Racial Bias in Health Care and Health
A landmark report from the Institute of Medicine (IOM) in 2003 documented that from the simplest to the most technologically advanced diagnostic and therapeutic interventions, African American (or black) individuals and those in other minority groups receive fewer procedures and poorer-quality medical care than white individuals. These differences existed even after statistical adjustment for variations in health insurance, stage and severity of disease, income or education, comorbid disease, and the type of health care facility. Very limited progress has been made in reducing racial/ethnic disparities in the quality and intensity of care. The IOM report concluded that multiple factors contribute to racial disparities in medical care and that unconscious bias by health care professionals contributes to deficits in the quality of care. This Viewpoint discusses the potential contribution of societal racial bias to disparities in health care and health status.
“A true understanding of disease risk requires a thorough examination of root causes. ‘Race’ and ‘ethnicity’ are poorly defined terms that serve as flawed surrogates for multiple environmental and genetic factors in disease causation, including ancestral geographic origins, socioeconomic status, education and access to health care. Research must move beyond these weak and imperfect proxy relationships to define the more proximate factors that influence health.”
Grand Rounds presentation by Tiffani Johnson, MD, MSc at Seattle Children’s Hospital on December 5, 2019. She addresses the impact of racism on health and well-being in pediatric populations.
An afternoon plenary from Health Action Conference 2018 featuring Dr. Camara Jones, Dr. David Williams, Dr. Marshall Chin, Andreas Ducas, Dr. Tekisha Everette, Aj Jones II, Ed Tepporn, Sinsi Hernádez-Cancio, and Frederick Isasi
NEW!
The Impact of COVID-19
Emerging data show that African Americans and other US ethnic minorities are being stricken by COVID-19 at a higher rate, and experiencing greater sickness and a higher death toll than other Americans. Some have said that COVID-19 is “ravaging” black communities. In this interactive conversation, five faculty members from the UC Berkeley School of Public Health will discuss how racism shapes vulnerability to COVID19, why African Americans are being so heavily impacted, and why these disparities matter.
Study after study affirms that doctors treat their patients differently, depending on the patient's race. Minority patients get different diagnoses, different treatments, and are often subject to being stereotyped by their physicians.
“So many medical conditions are differentially distributed to African Americans—heart disease, diabetes, hypertension, low birth weight babies—are we to believe that Black people were so evolutionarily unlucky that they got all the genes that predisposed them to every malady?”
"Race, Racism, and Medicine" Pediatric Grand Rounds presentation by Dr. Stephen Nelson at the University of Minnesota. February 11, 2015.
Internationally-noted expert on race and health, David Williams, MPH, PhD, provides an overview of the large and persistent socioeconomic and racial/ethnic disparities in health. Dr. Williams will highlight scientific evidence that reveals there are distinctive social exposures linked to racial status, and these race-related aspects of social experience create inequities in health and healthcare quality.
This session walks, step by step, through the historic timeline of health disparities linked to care administered to minorities, along with various racial barriers that limit and sometimes restrict access to health care. In addition, this session explores the lack of minority health professionals and thus a shortage of minority input into the healthcare system, and challenged attendees to consider the impact that cultural bias and racial microaggressions have in the everyday care provided to patients from diverse backgrounds.
Dr. Richard Garcia is a pediatrician in Stockton, California. He received his medical degree from University of Illinois College of Medicine and has been in practice for more than 20 years. Dr. Garcia and his colleagues have woven together a series of personal and emotional essays that highlight the inequalities that continue to plague us and significantly contribute to our national disease and economic burden. This talk was given at a TEDx event using the TED conference format but independently organized by a local community. Learn more at https://www.ted.com/tedx.
“Race is not the risk factor;
racism is the risk factor.”
Interactive Modules
Exploring Racism and Health: An Intensive Interactive Session for Medical Students
Free MedEdPORTAL module
Growing recognition of the deleterious effects of racism on health has led to calls for increased education on racism for health care professionals. As part of a larger curriculum on health equity and social justice, this MedEdPortal educational session on racism for first-year medical students consists of a lecture followed by a case-based small-group discussion.
Books
Black & Blue is the first systematic description of how American doctors think about racial differences and how this kind of thinking affects the treatment of their black patients. The standard studies of medical racism examine past medical abuses of black people and do not address the racially motivated thinking and behaviors of physicians practicing medicine today.
