EXPLAINER: Why Black Americans experience disparities in healthcare

When receiving healthcare people would think this is a time that all people would be treated equally however this is not always the case. To understand the division in healthcare certain factors, need to be explained, starting with implicit bias and history.

Implicit Bias

The Kirwan Institute for the Study of Race and Ethnicity, at The Ohio State University, defines implicit bias as an unconscious attitude or stereotype that can affect our understanding, actions, and decisions towards a race or gender. This type of bias can come from an experience an individual has or this type of bias can be learned, from what an individual has been taught or shown.

Examples of myths that some doctors still believe are true according to Dr. Janice A. Sabin, Research Associate Professor, Biomedical Informatics and Medical Education,

• Black people nerve endings are less sensitive than white people.
• Black people skin is thicker than white people.
• The blood of Black people coagulates more quickly than white people.

Myths like these can contribute to implicit bias, doctors are more likely to underestimate the pain level of Black Americans by almost 47%, according to the Proceedings of the National Academy of Sciences of the United States of America. This is still true for current medical students that are graduating.

Another element of the bias is involved when the doctor does recognize pain and underplays it anyways. Some doctors worry that Black patients have lower inhibition and will become addicted easier or will sell the medication. This has come up in many conversations around why there are not higher numbers of opioid-related deaths in the Black community.

These types of myths that can contribute to implicit bias were carried over from history, starting with slavery.

History

In the U.S., enslaved Africans were brought in the year 1619 and were deemed to be inferior to their captors. The need to justify the wealth gained by chattel slavery first came general prejudices and placing context in The Bible.

The European exploration and colonization in the late-1600s bought about the categorizations around race closer to what is recognized today. That same distinction was able to reinforce the “scientific” differences between races. The already existing myth of racial hierarchy began to be backed by science around the 1700s and its underlying still exists today.

One of those theories is that Black individuals feel pain differently and heal faster, with that theory came tests, dissections, surgeries and medical trials.

These operations were often done in, “slave hospitals,” where enslaved people were traded and bought at a higher price if that enslaved person suffered from some type of disease. Consent for these operations came from who the enslaved person belonged to- no consent was given to enslaved people.

 

TikTok of Dr. Jennifer Lincoln

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Examples of the types of medical trials

One example is James Marion Sims’ gynecology research. Sims is known as the “father of modern gynecology” and for inventing the Sim’s speculum, but Sims conducted his research on enslaved Black women without giving them any anesthesia. The women were considered property and therefore could not consent. In recent years, there has been a push to remember the enslaved Black women who were experimented on such as Anarcha, Lucy and Betsey and call them “The Mothers of Modern Gynecology.”

Another example of a medical trial that was conducted without the proper consent or information was “The Tuskegee Study of Untreated Syphilis in the African American Male.” This test was run on Black men for 40 years between 1932-1972. The purpose was to study the progression of the disease on the body and the Black community unknowingly to find that answer. Patients were under the impression they were receiving healthcare.

The Tuskegee Syphilis Experiment Revealed

 

With implicit bias that doctors sometimes might have against patients and history creates medical mistrust.

Medical Mistrust

Medical mistrust is the distrust of medical personnel and organizations. Medical mistrust stems from the historical events that have taken place between Black people and doctors. Because there is distrust, Black men are more than likely to not go to the doctor if they cannot obtain a Black doctor.

A Forbes study found the percentage of Black doctors was roughly 5% and as of 2020, 4% with only 2% of those being Black female doctors.

This distrust also comes to the theory that this is why fewer Black Americans participate in clinical trials, but according to a study that was done by Dr. Joyce Balls-Berry, a psychiatric epidemiologist and health educator showed that Black Americans are often overlooked to participate in clinical trials.

One factor that can go into this and goes deeper into healthcare in this era is socioeconomic status.

Socioeconomic Status

Socioeconomic status is defined by the American Psychological Association as the social standing or class of an individual or group. The status is measured off of a combination of education, income, and occupation. This comes into factor with the healthcare system because those three components can and have caused division when it comes to the type of healthcare a person who is less fortunate will receive compared to a person who is wealthier.

A study that was done in 2019 by the Joint Economic Committee showed that the average median of wealth for Black families was $17,000 and for white families, the average median was $171,000.

In Texas, the median household income for Black families is $46,306 and the median household income for white families is $65,651, this can affect health insurance.

Health Insurance

Gaps in health insurance coverage have been shown between Blacks and whites. In Texas, 13% of whites are uninsured and 16% of Blacks are uninsured. People that cannot afford healthcare are subjected to county hospitals with long wait times and more patients than there are doctors.

US Healthcare System Explained

Since proper healthcare cannot always be afforded this trickle into Black women healthcare versus the healthcare of white women.

Black Women and Infant Mortality Rate

It has been reported by American Heart Association News that Black women are three to four more times likely to die from pregnancy-related causes than white women. These deaths could be prevented but Black women are failed to be monitored as carefully as white women, their symptoms are often dismissed or looked into too late.

“The US medical system is still haunted by slavery”

Serena Williams, a professional tennis player, spoke about her birth experience after having to have a cesarean section and the complications that she endured. William’s explained that she did not get the treatment and the response she expected after she let her nurses know that she was experiencing complications after the cesarean section. The nurse thought that her pain medicine was making her confused about what she was feeling.

Even Black women who can afford the same healthcare as white women experience these treatment differences.

Statistics

• A Black woman is 243% more likely to die from pregnancy-related or childbirth-related causes than a white woman.
• Black women are 49% more likely to have to deliver prematurely than white women
• Black women have the highest number of cesarean deliveries among the other races.

As for the infants, studies have shown that the Black infant mortality rate is twice the rate of white infants.

Why are black mothers and infants far more likely to die in U.S. from pregnancy-related causes?

 

The healthcare system is a complex system before accounting for gender, class and race. These five topics just scratch the surface without delving into the discussion of environmental racism and food deserts — both of which affect health. The more knowledge that is known about this subject the better equip people are to make the change and advocate for others.

 

For more information

 Books

• “Medical Apartheid: The Dark History of Medical Experimentation on Black Americans From Colonial Times to The Present” by Harriet A. Washington
• “Medical Bondage: Race, Gender, and the Origins of American Gynecology” by Deirdre Cooper Owens
• “Forty Years of Medical Racism: The Tuskegee Experiments” by Michael Uschan
• “The Immortal Life of Henrietta Lacks” by Rebecca Skloot
• “Just Medicine: A Cure for Racial Inequality in American Health Care” by Dayna Bowen Matthew

 Movies

• “Power to Heal: Medicare and the Civil Rights Revolution” (2018)
• “The Angry Heart: The Impact of Racism on Heart Disease Among African Americans” (2001)
• “Unnatural Causes: Is Inequality Making Us Sick?” (2008)

 Podcasts

• Season 1, Episode 6: Fear of a Black Woman’s Body – Black History Year
• Episode 13: Black Maternal Healthcare: Racial Disparities in the US Healthcare System – Dear White Women
• The Praxis: Connecting Theory and Practice for Health Justice – Health Justice Podcast
• Episode: How Racism Harms Pregnant Women – and What Can Help – TED Talks Health