Fixing American Healthcare Begins with Racial and Ethnic Equity
By Julia Loritz
Image retrieved from Oprah Magazine
“Oftentimes, the system gets the concept of [B]lack people off the 6 o'clock news, and they treat us all the same way,” says an African American study participant on the topic of racial discrimination.
Prejudice against minorities applies to nearly every aspect of life, appearing within the education system, commerce, the workplace, and even at the doctor’s office. As recounted by the participant, people perpetuate stereotyping when they make snap judgments based on race or ethnicity instead of the situation itself; thus, healthcare in America is not exempt. Everyone is susceptible to harmful preconceptions, including physicians, nurses, legislators, and friends. Inevitably, a divergence between the quality of care for racial and ethnic minorities versus the white populace materializes, as a result, contributing to devastating yet universal health disparities.
With the recent pandemic, it is clear to see that minorities have borne a considerable portion of the blow. The country finds itself in a unique position, especially while riding the wave of the booming Black Lives Matter movement this past summer. The battles for equitable healthcare and anti-racism share similar goals. Without a doubt, they are connected. Some epidemiologists lament that diseases spread not only biologically, but sociologically. For example, people of color are more likely to live in multi-generational households and work in essential industries like factories, retail, and food processing. Similarly, outbreaks have been common in correctional facilities, homeless communities, and congregate housing: settings where minorities are disproportionately present (another issue empowered by deep-rooted racism). Such settings are all risks for high exposure. After playing an inherent role in the initial infective stage, disparities continue their journey into hospitals during treatment.
Compared to other developed countries, the United States spends more and gets less for medical treatment and consultation. ABC News reports, “In 2016, while only about 90 percent of the population had health care coverage, the U.S. spent about 18 percent of its GDP on health care.” Conversely, other countries spent about half of that with over 99% of citizens accounted for. One of many repercussions from medical-related debts is critically neglected communities, including those below the poverty line. As alluded to, this insinuates a high tally of affected minorities.
“These statistics are just an amplification of the ‘Slave Health Deficit’ which has been an aftermath of years of discrimination, unequal treatment and injustices in healthcare, criminal justice and employment.” The social determinants of health are chronically deprived of the African American community as a long-term result of America’s systems being built on the basis of racism, impacting the effectiveness of equitable promises outside of the white public. Several studies have delivered a prescient warning that the Black population suffers from higher unemployment rates, under-or uninsurance, and a lack of care accessibility. A coalesced ramification of these shortcomings in coverage can partially account for the health care debacle as well as higher disease and mortality rates: “Twenty-seven percent of people living in poverty are Black, and studies consistently show that the least educated and lowest income people are the most likely to be unhealthy.”. Ultimately, a domino effect began before the U.S. was affixed on the map — one which allows for institutionalized racism to persist today, especially in healthcare.
Image retrieved from CNN
The people with the most power and control over systemic matters are elected officials and workers in the medical field. Politicians thus far have not been adamant in fostering a solution. Instead, they have only acknowledged a surface-level concern, somewhat performatively. Concrete change never lies in obligatory statements. For the government, that change resides in relief checks, bills, and intersectional improvements in healthcare accessibility. That is to say, the government has the ability to apply direct aid to the situation, but the pressure is not there.
Representatives on any level should actively coerce their colleagues to campaign for policies that will provide better insurance quality for minorities along with better standpoints for economic growth. In the past, activists have called on the president to “unleash a recovery bill that focuses on poor and minority communities to ensure people make livable wages and have access to paid sick leave, adequate child care, rent forgiveness, and health care.” This is a start, but not a new proposal. Often in conversation regarding the state of American healthcare, the argument of cost arises. It is a valid question; where will this money come from?
