Racism: The American Healthcare System’s Deadliest Disease
BY Stephanie Diaz Feeney
Introduction
The American healthcare system prides itself on the quality of care it provides all its patients, considering itself the home of the globe’s best physicians and most advanced medical technologies. However, the healthcare system fails to create a universal standard of care that implements national benchmarks to provide accessible and high-quality medical treatments to patients of all ethnic and socioeconomic backgrounds. These shortcomings arose because of systemic barriers that exacerbate the health disparities felt by communities of color and contribute to the differences in the quality of care they receive. Additionally, the healthcare system suffers from implicit biases and internalized racism that physicians harbor. These biases disproportionately affect Black and Latino communities, costing patients their health and safety. Although instances of medical racism are more noticeable today, they have endured throughout American history. Such examples included the Tuskegee Syphilis Study and the case of Henrietta Lacks. In this paper, I will uncover how people of color are impacted by racism that has become normalized within the medical field, including the prevalence of pro-White sentiments amongst physicians, the lack of information concerning disease presentation in minorities, and the impact modern segregation has on patients’ access to accredited facilities.
Historical Context
During the Jim Crow era, anti-minority sentiments were propagated to reinforce ideas of White superiority following the Civil War. As a result, segregation and racism were institutionalized throughout America, thus seeping into the medical sector. Throughout this period, medical professionals abused African American patients by withholding vital health information and using invasive and inhumane treatments. One of the most disturbing instances of medical racism that continues to impact the health of African Americans was the Tuskegee Syphilis Study. In 1932, the United States Public Health Services (USPHS) conducted a study in Tuskegee, Alabama, to observe the effects of untreated syphilis. The test subjects included 600 African American men selected because of the stereotype that Black men were “inferior and animalistic,” which was adopted as medical doctrine. Researchers justified their studies through their flawed understanding of race and harmful stereotypes, including the idea that African Americans were mentally inferior regardless of their educational and socioeconomic backgrounds. Therefore, they concluded Black patients would reject treatment for syphilis (McVean).
Throughout their study, researchers attracted participants by promising medical attention and treatment for their conditions. Instead, previously syphilis-free participants were infected with the disease and then provided with ineffective medications to convince them that their illness was being treated appropriately. Researchers from the USPHS took further measures to prevent the study’s participants from receiving the appropriate syphilis treatments that could save their lives. This was seen through the researchers’ refusal to provide the patients with penicillin, despite its acceptance as an effective medication against syphilis. Their falsehoods prevented the infected individuals from seeking medical attention elsewhere, as participants believed they were adequately taken care of throughout the study. As years progressed, the USPHS denied access to life-saving antibiotics, stating that they would be ineffective because of the extended period that the participants’ syphilis was left untreated. The Tuskegee study resulted in the deaths of 87.7% of their original participants and the transmission of syphilis to their wives and children (McVean). The study highlighted the impacts of systemic racism in healthcare. It contributed to a legacy of mistrust towards physicians amongst African Americans due to the rise of preventable deaths at the hands of reputable medical institutions. Consequently, many African American patients refused to seek necessary medical care, contributing to worse health outcomes due to underlying medical conditions being left undiagnosed and unregulated. Suspicion towards medicine and healthcare providers continues to negatively impact the health of Black communities, contributing to the average lifespan of African American males being shorter than that of White males (Frakt).
