Saying the Words: Racial Discrimination
The Theme for Black History Month is Black Health and Wellness. Unfortunately, there is much to remind us of how far we have to go on both fronts.
There is no denying that the impact of discrimination in our health system is significant, as reflected by the disparities in care identified in “Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care,” published nearly 20 years ago. One need only look at the more recent COVID-19-related rates of hospitalization and death faced by communities of color. African Americans are 2.5 times more likely to be hospitalized and 1.7 times more likely to die than Whites.
These are not just statistics; how people are treated by the medical system plays a key role in their health, as the various types of bias have profound effects. Patients who experience discrimination in their interactions with the healthcare system tend to forego preventive services, postpone medical tests and treatment, underutilize health services, and report worse physician communication and lower satisfaction with care which can contribute to poor compliance and adherence.
A recent survey of patients in Chicago revealed that doctors were more likely to use negative descriptors in the medical record for people of color. The study found that Black patients had one or more negative descriptors in the history and physical notes of their Electronic Health Records at a rate 2.54 times White patients. Not only does implicit bias erode trust in medical care, it also affects the delivery of health care to racially marginalized populations and that contributes to people declining Covid-19 vaccinations.
A commentary by Kirsten Bibbins-Domingo, PhD, MD, MAS, describes one example, that of statistical discrimination; when doctors take race into account in deciding the diagnosis and treatment of a patient. For her niece, the diagnosis of a rare genetic disorder came too late. Her clinicians “reasoned that the disease did not occur in Black patients” and only tested for the condition after her liver failed. This blog post from Harvard Medical School, “Racism and Discrimination in Health Care: Providers and Patients,“ acknowledges most physicians are not explicitly racist and are committed to treating all patients equally. However, “they operate in an inherently racist system.”
While racism is pervasive, it is not just a part of the patient experience. It profoundly affects those who are hard at work delivering health care services. In a survey of nurses, nearly half agreed that there is “a lot” of racism in nursing; 63% said they have personally experienced an act of racism with the transgressors being either a peer (66%), patient (63%), or a manager or supervisor (60%). Nearly 60% of nurses said they challenged racism, but more than half said their efforts resulted in no change. More than half of those surveyed said racism in the workplace “impacted their professional well-being.”
I wouldn’t say that I’m encouraged because there is room for improvement on all fronts, but I do believe that we are taking steps to identify and address racism. This video documents a program for teaching medical students about how systemic racism affects people’s lives and health and how they can be more compassionate and effective care providers. Closer to home, this video offers a 50-year history of racism created by the Roosevelt Alumni for Racial Equity, a multiethnic group of Roosevelt High School alumni in 2020 following the death of George Floyd.
There are no easy answers to racism but this article from St. Catherine University, entitled “Racial Discrimination in Healthcare: How Structural Racism Affects Healthcare” sums up what health care leaders can do:
- Say the Words: Racial Discrimination. There are countless reports and studies on racism in healthcare and we cannot be afraid to call it what it is.
- Focus on Impact Rather Than Intentions. Implicit bias is everywhere and it’s just as important to address that as it is to confront overt racism.
- Prioritize Standardizing Systems of Care. By making sure all patients receive the same levels of care, we can make health care be more equitable and inclusive.
The Alliance is working to incorporate Diversity, Equity, and inclusion (DEI) into all aspects of our work. If you have suggestions on how we can do that, I encourage you to reach out to Alliance Medical Director Sharon Eloranta. For additions or suggestions to the Alliance’s DEI curated resource list, please contact Alliance Senior Communications Manager Leslie Bennett.
I believe that by working together we can make the change we want to see.
All the best,