Currently, only 3% of the federal budget goes towards public health. A common proposition in recent years has been cutting defense spending and diverting the excess towards healthcare accessibility. Indeed, the government will have to allocate fiscal resources from other departments in order to compensate for the issue at hand. However, setting up the basis for centralized negotiation for technology, pharmaceuticals, etc. will help taxpayers get more bang for their buck. If the government can bargain for cheaper prices on medical products, the price for the American people will drop in accordance. Unfortunately, racial disparities will not cease through this alone. Personal biases must also be addressed to combat years of oppression and to have the most holistic success.
Contrary to their efforts, even the most educated and culturally competent healthcare professionals fall victim to implicit biases that will alter the course of their care. Regrettably, these instances can be difficult to diagnose, per se, as white clinicians often benefit from the suppression of their bias; it is easier to let them go unacknowledged than to make an active effort to reverse them. As aforementioned, negative predispositions about racial and ethnic minorities are normalized in society, often in the semblance of microaggressions. Research in social psychology shows that over time, stereotypes and prejudices become invisible to those who rely on them. Automatic categorization of an individual as a member of a social group can unconsciously trigger the thoughts (stereotypes) and feelings (prejudices) associated with that group, even if these reactions are explicitly denied and rejected.
In a physical sense, doctors may interpret a patient’s case based on their assumptions about that group’s health-related behaviors. For example, Dr. Monique Tello recalls, “A patient of mine recently shared a story with me about her visit to an area emergency room a few years ago. She had a painful medical condition. The emergency room staff not only did not treat her pain, but she recounted: ‘They treated me like I was trying to play them, like I was just trying to get pain meds out of them. They didn’t try to make any diagnosis or help me at all. They couldn’t get rid of me fast enough.’” This is not an isolated event. People began to take notice of the issue after the Institute of Medicine published a report with evidence that minority patients are not reliably given the same quality treatment as their white counterparts, regardless of insurance or wealth. The correlation lies within individual yet widespread prejudices, ensuring its constant presence in healthcare.
Image retrieved from The Today Show
Prejudice is personally mediated, and therefore difficult to legislate against. It will take a long time for bills to pass through Congress and even longer to thoroughly disassemble the structural inequity within America’s framework. Still, the most immediate solution can be implemented efficiently in hospitals, clinics, and other facilities. If clinicians find and act on the motivation to terminate their racist tendencies, an explicit difference can be seen to some extent in their care within the hour. In reality, the idea has drawn attention from critics — they say no one can be forced into changing their beliefs. While this may be true, there are ways in which change can be encouraged and indirectly enforced.
One option is required cultural competency training in healthcare settings. For it to be effective, experts like psychologists Jeff Stone and Gordon Moskowitz suggest the incorporation of implicit bias education. Non-conscious stereotyping is displayed by two-thirds of medical professionals, making it the main perpetrator. Future doctors and nurses alike must be taught through training to search for commonalities rather than cultural differences by putting themselves in the shoes of the patient. They must recognize and shut down their initial judgments, pursuing the goal of respect and complete honesty for every appointment. In a similar sense, hospitals should be required by law to report data on their quality of care. In 2014, the New England Journal of Medicine published a study on this matter. Researchers concluded that racial disparities were reduced in 17 categories. This would place necessary pressure on the medical field to do only what is best for their patients, regardless of race or ethnicity.
Furthermore, the Health Care Discrimination law (Section 1557 of the Affordable Care Act) must be strengthened in terms of consequence. The current fine for violation lies between $2,500-$500,000. For big corporations like hospitals, this cost can be lower than the alternative: insured compensation for the victim. Therefore, they find it easier to pay the statutory fine than to do the patient justice (Erwin). With a more serious fine, hospitals will need to locate and eradicate the source of disparities within their service.
It is of vital importance that the nation faces disparities in healthcare with a growing sense of urgency. Everyone must be an integral part of the change. Ultimately, doctors take an oath to serve patients to the best of their knowledge just as all citizens have an obligation to uphold a country in which all people are created equal. Self-awareness costs people nothing. It pays off with its potential to revive minorities, which together make up the majority. Fixing American healthcare begins and ends with racial and ethnic equity.
Written by writer Julia Loritz