Mistrust of medical professionals and abuse of patients continued throughout the 20th century, exemplified by the case of Henrietta Lacks. Lacks was an African American woman with an aggressive form of cervical cancer. A sample of her cancerous tissue was used to develop the first human cell cultures that would contribute to significant advancements in biomedical technologies and continue to be used by researchers today. Despite her contributions to some of the most significant advances in modern medicine, her story highlights the effects of Jim Crow and the differences in the standard of care for African Americans at the time. Before her cancer diagnosis, Lacks’ medical records show that she had several diagnosed diseases that were left untreated, likely because hospitals refused to treat African Americans. This contributed to the avoidance of medical institutions among Black patients and worsened their illnesses (Wellings). Upon her discovery of a tumor in her cervix, Lacks was admitted to Johns Hopkins Hospital, which had a charity hospital that would provide medical care to minority groups. However, Black patients at the charity hospital received poorer care, including significantly more painful and less effective treatments than White patients. While receiving treatment for her cancer at the hospital, her doctors removed a tumor sample without Lacks’ consent. This emphasized that to her physicians, Lacks was an object for observation instead of a human being (Wellings). Lacks and her family remained unaware of the extraction and use of her cells for research purposes several years after their removal. Although Lacks’ initial radiation treatment was successful, her health began to decline again and she was declared cancer-free. However, Lacks’ doctors overlooked her pain and disregarded her claims that her cancer had returned. X-rays taken months later showed that Lacks’ organs were fully covered in tumors, reaching a state where treatment would be ineffective (Wellings). The story of Henrietta Lacks highlights how the health of a Black woman was disregarded despite the impact her cell cultures had on the advancement of medicine. Large corporations used and distributed her cells, allowing them to make significant earnings. In doing so, the medical sphere exploited and profited from the suffering of a Black woman, highlighting the impact of institutionalized medical racism and the dehumanization of Black patients.
Effects on Patient Care
Racism within healthcare is a prevalent issue affecting millions of Americans. These practices create distrust and fear of receiving medical attention amongst people of color. Additionally, it can contribute to unequal treatment of patients and delayed diagnosis of serious diseases. As a result, Hispanics and African Americans are often in worse health and face more medical complications than other ethnic groups (Frakt). This is due to the inaccessibility of high-quality medical care and avoiding receiving medical care. Consequently, people of color in America have lower life expectancies than White people, which can be prevented if a universal standard for health care were established.
All physicians strive to provide every American with equal and effective medical care. However, a physician’s implicit racial biases and belief in stereotypes can unknowingly impact doctors’ decisions regarding their patients’ health and contribute to the continuity of healthcare disparities. Elizabeth Chapman, a professor and researcher from the University of Wisconsin’s Department of Medicine, examined studies using the Race Preference Implicit Association Test (IAT) to measure biases among medical professionals. The IAT is a computerized program showing images of individuals of African American and Caucasian backgrounds. It would require participants to select which words, such as good or evil, they associate with the pictures as quickly as possible to determine their innate responses (Chapman et al.). Chapman analyzed a study conducted by professors at Harvard Medical School and UNC-Chapel Hill that surveyed the implicit biases of doctors and residents across four medical centers in Boston and Atlanta. The study concluded that most participants harbored pro-White bias and viewed Black patients as uncooperative despite not having explicit biases (Chapman et al.). Chapman also highlighted a study by researchers at the Johns Hopkins School of Medicine that demonstrated the impact of IAT results on patients’ opinions of their doctors. The study showed that Black patients were dissatisfied with doctors who exhibited low explicit bias yet demonstrated high pro-White sentiments on the IAT. The patients viewed the doctors as rude or unfriendly compared to their peers (Chapman et al.). This data indicates that although physicians do not intend to provide discriminatory treatment for their patients, their beliefs interfere with their ability to connect with patients and make them feel welcome in their offices.
Similarly, this bias is seen in the treatment of patients in the emergency room. When admitted to the emergency room, Black and Hispanic individuals are less likely to receive painkillers than their White counterparts. On average, Hispanic patients are up to seven times, and Black patients are 14 times less likely to receive opioids to alleviate pain from injuries (Chapman et al.). The difference in treatment of minorities and White patients is due to false and harmful stereotypes harbored by many doctors, specifically that African Americans and Hispanics are inclined to abuse drugs or that Black patients have higher pain tolerances because they have thicker skin. Such stereotypes lead to unnecessary patient suffering that could have been prevented if physicians were aware of how their implicit biases influence their practice.
