The Pandemic Brings Racism in Healthcare to the Forefront

As this year slowly comes to an end, we look back on the historic importance of 2020. The killings of George Floyd, Breonna Taylor, Tony McDade and too many others at the hands of the police and the national response have forced a reckoning of the role of racism within American life. As the U.S. is unable to control the spread of COVID-19, the pandemic continues to change the way we live. The Coronavirus has highlighted the failures of the American healthcare system, specifically the disproportionate negative effects for Black people of color. Racism plays a critical role in determining individual health outcomes and the healthcare system can no longer be complicit through inaction. 

What makes one person healthy and another unhealthy?

Determinants of health are used to predict health outcomes based on various factors that influence an individual’s health. These health determinants are divided into five different categories: biology and genetics, individual behavior, physical environment, access to healthcare and social interactions (Healthy People). Biological and genetic determinants include any factors that may affect some populations more than others. For instance, sickle cell is an inherited gene that makes the individual susceptible to sickle cell diseases. Individual behaviors, such as physical activity or smoking, contribute to health. The physical environment can influence public health as factors like climate or pollution levels. The accessibility of healthcare contributes to the general health of a population. If an individual does not have access to healthcare whether this is due to insurance coverage, high costs or general lack of availability makes negative health outcomes more likely. Social interactions such as economic status and education level also impact health. While the five types of determinants are distinct, there are interconnected relationships between these factors. Systemic racism impacts determinants of health leading to disproportionately negative health outcomes for people of color. 

The role of racism in public health and healthcare

The disparities in health between white and Black people are evident in many aspects of public health. In 2014, the Department of Health and Human Services found that Black women have an average life expectancy four years shorter than white people (Rees). Black people aged 18 to 34 years have higher mortality rates for eight out of ten of the leading causes of death (Nembhard and White). Black women are more than three times more likely to die during pregnancy while Black infant mortality is 11 in 1,000 in comparison to a 5 in 1,000 white infant mortality rate (Rees). How is it that racism is such a powerful factor in health outcomes?

The systemic racism in most aspects of life affect public health making race the most important determinant of American health. Other than biology and genetics, racism can be documented negatively affecting every type of determinant of health. Studies have found that elements such as “social stress, discrimination, nutrition, housing, transportation, crime, and environmental conditions are all influenced by race” and “Black Americans being disproportionately disadvantaged in each category” (Gay et al). For instance, in 2014 Black people were twice as likely to be unable to get health insurance (Rees). A separate study found that predominantly Black neighborhoods were 67% more likely to have a shortage of physicians (Rees). Racism within the criminal justice system also contributes to negative health outcomes. Black men and boys over the age of 10 are three times more likely to die in an interaction with police than their white peers (Nembhard and White). The stress and trauma related to racially motivated violence contribute to higher rates of depression, anxiety and post-traumatic stress disorder in Black Americans. The racism within other parts of American society spills into the healthcare of the Black population. 

There is also racism within the healthcare system itself. In 2016, a study found that 73% of white medical students thought there were biological differences between races such as believing “Black people having thicker skin, less sensitive nerve endings, or stronger immune systems” (Rees). It is possible that the students’ false beliefs are a byproduct of medical myths made up to justify the continuation of slavery in the nineteenth century (Rees). Racism against Black people is not isolated to learning medical professionals. Frontiers in Pediatrics found that Black children are less likely to receive emergency care, be admitted to the hospital after receiving emergency care or receive medical testing despite no “social, economic, or clinical factors that would change how doctors treat [people of color] in emergencies” (Rees). Studies show that healthcare providers have positive implicit biases toward white patients and negative biases towards Black patients contributing to a lack of acknowledgment of systemic racism within the medical community (Gay et al). While racism in other facets of life may impact the health of Black people of color, it is clear that racial biases and stereotypes by healthcare professionals play a critical role in health disparities. 

Racial disparity in health during COVID-19

Racism in healthcare has only been highlighted further during the pandemic. The disproportionately negative health outcomes experienced by Black people are reflected in COVID-19 cases. While the Coronavirus pandemic is a relatively recent medical phenomenon, the demographic breakdown of COVID-19 cases demonstrates disproportionate effects on the Black community. Predominately Black counties have an infection rate three times higher and a mortality rate six times higher than the rates associated with predominately white counties (Gay et al). When racism is built into the institutions we depend on, how do we go about addressing it?

Addressing racism against Black people in the medical community

Systemic racism within American public health is evident and must be confronted for equitable healthcare. The racism built into American society will not simply reverse itself, but will take active work towards healing. While this action may be led by Black people of color, non-Black people must use their privilege to dismantle the systems that unfairly benefit them at the expense of their Black peers. There needs to be action on institutional and individual levels to address racism with healthcare. Acknowledging racism as a powerful determinant of health is an important first step. Recognizing and taking responsibility for the impact of systemic racism on the community (Arya et al). Be prepared to actively engage in anti-racist action like confronting personal biases and self education (Arya et al). Institutions such as medical facilities and educational organizations need to support these individual efforts by reevaluating policies and procedures, dedicating resources to addressing institutionalized racism and ensuring that all community members are represented within the medical profession (Arya et al). There are also calls to declare racism a public health issue, to bring awareness to the urgency and danger of racism within healthcare systems (Nembhard and White). Commitment to change and honest dialogue will be at the forefront of the deconstruction of systemic racism within American society. 

To take action to dismantle the racism built into healthcare, medical professionals must be prepared to engage critically with the systems around them. Are Black people of color being proportionately represented in your field? Are Black patients being given the same empathy and care as their non-Black peers? Do the statistics support equitable treatment? Are you ready to confront a personal racial bias, even if this bias is contradictory to your conscious beliefs? Racism within American institutions took centuries to build and will take deliberate action to address. During a time when healthcare is so important to the safety of the public, it is impossible to ignore the harm being done to the most vulnerable members of society.

Works cited

Arya, V., Alvarez, N., Butler, L., Leal, S., Maine, L., Varkey, A., (2020, November 1). Systemic Racism: Pharmacists’ role and responsibility. Journal of American Pharmacists Association, 60(6), 43-46. https://doi.org/10.1016/j.japh.2020.09.003

Determinants of Health. (2020). Healthy People, https://www.healthypeople.gov/2020/about/foundation-health-measures/Determinants-of-Health#top

Gay, T., Hammer, S., Ruel, E., (2020, September 1). Examining the Relationship between Institutionalized Racism and COVID-19. City & Community, 19(3), 523-530. https://doi.org/10.1111/cico.12520

Nembhard, S., White, K., (2020, November 11). It’s Time to Declare Racism a Public Health Issue. Urban Institute, https://www.urban.org/urban-wire/its-time-declare-racism-public-health-issue

Rees, M., (2020, September 16). Racism in Healthcare: What you need to know. Medical News Today, https://www.medicalnewstoday.com/articles/racism-in-healthcare

Edited by Sean Francis