The Pervasive and Structural Problem of Racism in the U.S. Healthcare System

Racism Healthcare BeLatina Latinx
Hundreds of staff at the Massachusetts General Hospital participated in a kneel-in acknowledging the injustice of systemic and individual racism in America at the Bulfinch Lawn outside of the Wang Entrance of the hospital. (Jesse Costa/WBUR)

Take this in: according to the Marshall Project, while people of color (Black people, Latinos, Asians, and Native Americans) make up under 40% of the US population, they accounted for 52% of “excess deaths” in the first six months of 2020. These “excess deaths” are presumed to be COVID-19 deaths. 

The statistics are troubling. The numbers can’t be ignored or explained away. They mean one thing: our culture values white lives over those of non-white people. White supremacy is unequivocally killing Black and brown people. And during this unprecedented pandemic, the vehicle of white supremacy is the American healthcare system. 

This is likely not the first time you’ve heard that COVID-19 is disproportionately killing people of color, with Latinos making up 21.1% of overall deaths despite being only 18% of the population. Altogether, Latinos and Black people make up nearly two-thirds of COVID-19 related deaths among people under 65 in the U.S, according to the CDC.

It is also likely not the first time you’ve heard (anecdotally or otherwise) that there is a massive, pervasive structural racism problem within the healthcare industry. And the issue is not being adequately addressed. 

COVID-19 deaths aren’t the only cases. Although the coronavirus is shining a spotlight on how the healthcare industry is failing people of color, it is merely a microcosm of the more significant issue.

People of color are generally sicker and dying sooner than their white counterparts

According to the National Academy of Medicine, people of color are “more likely to die from cancer, heart disease, and diabetes simply because of their race or ethnicity.” Black mothers are more than three times more likely to die from pregnancy-related causes. Black patients are 22% less likely than white patients to receive pain medication. And these numbers aren’t because people of color are genetically predisposed to these health problems. 

Instead, the evidence is clear: doctors have been empirically proven to give non-whites less effective care whether intentionally or not.

According to the Applied Research Center at UC Berkeley, structural racism is marked by “inequalities in power, access, opportunities, treatment, and policy impacts and outcomes, whether they are intentional or not (emphasis my own).” Structural racism is preventing minorities from receiving adequate and effective medical treatment.

Like all Americans institutions, our healthcare system is deeply affected by structural racism

The researchers at UC Berkeley describe the insidious nature of structural racism the best. They describe it as “difficult to locate” because it includes the “reinforcing effects of multiple institutions and cultural norms, past and present, continually producing new, and reproducing old forms of racism.”

In other words: structural racism is so ubiquitous it is hard to see like a fish not knowing it is swimming in water. Structural racism is part of the fabric of national institutions like education, law enforcement, the justice system, and yes, the healthcare system. 

While it is tempting to chalk “racism” up to a few evil people’s actions in pointy white hats and robes (i.e., individual racism), the reality of racism in America is much more complicated. There are, by all accounts, well-intentioned white people out there who are complicit in structural racism. 

So, what causes this disparity in healthcare treatment in the U.S.? Experts have a few theories.

Implicit bias

The first is unaddressed implicit bias. Implicit bias is defined as “attitudes or stereotypes that affect our understanding, actions, and decisions in an unconscious way, making them difficult to control.” We are conditioned at a young age to have implicit biases. We are usually unaware of them.

For many, the idea of harboring biases against a particular racial or ethnic group feels shameful. Most of us have been taught the tenet that “everyone’s the same,” and we believe we cannot be good people if we are biased. But the reality is, we all hold some form of implicit bias against groups of people or individuals. It is when we don’t acknowledge and address our implicit biases that it becomes a problem.

But at the moment, medical education doesn’t sufficiently address implicit bias. In fact, it sounds like medical literature would rather not talk about race at all, which in itself is a problem. How can the issue be changed if it’s not being addressed?

There is a noted lack of diversity among healthcare professionals

Despite altogether making up over 30% of the population, only approximately 8.9% of physicians identify as of Black, Latino, or Indigenous descent. 

A 2016 study showed that 50% of white medical students and residents still believe harmful false stereotypes of Black people, like they are more impervious to pain, or that their skin is physically thicker. White doctors’ lived experiences affect the way they approach the treatment of non-white patients.

Communities of color often distrust medical institutions (and for a good reason) 

The distrust people of color in the United States have of the medical community can be traced back to specific historical horror stories. The first one that comes to mind, of course, is the Tuskegee Syphilis Experiment

In Tuskegee in 1932, the U.S. Public Health Service knowingly kept syphilis treatment from a group of unknowing Black men. They did so in order to “observe” the men as they advanced to late-stages of the disease and, sometimes, died. This inhumane treatment was all in the name of “science.” And the atrocities don’t end there. 

In 1946, the same U.S. Public Health Service purposefully infected 1,500 Guatamaleans with syphilis without their consent or knowledge to test whether penicillin could prevent sexually transmitted diseases.

Incidents like these (and countless less publicized others) have fueled a culture of suspicion among communities of color towards healthcare institutions, creating a negative feedback loop. Because of their lived experiences and the experiences of those around them, people of color are wary of doctors. This wariness prevents or delays them from seeking treatment. This lack of treatment is part of the reason they are sicker and dying earlier than their white counterparts. 

What can be done?

Experts believe that medical educational institutions must take steps to educate their students on the reality of implicit bias. The stakes are too high (i.e., life or death) for a doctor to be unwittingly biased against a patient without actively investigating and dismantling their biases. As the old saying goes: “You don’t know what you don’t know.”

It is also imperative that the U.S. Healthcare system finds a way to recruit more Black and brown doctors. A recent study showed that Black babies are more likely to survive when taken care of by Black doctors. Other studies have concluded that Black patients are more likely to live healthier lives when treated by Black doctors.

“We have to be thinking about [creating] a critical mass of providers from diverse backgrounds that are in tune with communities of color,” said Rachel Hardeman, a reproductive health equity researcher at the University of Minnesota. “[People] who understand that lived experience, and who can really build relationships and trust that seems to be missing right now.”

At this point, the worst thing we can do is stick our heads in the sand and refuse to acknowledge that racism in the healthcare industry exists. Although it can be comforting to convince ourselves that the days of physician neglect or medical experiments on unwilling people of color are behind us, the reality is much different. 

We need only to look at recent headlines to know that people of color are still being treated as glorified lab rats in the United States of America.