilliant doctor who invented the speculum and pioneered surgery for vesicovaginal fistulas and gall bladder removal. However, he did so by experimenting on enslaved BIPOC women without anesthesia. Some women received as many as 30 surgeries or procedures over the course of 4 years.  Not only was it unethical to perform medical surgeries without anesthesia, which he later did use when performing the same surgeries on white women, but slaves by definition cannot give voluntary informed consent for surgery. Dr. Sims performed these surgeries under the notion that Black women have a higher pain tolerance than Whites.  

This was just one of several experiments and studies performed on BIPOC women.  

Men too were subject to medical inequality. From 1932 to 1972 the Public Health Service began a study to record the history of syphilis. They tracked roughly 600 low-income African American men, 399 of them had syphilis and 201 did not. Researchers told the men they were being treated for “bad blood”, a local term used to describe several medical conditions like syphilis, anemia, and fatigue. However, researchers didn’t obtain informed consent, nor did they provide the participants with proper treatment.  As a result, many of the men passed the disease onto others and died from the Illness. An advisory panel was appointed to review the study, which was deemed unethical. In 1973, a class-action lawsuit was filed on behalf of the participants and their families, resulting in a $10 million, out-of-court settlement.   

Implicit Bias In Medical Racism 

All doctors in western medicine take the Hippocratic Oath, or an oath of some kind, where they pledge to “do no harm” and put the well-being of a patient first, regardless of age, sex, gender, race, ethnicity, or cultural background. Yet not all patients are treated equally.  Some would even argue that many doctors are betraying their oath, by neglecting the actual needs of the patient. 

 A recent study by John’s Hopkins University found that more than 250,000 people in the United States die every year from medical error and negligence. While it’s unclear how many of those deaths were of people of color, the study also found that 20-30% of minorities were misdiagnosed, which can contribute to prolonged illness and death.   

While some signs of medical racism are obvious, like having symptoms dismissed, less time with a doctor, or no access to one, there are other signs of racism in health care that aren’t so apparent: implicit bias. Implicit bias is described as negative unconscious or automatic feelings and beliefs about others that can differ from their conscious attitudes. For example, a person may claim they aren’t prejudiced but given subtle signs that they are.  

 A report from an Institute of Medicine (IoM) panel made up of several different health care professionals, concluded that even when access-to-care barriers, like insurance and income, were controlled for, racial and ethnic minorities still received worse health care than nonminorities. This indicates that both explicit and implicit bias played a role in the level of care they received.  

Some signs of physician implicit bias are: 

  • Language: Studies found that physicians with higher implicit bias commandeered a greater portion of the patient-physician conversation during the patient’s appointment. They are also more likely to dominate conversations with Black patients compared to White patients. Words doctors use are equally as important. Researchers found that physicians with a higher implicit bias are more likely to use first-person plural pronouns, like “we”, “ours” and “us”, when interacting with Black patients. The use of this language contributes to the power dynamic of maintaining control over the person of lesser power.  
  • Behavior: About 55% of communication relies on facial cues and body language. Studies found that people of color receive less compassionate nonverbal cues from physicians with high implicit bias compared to their white counterparts. This means that when physicians are with patients of color, they may smile less, avoid eye contact, limit hand gestures, or may even look bored. As a result, patients trust their doctors less and are less likely to comply with treatment protocols.  
  • Level of Support: In a study of black cancer patients and their physicians, researchers found that nonblack doctors with high implicit bias were less supportive of and spent less time with their patients of color compared to physicians with a low implicit bias. Physicians who provide less support to patients of color may appear less confident in treatment recommendations, provide fewer treatment options, and doubt the completion of them.    

Precautions You Can Take 

Health outcomes of people of color are a result of medical racism in conjunction with differences in behavior, education, and income levels.  The systemic medical racism in today’s society may take years to regulate. While this discrimination has led to poorer health outcomes among minorities, there are certain precautions one can take to improve the quality of care and receive better health outcomes. Some of these precautions include finding a doctor of color and making lifestyle modifications.  

A recent study found that care for black patients is better when they see black doctors. The study randomly assigned 1,300 African Americans to black or non-black primary care physicians. Those who saw black doctors received 34% more preventative services. While it may be difficult to see a doctor of the same color due to the lack of colored physicians or adequate resources, it can improve the quality of care.   

Although genetics play a role in many chronic health conditions, there are lifestyle modifications that can be taken to prevent these conditions. By getting regular exercise, eating a balanced diet, and monitoring mental health, you can decrease the likelihood of developing conditions like cardiovascular disease, diabetes, and autoimmune disorders.  

If you or a loved one had experienced medical racism, know you are not alone. There are thousands of members at PatientsLikeMe of various races, ethnicities, and cultures, who understand exactly what you are going through.  Join the conversation to learn what others are doing to fight against medical racism and get the care they deserve.  

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