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.
In the U.S., not everyone has equal access to good health care and treatment. These inequities affect certain racial and ethnic minorities the most. These groups -- which include Black and Hispanic people -- are more likely to have chronic diseases. They’re also less likely to have good control over those conditions.
There are lots of reasons for these disparities. The stress that discrimination can cause and bias within the medical system are two. Money also plays a big part.
“In our country, race and ethnicity track so closely with access to financial resources,” says Marcella Nunez-Smith, MD, associate professor of medicine at Yale School of Medicine. “A lot of the underlying cause has quite a bit to do with economic drivers and factors.”
Even when financial resources aren’t an issue, minorities are sometimes treated differently. That’s especially true when it comes to Black women and their reproductive health, says Bridget Goosby, professor of sociology at the University of Texas at Austin.
“Even for an African American woman who is highly educated or well-off with insurance, there is still this kind of bias in terms of not necessarily seeing her (pregnancy) issues as serious when she’s stating they are. This can lead to exacerbated health problems and elevated risk,” Goosby says, referencing the problems tennis star Serena Williams had after giving birth.
Here are other ways treatment might be different if you’re a person of color.
Lack of Health Insurance
Most doctors and hospitals require health insurance. And treatment can be costly for people with poor coverage or none at all.
The uninsured are less likely to get preventive health services. That includes screenings for diabetes, common cancers, and cardiovascular disease. Minorities make up more than half of the uninsured population. Some minorities are also more likely to be unemployed. That’s a barrier to treatment because health insurance is often tied to employment. But work doesn’t always guarantee coverage.
“[People of color] are more likely to have jobs that don’t come with insurance,” Goosby says. “And this, in and of itself, is going to put them at a disadvantage when it comes to access to care.”
Less Access to Health Services
Underserved areas, often communities of color, usually don’t have many options when it comes to affordable health care. Emergency or urgent care centers may be the only choice. “And those can be prohibitively expensive,” Goosby says. “That’s going to lower your likelihood of trying to access those resources.”
Folks in these communities are also less likely to have a regular doctor, Nunez-Smith says. That can lead to less preventive care, too, along with delayed diagnoses. Often, conditions aren’t caught until people come in with symptoms, she says, which is usually a sign of a disease at its later stage.
Lower Quality of Care
Historically, Black people and other minority groups tend to get fewer kinds of medical treatments than white people. There’s growing evidence that implicit, or unconscious, bias affects the kind of care someone gets. People of color, especially women of color, may end up getting a lower standard of care, Nunez-Smith says.
Studies show that Black women are three to four times more likely to die of a pregnancy-related death than white women. Experts aren’t exactly sure why. But bias from health care workers may be partly to blame.
“A prime example is Serena Williams, who had this really awful scare when it came to having her first child,” Goosby says. “And the fact that she said she was not listened to and she almost died. That’s an extreme example of what can be a pretty common occurrence among African American women -- feeling like they’re not being heard when they go to the doctor.”
Less Treatment for Pain
Some people hold the mistaken belief that Black people feel less pain than other groups. That’s a stereotype that Nunez-Smith knows is “still out there,” even among some doctors. That’s why she teaches medical students “explicitly” that it isn’t true.
Tinu Abayomi-Paul, 48, who is of Nigerian descent, says she’s spent the last 15 years trying to get help with her ongoing pain. She has several health conditions that can make her body hurt, including fibromyalgia, a degenerative spinal disorder, and chronic lymphocytic leukemia (CLL). She says she’s often denied medication that can help her feel better.
“I have a lot of medical professionals in my family, so I know what the standard of care is supposed to be,” Abayomi-Paul says. “But if I went to the emergency room, it was always, ‘She’s got to be a drug addict if she’s asking for pain medicine.’ They wouldn’t even call my doctor. It just made me stop going to the hospital.”
Abayomi-Paul also had a bad experience during the removal of her mediport. That’s a drug-delivery device her doctors put in to treat her CLL, a slow-growing kind of cancer. She assumed she’d get some kind of anesthesia since the doctors who put in the device -- who happened to all be Black -- put her to sleep for the original procedure. But her nurses this time, who were white, said she’d only need a numbing cream.
“They told me it would take 5 minutes and I wouldn’t feel a thing,” Abayomi-Paul says. “It took over an hour. I kept telling them it hurt. It wasn’t until after it was over that I wondered, “If I was a white woman, would they have listened to me?”
Not Being Heard
Some minorities may avoid the doctor because they’re unsure how they’ll get treated. But sometimes medical help can be hard to get, even when you repeatedly seek care, Abayomi-Paul says.
In 2012, blood tests showed Abayomi-Paul’s thyroid wasn’t working well. The results came up while she was getting treated at a hospital for a serious case of pneumonia. Her levels were “dangerously low,” she remembers the doctors telling her. She needed to get it rechecked later. But it took another 4 years -- and lots of doctor-switching -- for her to get that test.
“I didn’t find out until I went to a female Indian doctor,” Abayomi-Paul says. “Before that, all my doctors told me I was wrong, and they weren’t going to order the (thyroid) test.”
That same helpful doctor spotted something Abayomi-Paul hadn’t noticed. The lymph nodes on her neck were swollen. She needed to see a hematologist. “I went to see them a month later, and that’s how I found out I had cancer,” Abayomi-Paul says. With treatment, her CLL symptoms are now under control.
Diversity Among Doctors
There’s growing evidence that minorities have better health outcomes when they’re paired with a doctor who shares their race or ethnicity. Goosby says that might be because the doctor is more likely to understand the kinds of social conditions, backgrounds, and inequities that contribute to health risks for minorities.
Abayomi-Paul says she feels a little bit safer when she has a Black doctor or nurse. “There’s a layer of added trust. There are so many more chances to have people to appeal to and have camaraderie with,” she says. “It’s not necessarily because they’re Black, but because they’ve experienced racism too.”
But we’re a long way from being able to match people with doctors of the same race or ethnicity, Goosby says. In 2018, reports showed that 17% of doctors identified as Asian. Less than 6% were Hispanic. Only 5% were Black.
Steps Toward Equal Treatment
Minorities can’t control many of the barriers that prevent them from equal access to health care. That’s something Goosby hopes more people are starting to grasp. “It’s great that people are now talking about structural racism,” Goosby says, “because that’s part of our pathway to moving forward in a more equitable way when it comes to health.”
One group that is taking action towards equal treatment in health is the All of Us Research Program. It's a large, diverse organization that helps researchers find answers to pressing health issues. To do that, they're asking 1 million or more people to share their health data. The program aims to reflect the diversity of the U.S. and to include participants from groups underrepresented in health research in the past.