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Readers’ Guide to Racial Equity in Healthcare

Race is a Social Construct

To start, it’s important to understand that there is no biological basis for race. Race is purely a social construct, and racial inequities in health all have social roots (although health impacts on a social group can lead to genetic consequences for that group’s descendents, such as in sickle cell or Tay-Sachs disease).

The Role of Race Politics in the Development of the U.S. Healthcare System

The history of race politics in the U.S. is deeply intertwined with the unique development of our inequitable healthcare system, in ways that may surprise you. Gerard Boychuk’s book National Health Insurance argues that a primary reason universal healthcare passed in Canada was the national government’s attempt to prevent Quebec from seceding by instituting essential national services. In the United States on the other hand, segregationist politics in Congress blocked national healthcare for much of the 20th century – not, as is often claimed, the growth of employer-based insurance during WWII.

Treating Healthcare as a Commodity Allows Broader Racial Inequities to Impact Health

The growth and political entrenchment of a healthcare system that links access to care with ability to pay creates a dangerous dynamic in the U.S. as other large systems characterized by racial discrimination – such as access to employment, income, family wealth, housing, loans, social services, and more – translate into healthcare barriers. The literature here is vast, but we recommend Ira Katznelson’s history of how large federal programs that created the middle-class in the U.S. (Social Security, the right to unionize, the GI Bill, etc) largely excluded people of color, leading to a massive wealth gap, as well as recent studies showing the continued prevalence of racial discrimination across all areas of life – affecting employers, salespeople, doctors, legislators, and others – often due to “implicit bias” as opposed to intentional discrimination.

Experience of Racism as a Determinant of Health

These barriers to healthcare are all the worse since racial discrimination leads to greater health needs for some communities of color. In particular, a new body of a research in the last decade is showing that the daily experience of racism and the stress/self-doubt it causes, is a major cause of poor health itself, particularly for African Americans. This “embodied inequality” may also explain why immigrants, who are generally much healthier than native U.S. residents, experience declining health outcomes the longer they live here.

Racial Injustice in Medical Research and the Delivery of Care

Finally, for those who are able to access the healthcare system, medical research and the practice of medicine in the U.S. are marked by deep histories of racism as well. The Congressionally-funded 2002 study Unequal Treatment was a damning summary of the evidence that people of color are treated differently for the same medical conditions: receiving less routine care, lower-quality care, and more undesirable treatments such as lower-limb amputations.

The most notorious example of racist medical research is the Tuskegee syphilis experiment, conducted on rural African American men over the course of four decades up through the 1970s, to observe the end-of-life impacts of the disease. The men were not told they had syphilis or treated for it. Harriet Washington’s book Medical Apartheid places the Tuskegee experiment in the longer and larger context of inhumane medical experimentation on people of color – often in attempts to prove the racial basis of social behavior – which continues today.

We Can End Racial Inequities in Healthcare

We can and must end racial inequities in health. PNHP researchers have found, for example, that single-payer healthcare has almost eliminated racial gaps in unmet medical needs in Canada. Equity in health will require more than an equitable healthcare system, though: it will also require equity in the social determinants of health, such as education, housing, a healthy environment, and the equitable delivery of healthcare!

Comments

3 Responses to “Readers’ Guide to Racial Equity in Healthcare”
  1. bill shaver says:

    IMPLEMENT THE SINGLE PAYER…make it blind as to who’s the patent and cover all…unilaterally….

  2. David L Brown says:

    I am a Black man who has experienced repeated incidents of substandard medical care. I believe my race has played a part in this poor care. This poor care has contributed to the challenging medical situation I now find myself in. This situation, of course, also impacts my immediate and extended family.

    It all started in December 2010 when, at age 50, I came close to dying from multiple pulmonary emboli and deep vein thrombosis. Since I did not have any of the common risk factors, my GP referred me to a hematologist/oncologist for special testing to determine the cause of this abnormal clotting. After a month of so of seeing the specialist and not receiving any feedback from him about the test results, I asked him directly what the results were. He told me they came out okay. I also asked him directly if cancer was a cause of the clotting. He said no.

    After 6 months of treatment, the specialist took my off the anticoagulant (warfarin) I’d been treated with. Then in January 2011, I had another pulmonary embolism. This time I decided to obtain my medical records because I wanted to see the results of the testing he said was okay. In reading through the records, I learned that he never completed any of the tests.

    When my wife and I confronted him about this, he was outraged and became hostile. He went to on to deny that my GP had referred for this testing (hypercoagulability workup it is called). He insisted that I had been referred only to have my warfarin levels monitored, something that my GP had been doing and could’ve kept doing at a fraction of the cost, I might add. I had a protracted struggle with this doctor to get him to do just a couple of the tests.

    I continued in treatment with this specialist and many things emerged which were concerning. He would dictate into his digital recorder towards the end of each appointment that my “abdomen was soft, non-tender”. He only palpated my abdomen 2 times out of the many appointments I had with him in 2011 and 2012. He also falsified medical records, documenting that I had taken myself off warfarin after the first course of treatment with him. That was a bald faced lie. He directed me to stop. He also falsified records by saying the I had gone against his recommendation to do low dose aspirin therapy as a prophylactic. He never directed me to use it or Rxd aspirin. He simply said that I could use it if I wanted to, which I did for a month or two.

    Unfortunately, I fell ill again in 2013, landed in the hospital and was diagnosed with stage 4 adenocarcinoma of the small intestine. And the cancer had spread to my liver. It is highly likely that the cancer is what was causing my blood to clot abnormally in 2010 and 2011. Which suggests that all the while I was under the “care” of the hematologist/oncologist, the disease was growing and spreading. Oh, the irony.

    Only now do I know that there were tests that he should have completed to rule-out cancer. He did not. And by not doing them, he prevented me from receiving intervention to treat this cancer in an earlier stage.

    This specialist is a different race than I am. I tried to work with him as an informed consumer. I do my research on health and medical care and have done for years. So, I would ask questions and make suggestions. He comes from culture in which questioning professionals is seen as insulting. So, although l was always respectful towards him, he was unable to see me as a participant in my health care. Thus, it was easy for him to deny me testing, get angry when I asked questions, falsify my medical records, etc. Sadly, my GP is Black. He did not do his job either. He never insisted on my getting the testing he referred my for.

    In hindsight, I recalled a study in which it was found that a very high percentage of Black healthcare consumers receive substandard medical care even when their physician is Black.

    I am outraged by having been pulled down into a rabbit hole with this healthcare experience. I’ve sought legal recourse. But no firm would take my case. I will file a complaint against this specialist. But it will most likely come to nothing. Sitting here dying of cancer which could have likely been diagnosed and treated 2 years earlier and struggling with the fact that I was bitch-slapped by the medical profession on top of that, leaves a sour taste in my mouth.

    I no longer have much respect for the medical profession. But I truly understand what is meant by the phrase “practicing medicine”. As with any endeavor, there will be doctors who practice and practice and practice some but never get things right.