Dealing with discriminatory and dehumanizing laws and policies, as well as being treated in a racist manner by individuals, is a fact of life for Black folks in the United States. The long-term health effects of prejudice and oppression range from higher rates of chronic diseases to higher infant and maternal mortality rates — and it’s not a secret that this is the case. The impact of racism on health is so well known in medical circles that in 2020 the American Academy of Family Physicians wrote a letter to the White House saying that “it is time for the United States to officially recognize racism as a public health issue.”
So what happens when the very healthcare system that acknowledges the negative health effects of racism further perpetuates the social evil Black folks are trying to heal from?
A new report from the Commonwealth Fund reveals that doctors’ offices and other healthcare providers don’t always treat Black people with dignity and respect.
According to the report, one in four Black and Latinx adults, age 60 and older, reported that they’ve experienced racial discrimination from health professionals. These providers either treated them unfairly or didn’t take their health concerns seriously because of their race or ethnicity.
Racial discrimination in healthcare can show up differently for everyone. Commonly, it looks like providers dismissing a patient’s symptoms or health concerns or offering different treatment based on a patient’s type of insurance.
The Fund’s report, How Discrimination in Health Care Affects Older Americans, and What Health Systems and Providers Can Do, reveals more than 25% of older adults in the U.S. who experienced racial and ethnic discrimination felt they didn’t get the care they needed.
The Fund talked in-depth with older adults about the kinds of racial discrimination they’ve experienced in another soon-to-be released study.
“Some of the things that they have said is they’ve experienced insensitive or racist comments. They feel that they’ve had to wait longer to be seen by doctors. They’re being rushed during appointments,” Michelle Doty, Vice President of Organizational Effectiveness, Survey Research and Evaluation at the Fund tells Word In Black.
“Another example is not being listened to or taken seriously or feeling like they’re being denied pain medications.”
As a result, these patients have more health needs and are more likely to have feelings of isolation than older patients who don’t report discrimination. Additionally, they’re also more likely to report experiences of financial hardship. It’s not uncommon for people who experience racism in healthcare to also struggle to pay rent or secure basic needs like heat, for example.
“So, it’s almost as if it’s a double whammy,” Doty explains. “You’re feeling discriminated against in the healthcare system and at the same time you’re experiencing these other health concerns that will impact your quality of life.”
But that’s not the only negative effect — racist healthcare also takes a toll on psychological health.
“We see that people who report this racial and ethnic-based discrimination are more likely to report a mental health diagnosis,” Doty says.
Additional research reveals racism-related stress over a lifetime also contributes to physcial health issues; including high blood pressure, negative health behaviors, and early aging, the report noted.
On top of navigating racism in other areas of life, when confronted with it in healthcare, older Black people face even greater health risks because they’re less likely to return to treatment after being discriminated against.
Doty says other research shows “that if people’s health concerns are not taken seriously, they’re less likely to come back to the healthcare system when they are sick and they’re going to delay seeking care, which could have serious consequences.”
“This study is just supporting that work and once again, pointing out that there are these long term consequences of racial and cumulative race-related stress that is particularly acute around older adults,” she says.
The Black adults who participated in the study, ranging from ages 60 to 75 and older, have lived long enough to witness some of America’s most heinous acts of healthcare-related racism.
From 1931 to 1972, the United States Public Health Service intentionally withheld penicillin from nearly 400 Black men with syphilis in Macon Country, Ala. The experiment, officially known as the “Tuskegee Study of Untreated Syphilis in the Negro Male” but commonly referred to as ”The Tuskegee Experiment,” resulted in severe health issues among the men; including blindness and death.
In 1951, the cancer cells of Henrietta Lacks were taken without her or her family’s permission by scientists at Johns Hopkins Hospital in Baltimore, Md. and used to create the HeLa cell line — the world’s first immortalized human cell line still widely used in medicine today.
In an effort to remedy racist healthcare at its core, The Fund worked alongside a diverse group of grantees to propose policy recommendations, including developing medical school curricula that educates students about how the U.S. healthcare system has harmed patients of color.
Some other organizations are also leading the way to educate medical students on American’s history of health-related discrimination.
“We’ve been hearing more generally that medical schools are taking that next step, but one of the leaders of the efforts would be the American Medical Association,” Morenike Ayo-Vaughan, Advancing Health Equity Program Officer at the Fund says. “They have a separate initiative focused on health equity and focused on preparing the workforce, particularly the medical workforce to basically be able to treat a wide variety of patients and to be more aware.”
Other solutions proposed by the Fund include addressing the lack of diversity in the U.S. healthcare workforce, identifying and publicly reporting discriminaiton data, removing or reforming current discriminatory policies, and providing culutrally appropriate care that addresses patients’ communicaiton needs and preferences.
“Part of what’s going to be important for advancing health equity and advancing racial equity in terms of health is generating evidence,” Ayo-Vaughan says. “We started with this survey where the hope is that it will illuminate that there are these existing issues and we want to continue to support that work.”