Due to the racism individuals face when seeking medical attention, many African Americans and Hispanics feel discomfort during routine medical checkups. According to data released by the Commonwealth Fund, approximately 32% of Latinos and African Americans ages 60 and older have had a physician who discriminated against them because of their race. The study also shows that 27% of the surveyed patients believed they did not receive the treatment necessary to manage their conditions (Doty). These experiences have damaging effects within this age group, as health becomes increasingly delicate with age. The study further illustrates the impact of bias amongst doctors because nearly half of the individuals who reported being discriminated against are in poor health and have several chronic conditions. These outcomes are tied to being overlooked by doctors because of their racist ideologies or because patients avoid seeking medical attention out of fear of being discriminated against.
Patients avoid specialized medical attention, including dermatological treatment, because doctors lack knowledge regarding the nuances of treating minority patients. According to CBS News, approximately 42% of dermatologists feel underprepared when treating patients with skin of color. According to dermatologist Jenna Lester, most medical school textbooks and literature only show how skin conditions present themselves in patients with fair skin. Jules Lipoff, a professor at the University of Pennsylvania, analyzed the university’s textbooks to determine the extent of representation of deeper skin in dermatological literature. She concluded that only 4-18% of the images showed people with deeper skin. Her analysis also showed that sexually transmitted diseases often used patients with darker skin as examples (McFarling). This negative representation within medical literature reinforces harmful stereotypes and associates Black patients with higher rates of sexually transmitted diseases. Due to this lack of preparation, many dermatologists refuse to treat patients with darker skin or fail to provide accurate diagnosis and treatment (“Consequences of the Dermatology Industry’s Lack of Diversity” 0:44 ). For years, patients like Shane Bloomfield suffered skin discoloration that puzzled dermatologists. After many failed attempts to treat and manage his condition, dermatologists eventually turned him away. Eventually, he was referred to Dr. Nada Elbuluk, a dermatologist specializing in skin disorders in people of color. The doctors finally diagnosed Bloomfield’s skin disorder as Lichen planus pigmentosus. This disease predominantly targets melanated skin that causes hyperpigmentation, burning, and potential hair loss (“Consequences of the Dermatology Industry’s Lack of Diversity” 1:12). Although Bloomfield is now receiving treatment, his condition might not be fully treatable due to its detection at such a late stage. His story emphasizes how medical schools do not adequately educate their students on skin disorders that target people of color, causing those affected to feel shame and embarrassment due to the appearance of their skin due to their lack of treatment.
Delayed diagnoses, especially concerning diseases like cancer, can lead to unfortunate health outcomes in Black and Latino communities. This is evident in the dermatology industry, as skin cancer is underdiagnosed in Black and Hispanic patients because of doctors’ limited exposure to cases involving deeper skin tones. Skin cancers such as melanoma or basal cell carcinoma are more common in non-Hispanic White patients. However, Hispanic and Black patients are twice as likely to get diagnosed with skin cancer at later stages. Even if the cancerous mole was discovered at the same stage, minority patients are at higher risk of dying than White patients (Shao and Feng). Delayed diagnosis is due to the lack of modern literature considering how these cancers may appear in melanated skin. Additionally, skin pigmentation might mask some signs of a mole being cancerous. Less common skin cancers lack documentation of their appearance in patients with darker skin. As a result, dermatologists cannot confirm whether their patient presents an uncommon form of cancer, leading to it going undiagnosed and untreated (Shao and Feng). Patients of color are more vulnerable to skin cancer due to a lack of community knowledge. Many Hispanic and Black communities are unaware they can also develop skin cancer from sun exposure. This contributes to most people of color failing to practice proper routines to protect themselves from sun exposure (Buchanan Lunsford et al.). People with darker skin are also less likely to perform self-examinations of any moles on their bodies, indicating that they do not schedule medical checkups to examine them (Shao and Feng). Thus, patients allow cancerous moles to advance to more deadly stages, ultimately contributing to higher skin cancer mortality rates.
