Racism can take its toll on mental health. The impact will likely be worse if it occurs in a health facility where we are most vulnerable. However, there’s also a physical health angle to it. According to the Centers for Disease Control and Prevention (CDC), Black, Indigenous, and people of color (BIPOC) have higher rates of death and hospitalization compared to white populations.
For example, in New York City the mortality rate for Black infants is three times more than that of white infants. In 2015, it was observed that the mortality rate of Black New Yorkers younger than 65 years was 51% higher than white New Yorkers.
To address the inequality that stems from racism in healthcare, we must first understand how structural racism shapes the healthcare outcomes of our communities and its effect on all aspects of healthcare from resource availability in our communities to what happens behind closed doors in the doctor’s office.
The root cause of racism in healthcare
Structural racism is at the heart of health inequalities in the United States—and most other places. Types of structural racism include discriminatory practices and policies. For example, discriminatory policies (eg, residential segregation) have often confined our people to poorer neighborhoods, shaping where we work, and how we learn and play. All these issues influence our mental and physical health, directly or indirectly. But what set the foundation for structural racism?
In 1934, the Federal Housing Administration was formed by Congress. The agency collaborated with other organizations to rank neighborhoods from most desirable to least desirable. They ended up redlining predominantly Black and Latino neighborhoods on the residential maps.
Banks and other institutions used these maps to determine investment areas. Consequently, redlined neighborhoods received far less investment while white-only residents got more because they were believed to be safer for investment. The impact of redlining continues to this day.
10 negative impacts of racism in healthcare
Fewer investments have kept our neighborhoods poor with lower-quality schools, fewer safe places for physical activities, limited employment opportunities, and diminished access to fresh fruits and vegetables. These conditions negatively affect health outcomes. Here are 10 negative impacts of racism on the health of our communities:
- Misdiagnosis of mental illness: Clinicians often overlook depression symptoms and focus more on psychotic symptoms when dealing with Black patients. The outcome is that we are four times more likely to be handed a schizophrenia diagnosis compared to white males.
- Withholding anesthesia: Black adults are often treated without anesthesia even when they deserve one. A 2016 study found that most white medical students erroneously believe Black adults have a higher pain tolerance than white adults.
- Limited access to healthcare: The redlining of Black communities has also robbed us of significant investment in healthcare. We often must travel farther to get access to specialized healthcare like trauma centers.
- Denial of emergency care: White physicians often treat Black and White emergencies differently. A 2019 study found that Black and Latinx children are less likely to get emergency care or be admitted to the hospital after visiting an emergency department.
- Increased insurance claim denial: Black adults are more likely to visit a physician more than 3 times a year which increases their chance of claim denial. This forces out-of-pocket payment for healthcare procedures which further impoverishes our community.
- Lower health insurance coverage: A publication by the National Library of Medicine showed that Black adults are less likely to have insurance coverage from a private insurer and more likely to rely on public health insurance coverage compared to whites.
- Rising infant mortality: Lack of access to evidence-based prenatal care has led to an increase in pre-term births in our community which is one of the risk factors that favors infant mortality.
- Racial profiling and stereotyping in emergency situation: Several studies have reported instances where a Black patient is assigned a lower Emergency Severity Index (ESI) score than a white patient even when they share identical symptoms. A higher ESI score means the patient’s condition is severe and more resources would be assigned to them.
- Cultural insensitivity in healthcare facilities: Healthcare providers often make assumptions or use inappropriate languages that disrespect our cultural background, beliefs, and practices. This can potentially lead to distrust and misunderstanding and impact the quality of treatment.
- Avoidable deaths: There are heartbreaking stories of people who have lost loved ones because of lack of access to healthcare or misdiagnosis by the healthcare practitioner based on racial bias.
What you should do if you have been a victim of healthcare racism
If you have ever been a victim of healthcare racism, it is important to realize that you are not alone. There are steps you can take to seek redress:
1. Call out the behavior immediately. Ask the healthcare provider for clarification to determine if their comment was racially motivated. Let them know how their behavior has impacted you mentally.
2. The American Psychological Association (APA) suggests that having an open conversation about your experience rather than bottling it up can help alleviate the stress and trauma. Involve a counselor if talking about your experience fills you with rage, hopelessness, or distress.
3. Ask the healthcare facility to change the provider if their comment or actions has made it hard for you to trust their professionalism in handling your situation.
4. Report the healthcare provider to the patient relations department or ethics committee. You can also file a report with your state’s medical board or the relevant healthcare regulatory body. If you choose this route, make sure you document the details of the abuse including date, time, location, and the name of the healthcare provider.
Another way of channeling the negative feeling into a positive course is getting involved in activism. Use your voice and social media influence to campaign for racial equality. Following this route can also expand your connection with like-minded people.
For more reading:
https://www.medicalnewstoday.com/articles/effects-of-racism
https://www.cdc.gov/healthequity/racism-disparities/impact-of-racism.html
https://www.pnas.org/content/113/16/4296
https://www.frontiersin.org/journals/pediatrics/articles/10.3389/fped.2019.00525/full
https://www.ncbi.nlm.nih.gov/books/NBK24693
https://www.medicalnewstoday.com/articles/effects-of-racism#overview
Hoffman KM, Trawalter S, Axt JR, Oliver MN. Racial bias in pain assessment and treatment recommendations, and false beliefs about biological differences between blacks and whites. Proc Natl Acad Sci U S A. 2016;113(16):4296-301.
https://www.apa.org/topics/racism-bias-discrimination/managing-distress-racial-trauma