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Institutional Racism and Health Care for Minorities

Medically Reviewed by Hansa D. Bhargava, MD on October 07, 2020

Editor's Note: This article is part of a series in partnership with the All of Us Research Program, which collects and studies health data to help scientists identify health trends. More than 80% of participants are from groups that have been historically underrepresented in research.

 

After tennis champion Serena Williams gave birth to her daughter in 2017, she almost died. Williams has a history of blood clots in her lungs. So when she had trouble breathing, she told a nurse that she needed a CT scan and blood thinner right away.

The nurse thought her pain medicine was making her confused, but Williams insisted. A CT scan revealed that she had several blood clots in her lungs.

While Williams credits her doctors for saving her life, her story shines a light on the risk of giving birth while Black. African-American women are three to four times more likely to die from pregnancy-related causes than white women, according to the CDC.

The reasons behind this are complex, says Rachel Hardeman, PhD, MPH, professor of health and racial equity at the University of Minnesota. Because of social inequities, women of color often enter pregnancy with more health issues.

It's also because people of color, especially black and brown people, face racism in health care. Research shows that doctors spend less time with Black patients than with white ones. They may not listen as carefully and are more likely to dismiss concerns or symptoms, Hardeman says.

This adds up to reduced care. And it doesn't just happen in the maternity ward. According to a report from the Institute of Medicine, there's evidence that minority groups get worse care in a number of fields, including diabetes, heart disease, and cancer treatment.

What Is Institutional Racism?

"Racism is a system that ensures racial inequality," says Gilbert Gee, PhD, professor of community health sciences at the University of California, Los Angeles. It happens at different levels. In institutional racism, the discrimination takes place within an organization, such as the health care system.

Doctors, nurses, and other health care workers are usually careful, thoughtful people, but they're also human beings living in a racist society, Gee says. "When they're busy or stressed out, they can revert back to the stereotypes they grew up with." This unconscious prejudice is called implicit bias.

For example, a doctor may assume a patient isn't going to take their medicine as directed and suggest a different treatment instead. In one study, doctors who thought of Black patients as "less cooperative" were less likely to refer those with heart symptoms for heart attack treatment.

Institutional Racism and Medical Education

Because of racism in society, some doctors enter medical school with bias. One survey found that half of white medical students believe myths about Black people, such as they have thicker skin or less sensitive nerve endings than white people.

Academic experts say this racism gets reinforced throughout the health care system, including medical and nursing schools. It's built into the curriculum. Even medical textbooks, which feature pictures of symptoms on patients, are biased.

One study found that most medical textbooks underrepresent dark skin tones. For six common cancers, there were zero pictures of symptoms on people of color. This may contribute to why people of color are more likely to die from skin cancer. The disease often takes longer to detect, so it's diagnosed at a more advanced stage.

What's more, race-based medicine is still taught and practiced. That's the idea that race is caused by biological or genetic differences instead of social and political ones.

Even today, some of the tools and formulas doctors use to prescribe treatments factor in race. As an unintended result, Black patients may be less likely to get certain drugs, transplants, and referrals to specialists.

For example, heart surgeons use a formula to estimate the risk of complications and death during surgery. Black patients have higher odds of death, which may cause surgeons to recommend a different treatment instead of surgery. A study shows that one computer algorithm used by hospitals and insurance companies was less likely to recommend Black patients for more personalized health care.

Reduced Care for Minorities

The institutional racism in health care results in reduced care for minorities. It's found in all fields of medicine. But research highlights these areas:

Pain management. Doctors tend not to prescribe pain medicines to minorities as often. In one study of emergency rooms, Black patients were 40% less likely and Hispanic patients were 25% less likely to get drugs for acute pain.

Childbirth. According to the CDC, Black, Native American, and Alaska Native women are dying from pregnancy-related causes at two to three times the rate of white women.

Newborn care. A study shows that Black newborns are more likely to live if they're cared for by a Black doctor compared with a white doctor. Some think that the reduced care is caused by differences in communication between white doctors and black patients, Hardeman says. "But this research on newborns shows that it's beyond that."

One organization tackling the issue of institutional racism in health care is the All of Us Research Program. Eighty two percent of their program participants are from communities underrepresented in biomedical research and more than 50% are from racial and ethnic minority groups.

WebMD Feature

Sources

SOURCES:

American Heart Association: "Why are Black Women at Such High Risk of Dying from Pregnancy Complications?"

Asian Pacific Journal for Cancer Prevention: "Skin Cancer Concerns for People of Color: Risk Factors and Prevention."

CDC: "Pregnancy-Related Deaths," "Racial and Ethnic Disparities Continue in Pregnancy-Related Deaths."

Gilbert Gee, PhD, professor of community health sciences, University of California, Los Angeles.

Journal of Health Care for the Poor and Underserved: "Physicians' Implicit and Explicit Attitudes About Race by MD Race, Ethnicity, and Gender."

New England Journal of Medicine: "Hidden in Plain Sight -- Reconsidering the Use of Race Correction in Clinical Algorithms."

Rachel Hardeman, PhD, MPH, Blue Cross endowed professor of health and racial equity, University of Minnesota.

Science: "Dissecting Racial Bias in an Algorithm Used to Manage the Health of Populations."

Social Science & Medicine: "Representations of Race and Skin Tone Imagery in Medical Textbook Imagery."

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