Although skin cancer diagnoses have the most noticeable differences in patient treatment, the disparities in medical facilities also cause inequalities in cancer treatment and detection. Yamile Molina, a researcher at the University of Illinois-Chicago, organized a study to survey women in Chicago between the ages of 30 and 79 when they received their breast cancer diagnoses to analyze possible factors influencing their health outcomes. The data shows that although breast cancer is less prevalent in Hispanic and Black women, they are more likely to experience late-stage diagnosis when compared to White women (Molina). This results from predominantly Black and Hispanic neighborhoods having fewer medical facilities that meet national standards. As described by Molina, reliable radiology clinics are accredited by the National Consortium of Breast Centers (NCBC) and are certified as Breast Imaging Centers of Excellence (BICOE). However, non-accredited radiologists may adhere to national breast imaging standards set by the Mammography Quality Standards Act. Despite their ability to adhere to federal benchmarks, non-accredited institutions fail to deliver the same quality of technology and care accredited radiologists provide. Molina’s study shows that a small percentage of women of color receive care at nationally recognized facilities due to a lack of neighborhood accessibility. Consequently, women of color are more likely to receive cancer screenings at unaccredited breast imaging facilities. The study found that women who visited unaccredited radiologists were 22% more likely to receive delayed breast cancer diagnoses by approximately 60 days (Molina). As a result, the contrast between facilities’ mammogram technology, technicians, and ability to provide patients with necessary lab work and test results contributes to the minority death rate being 62% higher than that of White women (Grimes). Modern-day segregation, or the effects of structural racism that have created distinctly Black and White neighborhoods, is a leading cause of the disparities between facilities in White and minority communities (Grimes). In cities such as Chicago, modern-day segregation amplifies disparities in healthcare. Creating racially homogeneous neighborhoods contributes to the continued inability to provide medically underserved communities with access to nationally accredited clinics and skilled doctors. Consequently, it contributes to higher mortality rates of cancer and other diseases among communities of color and the continued distrust toward medical professionals.
Conclusion
Racism is one of the American healthcare system’s worst epidemics and, unfortunately, one of the most difficult to cure. Medical racism has permeated throughout American history and continues to impact the well-being of millions of Americans who suffer the consequences of not having access to unbiased medical care. Policy changes have been made in the past decades toward eliminating discrimination, starting with the Civil Rights Act of 1964. It prohibited explicit racial bias in healthcare and threatened to strip federal funding from hospitals that failed to provide patients of all ethnic backgrounds with universal access to care (Fields Allsbrook and Keith). More recently, the American Medical Association delivered a public apology to minorities concerning their history of racism. The apology included the AMA’s goals of eliminating racial bias and encouraging activism within the medical community (Davis). Despite their positive intentions, the Civil Rights Act and American Medical Association failed to address institutionalized practices that have adversely affected people of color and the impact of implicit biases within the medical system.
Although policy changes and apologies from medical associations are necessary to eliminate racism within medicine, efforts must be made to educate physicians and promote greater representation within medicine. Starting in medical school, students should recognize the structural issues within medicine that amplify the impact of racism. Both medical students and practicing physicians should also be encouraged to recognize their privilege, acknowledge the effects of implicit bias and belief in stereotypes within their practices, and determine measures to take to correct their shortcomings to minimize their impact on patients. Diversifying the medical field is also essential to reestablish physicians’ credibility with people of color. Pairing Black and Hispanic patients with doctors of similar ethnic backgrounds creates trust between doctors and patients as opposed to an imbalance of power felt when visiting their White peers. In doing so, patients can develop a more personal relationship with their physicians. These improved relationships allow patients to feel that their concerns are being acknowledged, seek medical attention at higher rates, and follow through with treatment plans for their medical conditions.
If doctors are not taught to be culturally sensitive and patient-physician relationships are not improved, the American medical system will continue to fail people of color despite its identity as one of the most medically advanced countries. Without change, institutionalized medical racism will continue to ostracize Black and Hispanic patients and deepen mistrust toward doctors. People of color will thus stop scheduling necessary medical visits due to their discomfort. As a result, Black and Hispanic communities will continue to fail to monitor and manage their medical conditions. Similarly, the lack of education and proper representation of people of different ethnic backgrounds will persist, allowing certain diseases, such as cancer, to remain untreated. Thus, Black people and Latinos will continue to experience worse health outcomes and shorter life expectancies than other ethnic groups, emphasizing the importance of promoting efforts to dismantle the institution of racism within medicine.
