#BlackLivesMatter: Is Our Health Care System Fundamentally Racist?
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Exhibit A:
A young white woman visits a medical clinic with acute pain in her lower abdomen. She’s preliminarily diagnosed with appendicitis.
A young black women visits the same clinic with identical symptoms. She’s given a diagnosis of pelvic inflammatory disease, which usually is the result of an untreated sexually transmitted disease.
Exhibit B:
Among women diagnosed with breast cancer, African-American women are the most likely to die from the disease.
Exhibit C:
In New York City, the rate of premature death is 50 percent higher among black men than among white men.
The Verdict:
The #BlackLivesMatter movement — which began in 2013 as a hashtag when George Zimmerman was acquitted in the shooting death of Trayvon Martin, and gained momentum after the deaths of Michael Brown and Eric Garner in 2014 — needs to extend to the American health care system.
That’s the message of three experts in Thursday’s edition of the New England Journal of Medicine — that it’s essential to recognize racial disparities in access to and quality of health care, the disproportionate number of preventable deaths and illness within the African-American community, and the overall underrepresentation of people of color within the medical establishment.
In her piece “#BlackLivesMatter – A Challenge to the Medical and Public Health Communities,” New York City’s health commissioner Mary Bassett, MD, MPH, says that “[t]here is great injustice in the daily violence experienced by young black men. But the tragedy of lives cut short is not accounted for entirely, or even mostly, by violence. In New York City, the rate of premature death is 50 percent higher among black men than among white men…and this gap reflects dramatic disparities in many health outcomes, including cardiovascular disease, cancer, and HIV. These common medical conditions take lives slowly and quietly — but just as unfairly.”
The trickle-down inequalities of health care in the black community are not just limited to men. “Black women in New York City are still more than 10 times as likely as white women to die in childbirth,” Bassett points out.
According to data from Young Invincibles, a policy group focused on health care reform for young adults, African-Americans ages 18 to 34 have, historically, been disproportionately uninsured — and one of the populations most significantly impacted by the Affordable Care Act (or ACA, known by many colloquially as Obamacare). Since the implementation of ACA, about half a million young African-Americans have gained access to health insurance because they are now able to remain on their parents’ plan through age 26. An additional 1.8 million uninsured young adult African-Americans could be eligible for tax credits for lower premiums and an additional 1.7 million could be eligible for free or low-cost Medicaid coverage if all states were to participate in the ACA’s Medicaid expansion program (currently just 27 do).
The lack of health insurance among this demographic contributes to poor health outcomes compared to other groups (and white peers especially): African-Americans are more likely to die from chronic diseases and heart disease; experience negative health effects from poverty such as asthma, obesity, and infectious diseases; and are 12 percent less likely than white adults to receive a flu vaccine. Furthermore, a disproportionate number of these deaths are the result of pregnancy complications in young African-American women and chronic lower respiratory diseases in young African-American men.
Racial disparities in the American healthcare system impact children, too.
A 2009 report published by First Focus, a bi-partisan advocacy group, found that not only are African-American children more likely to suffer from asthma, skin allergies, speech problems, and unmet prescription needs, but that African-American children are at a 12 percent greater risk of being uninsured — and thus left with sub-optimal health care. And yet, many of these children are eligible for, but not enrolled in, Medicaid of the Children’s Health Insurance Program (CHIP).
The report concludes that providing insurance to these children would result in “significant reductions in unmet needs for medical care” and “increased visits for preventive specialty care; improved quality of care…higher immunizations rates…reduced emergency department visits for asthma and reduced hospitalizations.”
Young women face their own unique challenges; a spokesperson for Planned Parenthood notes that black teens ages 15-19 have higher rates of pregnancy, birth, and abortion than non-Hispanic white teens. While at a historic low, the birth rate for African-American teens is more than twice that of non-Hispanic white teens.
In January of this year, Cecile Richards, President, Planned Parenthood Federation of America, addressed the National Press Club to call attention to disparities in women’s healthcare. In her remarks, Richards urged Congressional leadership to address these inequalities by expanding access to publicly funded family planning services; support medically accurate, age-appropriate sex education nationwide; make birth control available and accessible; and support efforts to strengthen and protect Medicaid.
A study out today in the Journal of the American Medical Association (JAMA) found that while they did not ultimately impact clinical decisions, unconscious race and social class biases were present in most trauma and acute-care clinicians. 215 clinicians were surveyed; almost all were found to have moderate racial biases, and strong social class biases, regardless of the clinician’s respective age, race, and clinical specialty. One particularly startling finding was that respondents were more likely to diagnose a young black woman with pelvic inflammatory disease rather than appendicitis when presented with the same set of symptoms among black and white patients.
This data speaks strongly to a second piece regarding black lives and healthcare in Thursday’s New England Journal of Medicine. In it, David Ansell, MD, MPH, and Edwin McDonald, MD, write about the “White Coats for Black Lives” die-ins held at medical schools across the country this past December, “the largest coordinated protests at U.S. medical schools since the Vietnam War era,” a movement that set out to call attention to “the explicit and implicit discrimination and racism in our communities and reflect on the systemic biases embedded in our medical education curricula, clinical learning environments, and administrative decision-making.”
Ansell and McDonald reiterate the findings of the JAMA study, noting that implicit racial biases often impact the kind of care a patient receives. A 2002 Institute of Medicine (IOM) study found that “for almost every disease studied, black Americans received less effective care than white Americans. These disparities persisted despite matching for socioeconomic and insurance status.”
Ansell and McDonald also point out that while “black medical students are more than twice as likely as white students to express a desire to care for underserved communities of color,” the number of African-American men graduating from American medical schools has declined over the past twenty years. Perhaps not coincidentally, “only 2.9 percent of all faculty members at U.S. medical schools are black” and “black faculty members are less likely than their white counterparts to be promoted, to hold senior faculty or administrative positions, and receive research awards from the National Institutes of Health.”
The authors conclude that the racial disparities that exist in our healthcare system cannot be fully addressed until the biases happening in medical education are first addressed.
