As protests of police brutality continue nationwide, doctors and nurses are speaking up about a public health crisis of equal importance: medical racism. Defined as “prejudice and discrimination … in the medical/health care system based upon perceived race,” it’s a centuries-old, complex web of ignorance, racism and implicit bias that has deadly implications.
In Texas, Utah, Washington, D.C., New York, Illinois, Missouri, Minnesota and elsewhere, health care workers are saying enough — holding vigils, marching outside hospitals and posting hashtags like #blacknursesmatter and #whitecoatsforblacklives. Their goal, as several tell Yahoo Life, is not only to raise awareness about how systemic oppression leads to poorer health outcomes, but also to expose the medical world’s continued failure to listen to and care for black individuals.
Dr. Darrell Gray, a gastroenterologist at the Ohio State University Wexner Medical Center and medical director for the National African American Male Wellness Initiative, says he joined a demonstration on OSU’s campus recently in which doctors and nurses knelt for eight minutes and 46 seconds, the amount of time Minneapolis police officer Derek Chauvin had his knee on George Floyd’s neck. “Global protests around racial injustice ... bring to light not only just the horrific police brutality, but also the racial disparities and health disparities that we’ve seen for some time,” Gray tells Yahoo Life.
‘Protesting is just step one’
Gray says that the protests against medical racism are merely the tip of the iceberg when it comes to addressing this problem. “Kneeling and protesting is just step one,” he says. “Step two has to be the action to follow up and how we address racism.”
One of the key steps, he says, is heightening awareness around this issue. In the midst of a global outcry over systemic racism, and a pandemic that is killing black people at 2.4 times the rate of whites, it’s nearly impossible to ignore. “COVID-19 has disproportionately impacted people of color, particularly African-Americans. And that’s no surprise, right?” says Gray. “Because most of the health disparities, whether we’re talking about cardiovascular disease or diabetes, disproportionately impact these populations, and it’s those chronic conditions that predisposed them to worse outcomes with COVID-19.”
A worse health outcome for black people isn’t the exception in most cases — it’s the rule. Black people not only have higher rates of underlying conditions like diabetes, heart disease and stroke, but they’re also more likely to die of complications from them. According to the U.S. Department of Health and Human Services’ Office of Minority Health, black Americans have a higher death rate than any other racial group for heart disease, stroke, cancer, asthma, influenza and pneumonia, diabetes, HIV/AIDS and homicide.
In a recent piece on this issue, Melissa Creary, an assistant professor of health management and policy at the University of Michigan School of Public Health, made an important distinction about these statistics. “It’s not the fact that [black people] have these diseases that’s causing the higher death rate because people of all races, classes and creed have these diseases,” Creary said. “It’s the fact that we see an undeniable burden of disease in the black population. It’s this disproportionate amount that is worrisome. The underlying issue to why we see so many is actually attributed to structural inequity.”
It’s that structural inequity that Ohio State’s Gray and others are pushing to unearth. “We have to take a step back and say, ‘Well, why is it that there are other kinds of social determinants of health that lead to those poor downstream health outcomes?’” Gray asks.
‘It’s not designed for them to be healthier’
Social determinants of health — defined by the World Health Organization as “the conditions in which people are born, grow, live, work and age” — are a pivotal part of the conversation. Things like access to health care, socioeconomic status, education, neighborhood and availability of healthy food have all been connected to many of the same underlying conditions linked to COVID-19, as well as countless others.
A former nurse turned professor (who requested anonymity due to her job) says she’s joined the protests to stand with her black colleagues — and to fight for more awareness of these factors. It’s something she teaches her students as well. “I say, ‘OK, examine your community. How many fast food restaurants are around this hospital? And they’ll count them off, White Castle, KFC, McDonald’s. I say, ‘OK, if you wanted to buy an apple, how far would you have to walk?’ They’ll say, ‘Oh, down about 10 blocks.’ And I’ll say, ‘Exactly,’” she says. “You have to understand where your patients are coming from and the social determinants of health that are impacting them,” she tells Yahoo Life. “It’s very hard to tell someone, ‘Be healthy, be better,’ when socially it’s not designed for them to be better. It’s not designed for them to be healthier.”
