Racial discrimination has shaped so many American institutions that perhaps it should not surprise us that medical care is among them. Simply put, people of color receive less attention, and often worse attention, than white Americans.
Reasons includes lower rates of health coverage; communication barriers; and racial stereotypes based on false beliefs.
As expected, their health outcomes are worse than those of whites.
African-American patients tend to receive lower quality health services, including for cancer, H.I.V., prenatal care and preventive care, according to vast research. They are also less likely to receive treatment for cardiovascular disease, and are more likely to have unnecessary limb amputations.
As part of the "Project 1619", Evelynn Hammonds, a historian of science at Harvard, told Jeneen Interlandi of The New York Times: "There has never been any period in the history of the United States in which the health of blacks has been equal to that of the whites. The disparity is integrated into the system. "
African-American men, in particular, have The worst health outcomes of any major demographic. In part, the investigation shows that this is the result of distrust of a legacy of discrimination.
Tuskegee and lower life expectancy
At 45, the life expectancy of black men is more than three years lower than that of non-Hispanic Caucasian men. According to a study in the Quarterly Journal of Economics, part of the historical difference in mortality between whites and blacks can be attributed to a 40-year experiment conducted by the US Public Health Service. UU. That shook the confidence of African Americans in the nation's health system.
From 1932 to 1972, the Public Health Service tracked some 600 hundred low-income African-American men in Tuskegee, Alabama, of which about 400 had syphilis. The stated purpose was to better understand the natural course of the disease. To do so, men were lied about the study and were given fake treatments. Many transmitted the disease unnecessarily to family members, suffered and died.
The study was published in 1972 and immediately stopped. To this day, he is frequently cited as a driver of documented distrust in the health system by African Americans. That distrust has helped to engage many public health efforts, including those to curb the spread of H.I.V., contain outbreaks of tuberculosis and expand the provision of preventive care.
According to the work of economists Marcella Alsan and Marianne Wanamaker, black men are less likely than white men to seek medical attention and more likely to die at earlier ages. Their analysis suggests that a third of the black and white gap in male life expectancy immediately after the study could be attributed to the legacy of mistrust related to the Tuskegee study.
His study is based on the interpretation of observational data, not a randomized trial, so there is room for skepticism about specific findings and interpretation. However, the findings are consistent with many other works that reveal the distrust of African-Americans in the health system, their lower attention and their worse health outcomes.
Tuskegee's study is far from being the only unfair treatment of non-white groups in medical care. Thousands of non-white women have been sterilized without consent. For example, between the 1930s and 1970s, one third of Puerto Rican women of childbearing age were sterilized, many of them under duress.
Similarly, in the 1960s and 1970s, thousands of Native American women were sterilized without consent, and a eugenic law in California forced or forced thousands of sterilizations of women (and men) of Mexican descent in the twentieth century. (Another thirty-two states have had such laws, which were disproportionately applied to people of color.)
For decades, sickle cell disease, which primarily affects African Americans, received less attention than other diseases, which raised questions about the role of race in how medical research priorities are established.
Outside the investigation, routine medical practice continues Treat black and white patients differently. This has been documented in innumerable ways, including the way professionals see pain. Racial bias in medical care and excessive prescription of opioid analgesics accidentally saved some African Americans from the level of opioid drug mortality observed in white populations.
"While African Americans may not have died at similar rates due to the misuse of opioids, we can be sure that unnecessary suffering and, perhaps even death, occurred because provider racism prevented them from receiving adequate care and medication. for pain, "said Linda Goler Blount, president and CEO of Black Women & # 39; s Health Imperative.
Black patients and black doctors
Of course, the health outcomes are result of much more than medical care. The health of people of color is also unequal to that of whites due to differences in health, education and income behaviors, to name a few factors. But there is no doubt that the health system also plays a role. There is also no doubt that a history of discrimination and structural racism underlies racial differences in all these health drivers.
Reinforcing the fact of racial bias in medical care, a recent study found that care for black patients is better when they see black doctors. The study randomized 1,300 African Americans to black or non-black primary care doctors. Those who went to black doctors received 34 percent more preventive services. One reason for this, backed by the study, is greater trust and communication.
The study findings are great. If all black men received the same increase in preventive services as those in the study (and received adequate follow-up care), it would reduce the black and white cardiovascular mortality rate by 19 percent and reduce the life expectancy gap 8 percent black and white male, researchers said.
But it is unlikely that all black men can see black doctors, even if they want to. Although African Americans represent 13 percent of the US population. UU., Solo 4 percent of current doctors, and less than 7 percent of recent graduates of medical school, are black.
This study is not alone. A The systematic review found that racially compatible pairs of patients and doctors achieved better communication. Other studies found that many non-white patients they prefer practitioners who share their racial identity and receive better attention from them. They consider them better than white doctors to communicate, provide respectful treatment and be available.
Racial bias in medical care, as in other American institutions, is as old or older than the republic itself.
Title VI of the Civil Rights Act of 1964 stipulates that neither race, color nor national origin can be used as a means to deny the "benefits of, or be subject to discrimination under any program or activity that receives assistance federal financial. " As almost every facet of the US health system receives federal funding and support, well-documented and current discrimination in medical care suggests that the law has not yet had the desired effect.