Works Cited
Buchanan Lunsford, Natasha, et al. “Skin Cancer Knowledge, Awareness, Beliefs and Preventive Behaviors among Black and Hispanic Men and Women.” Preventive Medicine Reports, U.S. National Library of Medicine, 6 Oct. 2018, www.ncbi.nlm.nih.gov/pmc/articles/PMC6199782/#:~:text=Black%20and%20Hispanic%20populations%20perceive,and%20behaviors%20among%20these%20groups.
Chapman, Elizabeth N, et al. “Physicians and Implicit Bias: How Doctors May Unwittingly Perpetuate Health Care Disparities.” Journal of General Internal Medicine, U.S. National Library of Medicine, Nov. 2013, www.ncbi.nlm.nih.gov/pmc/articles/PMC3797360/.
“Consequences of the Dermatology Industry’s Lack of Diversity.” CBS News, CBS Interactive, 8 July 2022, www.cbsnews.com/video/consequences-of-the-dermatology-industrys-lack-of-diversity/.
Davis, Ronald M. “July 30, 2008 – American Medical Association.” American Medical Association, 30 July 2008, www.ama-assn.org/sites/ama-assn.org/files/corp/media-browser/public/ama-history/ama-apology-african-americans.pdf.
Doty, Michelle M., et al. “How Discrimination in Health Care Affects Older Americans, and What Health Systems and Providers Can Do.” Commonwealth Fund, 21 Apr. 2022, www.commonwealthfund.org/publications/issue-briefs/2022/apr/how-discrimination-in-health-care-affects-older-americans#1.
Fields Allsbrook, Jamille, and Katie Keith. “ACA Section 1557 as a Tool for Anti-Racist Health Care.” Health Affairs, 8 Dec. 2021, www.healthaffairs.org/do/10.1377/forefront.20211207.962085/.
Frakt, Austin. “Bad Medicine: The Harm That Comes From Racism.” The New York Times, The New York Times, 13 Jan. 2020, www.nytimes.com/2020/01/13/upshot/bad-medicine-the-harm-that-comes-from-racism.html.t
Grimes, Katie. “Breast Cancer and Structural Racism.” Women in Theology, 23 Aug. 2011, womenintheology.org/2011/01/23/breast-cancer-and-structural-racism/.
McFarling, Usha Lee. “Dermatology Faces a Reckoning: Lack of Darker Skin in Textbooks and Journals Harms Care for Patients of Color.” STAT, 20 July 2020, www.statnews.com/2020/07/21/dermatology-faces-reckoning-lack-of-darker-skin-in-textbooks-journals-harms-patients-of-color/.
McVean, Ada. “40 Years of Human Experimentation in America: The Tuskegee Study.” Office for Science and Society, 30 Dec. 2020, www.mcgill.ca/oss/article/history/40-years-human-experimentation-america-tuskegee-study.
Molina, Yamile, et al. “Racial/Ethnic Disparities in Time to a Breast Cancer Diagnosis: The Mediating Effects of Health Care Facility Factors.” Medical Care, vol. 53, no. 10, 2015, pp. 872–878. JSTOR, www.jstor.org/stable/26418060.
Shao, Kimberly, and Hao Feng. “Racial and Ethnic Healthcare Disparities in Skin Cancer in the United States: A Review of Existing Inequities, Contributing Factors, and Potential Solutions.” The Journal of Clinical and Aesthetic Dermatology, U.S. National Library of Medicine, July 2022, www.ncbi.nlm.nih.gov/pmc/articles/PMC9345197/.
Wellings, Han. “Anti-Black Racism and Healthcare: Henrietta Lacks and Her Immortal Legacy.” MissINFORMED, MissINFORMED, 23 Mar. 2021, www.missinformed.ca/post/anti-black-racism-and-healthcare-henrietta-lacks-and-her-immortal-legacy.
About the Author
Stephanie Diaz Feeney is a rising sophomore at Fordham University’s Rose Hill campus. She is majoring in chemistry on a pre-health track. After graduating, she intends to attend dental school specializing in orthodontics. Outside of school, she enjoys collecting stickers, attending concerts, and visiting museums.