On top of a lack of access to healthy food options, studies have shown that actual living conditions play a role in health as well. Harriet A. Washington, author of Medical Apartheid, explored this recently in a paper for Nature, in which she revealed that many health issues more prevalent in black people — including coronavirus — can be traced to unequal housing, which disproportionately exposes individuals to things like lead paint and air pollution. “Vulnerability from diabetes, to kidney disease and heart disease to respiratory weaknesses — all of those are worsened or created by environmental exposure,” Washington tells Yahoo Life.
But even when these factors are controlled, many black Americans continue to show worse health outcomes than whites in similar socioeconomic brackets. One reason may be what’s known as allostatic load, or the effect of chronic stress on the body — specifically, in this case, racism. A 2012 study on the topic of more than 4,000 individuals found that the “chronic physiologic stressors” caused by racism are linked to higher mortality rates among black people. The high rates of allostatic load have been connected to an earlier deterioration in health for black Americans, which is sometimes referred to as “weathering.” This has been shown to be particularly prevalent in black women, who experience stress from both racism and sexism simultaneously.
‘We still believe that African-Americans don’t feel pain as whites do’
While outside factors like poverty and food insecurity may contribute to underlying conditions, distrust and mistreatment of black people by those in the medical world have been shown to contribute to higher mortality rates as well. Black people have routinely been shown to receive both less care and poorer quality care overall. One of the most glaring examples of this is among black mothers, who are more than three times more likely to die from a pregnancy-related complication than white women.
Gray says it’s something that’s seen in every specialty, including his. “I think there are patients who experience the detrimental impacts of implicit bias, meaning those unconscious kind of stereotypes that influence someone’s care,” he says. “So if a patient comes in and looks a certain way or talks a certain way, there may be bias and that could impact their treatment, whether it’s treatment for inflammatory bowel disease, whether it’s treatment for colon cancer.”
Washington, who has been studying the historical context of this for decades, says this failure to treat black patients fairly has origins in 18th century medical studies in which experts declared that black people were a different species than whites — and were less able to feel pain. It’s a dangerous myth that persists to this day.
“We still believe that African-Americans don't feel pain as whites do,” Washington tells Yahoo Life. “There’ve been studies conducted frequently in modern times to show this. The most recent I read was in 2016 at the University of Virginia, where fully 50 percent of medical students — and then almost as high a percent of the practicing physicians — believe that African-Americans don’t feel pain as whites did.”
Other studies have backed this up. A 2016 study from Princeton University found that nearly half of first- and second-year medical students believed one or more of the following statements: “Black people’s nerve endings are less sensitive than white people’s,” “Black people’s skin is thicker than white people’s,” “Black people’s blood coagulates more quickly than white people’s.” None of which, of course, is true.
This lack of understanding is something the professor says she has even experienced herself. “I’ve done lectures on ... how when we see someone of color, how unconsciously we don’t realize we don’t believe their pain,” she says. “If I have an African-American patient versus a white patient both saying they’re in pain, I’m going to the white patient first. It took many years for me to realize: You’re biased against your own people.”
‘We all have to be outraged’
Gray says that the fact that medical workers are making a point to stand up against these issues is crucial. “We all have to be outraged — not only for our own personal lives and our children and our communities, but for our patients,” Gray tells Yahoo Life. “We need to be outraged, and we have to turn that outrage into action.”
For those unsure of how they can help, he suggests not only educating yourself and your community, but looking for actual steps you can take to dismantle these systems. “I think it’s up to all of us to really advocate. Maybe our workplace is in housing development, maybe our workplace is in food, maybe our workplace is in health — leverage those assets for a better world.”
While there is undoubtedly much work to be done, Washington — who remembers being spat on during demonstrations during the 1960s civil rights movement — is hopeful. “The fact that medical workers are also involved in decrying deficiencies in the system [makes me] very, very happy,” Washington says. “It really gives me hope if we’re going to see genuine change and, you know, out of some very horrific circumstances and events. I think at least we’re going to see real change and something I hope I have not had for a while.”
Gray is too. “I’m hopeful that this is a tipping point and that we can leverage this momentum and global outcry toward action — action toward health equity and racial equity,” he says. “And I’m hopeful that this leads to dollars being put into resources to accomplish that.”
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