Black & Blue penetrates the physician’s private sphere where racial fantasies and misinformation distort diagnoses and treatments. Doctors have always absorbed the racial stereotypes and folkloric beliefs about racial differences that permeate the general population. Within the world of medicine this racial folklore has infiltrated all of the medical sub-disciplines, from cardiology to gynecology to psychiatry. Doctors have thus imposed white or black racial identities upon every organ system of the human body, along with racial interpretations of black children, the black elderly, the black athlete, black musicality, black pain thresholds, and other aspects of black minds and bodies. The American medical establishment does not readily absorb either historical or current information about medical racism. For this reason, racial enlightenment will not reach medical schools until the current race-aversive curricula include new historical and sociological perspectives.
In The Cost of Racism for People of Color, leading scholars examine the felt experience of being the target of racism, with a focus on mental and physical health — as the result of particular racist encounters as well as across the lifespan — in addition to group contexts such as education and the workforce.
Authors examine the subtle but persistent links between everyday microaggressions and historical racial trauma, and offer practical tools to assess and measure perceived racial discrimination. They describe compelling new interventions for individuals and communities, and offer social policy prescriptions to promote healing and help dismantle institutional discrimination.
With its skillful synthesis of voices and approaches, this work should appeal to a broad range of scholars and practitioners in clinical psychology, as well as ethnic studies, sociology, and public and allied health.
Over 84,000 black and brown lives are needlessly lost each year due to health disparities: the unfair, unjust, and avoidable differences between the quality and quantity of health care provided to Americans who are members of racial and ethnic minorities and care provided to whites. Health disparities have remained stubbornly entrenched in the American health care system—and in Just Medicine Dayna Bowen Matthew finds that they principally arise from unconscious racial and ethnic biases held by physicians, institutional providers, and their patients.
Implicit bias is the single most important determinant of health and health care disparities. Because we have missed this fact, the money we spend on training providers to become culturally competent, expanding wellness education programs and community health centers, and even expanding access to health insurance will have only a modest effect on reducing health disparities. We will continue to utterly fail in the effort to eradicate health disparities unless we enact strong, evidence-based legal remedies that accurately address implicit and unintentional forms of discrimination, to replace the weak, tepid, and largely irrelevant legal remedies currently available.
Our continued failure to fashion an effective response that purges the effects of implicit bias from American health care, Matthew argues, is unjust and morally untenable. In this book, she unites medical, neuroscience, psychology, and sociology research on implicit bias and health disparities with her own expertise in civil rights and constitutional law. In a time when the health of the entire nation is at risk, it is essential to confront the issues keeping the health care system from providing equal treatment to all.
Medical Apartheid is the first and only comprehensive history of medical experimentation on African Americans. Starting with the earliest encounters between black Americans and Western medical researchers and the racist pseudoscience that resulted, it details the ways both slaves and freedmen were used in hospitals for experiments conducted without their knowledge—a tradition that continues today within some black populations. It reveals how blacks have historically been prey to grave-robbing as well as unauthorized autopsies and dissections. Moving into the twentieth century, it shows how the pseudoscience of eugenics and social Darwinism was used to justify experimental exploitation and shoddy medical treatment of blacks, and the view that they were biologically inferior, oversexed, and unfit for adult responsibilities. Shocking new details about the government’s notorious Tuskegee experiment are revealed, as are similar, less-well-known medical atrocities conducted by the government, the armed forces, prisons, and private institutions.
Her name was Henrietta Lacks, but scientists know her as HeLa. She was a poor Southern tobacco farmer who worked the same land as her slave ancestors, yet her cells—taken without her knowledge—became one of the most important tools in medicine: The first “immortal” human cells grown in culture, which are still alive today, though she has been dead for more than sixty years. HeLa cells were vital for developing the polio vaccine; uncovered secrets of cancer, viruses, and the atom bomb’s effects; helped lead to important advances like in vitro fertilization, cloning, and gene mapping; and have been bought and sold by the billions.
Yet Henrietta Lacks remains virtually unknown, buried in an unmarked grave.
Henrietta’s family did not learn of her “immortality” until more than twenty years after her death, when scientists investigating HeLa began using her husband and children in research without informed consent. And though the cells had launched a multimillion-dollar industry that sells human biological materials, her family never saw any of the profits. The Immortal Life of Henrietta Lacks brilliantly shows, the story of the Lacks family—past and present—is inextricably connected to the dark history of experimentation on African Americans, the birth of bioethics, and the legal battles over whether we control the stuff we are made of.