January 08, 2020⋅ 4:30 P.M ⋅ Faaizah Arshad⋅ Editor: Guadalupe Sandoval
Last summer, I read a book titled Black Man in a White Coat by Damon Tweedy. Tweedy’s anecdotes reflect a deep-seated issue of racial inequality in medicine. I’d like to urge you to read this book if you are even slightly interested in a health profession. Not only does Tweedy reveal the current flaws of our health-care system through the standpoint of a minority, but he also presents data that suggests a history of racism in the medical field. His book inspired me to research further into the root issue of racism in the medical field today.
In the United States, there are prominent differences between the socioeconomic status of black people compared to that of white people. This gap subsequently leads to differences in access to health care. Compared to white people, black people have lower household incomes, lower occupational prestige, decreased quality of education, and decreased presence in political and governmental offices (Phelan and Link 315). This idea of systemic racism in the United States today stems from slavery. When I first learned while researching this topic that a complex structure of the 18th and 19th centuries is a mechanism of health inequality today, I was skeptical. After all, slavery was abolished and Civil Rights Acts were later enforced. Thus, my first instinct was to assume that slavery, a 400 year old principle, should have little to no effect on medicine today. However, upon further examination of the relationship between racism and health, I found that the maintenance of segregation and overt discrimination, after Jim Crow laws, caused differences between “housing, employment, and schooling” between black people and white people overtime (Phelan and Link 312). Since education, income, and housing are components of socioeconomic status, and black people are often discriminated in these sectors, they are more likely to face poor access to health resources.
For example, according to a study (shown in Figure 1 on the right) by the Southern Jamaica Plain Health Center, 56% black people versus 38% white people reported that they rely on a bus service to attend their health appointments (Hostetter and Klein). Logically, if a black patient is more reliant on public transportation in order to receive medical care, then he/she is also more likely to be unable to access that care if he/she misses the bus or the bus does not show up. Essentially, black patients may need to “go the extra mile” and take the extra step of securing a ride to their health center before they are sure that they can attend their appointment. This thwarts them from accessing medical care that may be a simple walk or car ride away for their white counterparts.
Furthermore, 50% of black people compared to 45% of white people reported having missed or been tardy to their health center in the past year due to public transit, suggesting that black patients face greater challenges than white patients in accessing health care (Hostetter and Klein). Since the need to take public transportation may arise from being low income due to poor employment and education or living in unstable housing (issues that are more prevalent in black communities due to racism), black patients are often at an unfair disadvantage for medical treatment. This leads to health outcomes, such as differences in life expectancy between black and white babies. In fact, a 2010 census showing that at birth black Americans were expected to live 4 years shorter than their white counterparts demonstrates that “black Americans have substantially worse health and shorter life expectancies than white Americans” (Phelan and Link 313). These racial inequalities in health and mortality suggest that socioeconomic differences are at the forefront of medical disparities.
Take a look at Figure 2 on the left that diagrams the complex network between racism, societal factors, and health outcomes. Clearly, racism is illustrated as the root cause of disparities in many important developmental as well as essential social structures such as education, transportation, employment, health behaviors, and housing— all which affect health outcomes.
There are also mechanisms independent of socioeconomic status that cause black Americans to face poorer health outcomes than white Americans. Black neighborhoods are several times more likely than white neighborhoods to have fast-food outlets and lack healthy food options, tobacco and alcohol industries target minority black communities, and crimes are higher in black neighborhoods (Phelan and Link 322-333). Because there is a tendency for black people to struggle with medical care, I strongly believe that as patient advocates, physicians and health professionals must speak and fight for vulnerable, minority populations, like African Americans.
Examples of poorer health outcomes include that black Americans are “less likely to undergo coronary artery bypass surgery,… receive peritoneal dialysis, or [have] kidney transplantation” (Phelan and Link 322). Based on research presented above, perhaps black Americans struggle to undergo these operations that are necessary for their health because of financial instability or lack of education regarding the need for such treatments. Data also shows that black Americans experience lower quality and greater delays in care (Phelan and Link 322). Overall, it shocks and frightens me that medicine, a system that should be intact and faultless through advancing and saving lives, may instead be responsible for deaths due to systemic racism.
Likewise, in his passionate memoir, Tweedy, a black physician, reflects on his experiences with racism and prejudice in medical school and shares statistics that echo the idea that black patients are more likely to suffer from health complications than white patients.
So, as medicine emerges with ground-breaking treatments and solutions, let’s break the framework upon which systemic racism persists and make racial equity in medicine a priority. For every reason stated above, I strongly believe that we must increase racial diversity among physicians and health professionals. In 2016, “just 6% [of] practicing doctors [were] underrepresented minorities” (Robins). Do you understand the dire implications of that statistic? That means that most black patients rarely, if ever, meet a doctor who looks like them! Less than 10% of physicians in the United States represent the African American, Hispanic, and Native American population. The issue is that white doctors may struggle to empathize with black patients and people of minority backgrounds. Likewise, black patients may be less motivated to take charge of their medical care because they are not treated by someone of the same race who understands their challenges and needs. Seeing more doctors of the same race and ethnicity may encourage minority patients to be more trusting of their providers, more vocal about their needs, and more willing to make decisions that their doctors recommend, thus leading to better health outcomes. So, only by hiring minority doctors will the medical field be able to facilitate and represent underrepresented communities. America needs more black physicians in white coats.
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About the Author
Faaizah Arshad is an undergraduate at University of California - Los Angeles.