Systemic racism is a problem in our society. There is no denying that people who are Black and Brown have more obstacles navigating a system geared to support White people. While this can be traumatizing emotionally and physically, it is not often considered life-threatening. However, healthcare is one of the exceptions. When systemic racism is perpetuated in healthcare, it can be life-threatening and can lead to increased morbidity and mortality of Black and Brown patients. Healthcare students should be taught about systemic racism and how it impacts healthcare practices today. By learning the history of how Black people have been exploited through atrocities like the Tuskegee Experiment which harmed and withheld treatment from Black patients without their consent, and the taking of Henrietta Lack’s cells without her consent as written in The Immortal Life of Henrietta Lacks by Rebecca Skloot, students can gain a better understanding of how systemic racism has not only led to a distrust of the healthcare system by minorities but has led to poorer outcomes for minorities (CDC, 2015; Johns Hopkins Medicine).
Tello (2017) tells the story of a Black woman who describes being treated as if she was just trying to obtain pain medication when she went to the Emergency Department and had a painful procedure. Despite the fact that she had no history of substance abuse or pain medication seeking behavior, she was treated as if she was drug seeking. This is not an unusual occurrence. Studies have shown that non-White patients are less likely to receive analgesia, especially opiate-based analgesia, and they have to wait longer to receive the medication, if offered, as compared to White patients with all other factors being the same (Mills, Shofer, Boulis, Holena, & Abbuhl, 2011). Additionally, it has been studied and documented that “Blacks and other minority groups in the U.S. experience more illness, worse outcomes, and premature death compared with whites” (Tello, 2017). How, in the 21st century does this happen? Despite the time that many believe has passed since the Civil Rights movement of the 60s, healthcare still operates in a racist system that allows prejudices and implicit bias to drive how patients are treated (Tello, 2017). It has been over 30 years since the Secretary of Health and Human Services, Margaret Heckler, published her report showing health disparities between Black and other minorities as compared to the White population. This report supported improving access to healthcare, expanding healthcare education in the minority population, increasing the numbers of minority healthcare providers, and better tracking minority health issues (National Center for Health Statistics, 2017). While much has been done to bridge the gap of racial disparity in healthcare, it still lingers. Black men and women still have shorter life expectancies than any other group (American Nurses Association, 2013). While birth mortality has gone down nationally, it is still highest within the Black population at nearly 11/1000 live births, American Indian and Alaskan Natives have a rate of ~7.5/1,000, White not Hispanic and Hispanic have a rate of ~5/1,000, Asian/Pacific Islander have a rate of ~3.9. Preterm birth rates are highest in the Black population (National Center for Health Statistics, 2017). When a specific population starts life with higher risk of mortality and morbidity related to prematurity, it is not difficult to see that there may be racial disparity at play. Did mothers receive the same access to high-quality prenatal care? Were their symptoms placing them at high risk treated the same and taken seriously as compared to White patients? When we live in a society where even high-profile Black women like Serena Williams almost die related to complications after birth, we begin to recognize that Black patients are often not taken seriously no matter what their social status. Each year in the U.S., ~700 women die due to pregnancy/childbirth related complications making the U.S. rates much higher than any other country in the developed world (CDC, 2018). When looking at those numbers, Black women are three to four times more likely to die than White women (Howard, 2017). These numbers could be related to higher rates of obesity, diabetes, and high blood pressure, as well as access to care, but bottom line, the numbers show a significant disparity.
While it is said that blatant racism is no longer prevalent in healthcare, subtle biases and stereotypes continue, and these can cause significant harm. One way to describe this is like an iceberg. Blatant racism is the portion above water, we can clearly see it. Systemic racism and ingrained biases and stereotypes are the portion of the iceberg underwater. This comprises 90%. It is subtler; we can’t see it clearly, but it is still there and it can cause as much if not more damage (Gee & Ford, 2011).
As a nurse, I am most familiar with nursing care. Nurses are at the frontline of patient care. Nurses are in a position to reinforce or prevent prejudices that can lead to disparities in care (American Nurses Association, 2013). Due to their work directly at the bedside, nurses can be at the forefront of removing barriers to care and to prevent racial bias that may lead to delayed care, disproportionate treatment, lack of necessary referrals. Nurses, as a group, are predominantly White and need to address the racism, perpetuated by Whites against people of color (American Nurses Association, 2013).
What are some of the reasons Black people may suffer from health inequality? As mentioned, much of this stems from systemic racism. This is not a new issue. Over a century ago, W. E. B. DuBois stated, “the Negro death rate and sickness are largely matter of [social and economic] condition and not due to racial traits and tendencies” (DuBois, 2003 , p. 276). Not all of this occurs inside the healthcare setting. Much of it occurs throughout life and leads to greater health concerns. Due to systemic racism, the Black population work in lower paying, higher health-risk occupations (American Bar Association, 2012). Due to lower income, Black people are more likely to live in areas where there are food deserts without access to fresh fruits and vegetables, yet a higher number of stores that sell tobacco and alcohol. Fast food that is higher in fat and salt is more prevalent. “Health status disparities are a direct result of policies, practices, procedures, and laws-institutional discrimination-that protect white privilege at the expense of black health” (American Bar Association, 2012). When a racist comment was made that African Americans should be grateful for being in the United States, it was pointed out that Black Americans have more low-birthweight babies than babies born in Rwanda, Ghana, and Uganda (American Bar Association, 2012). This is not related to economics, this is related to race. Studies have shown that even as compared to equal counterparts, Blacks who are middle class have worse health than Whites who are middle class. Case in point is the example of Serena Williams above, or Shalon Irving, an epidemiologist at the Centers for Disease Control and Prevention (CDC) who died three weeks after giving birth. She had spent her professional life working on eradicating disparities in health access and yet she died of the very thing she was fighting to end (NPR, 2017). “It is proposed that the stress of living in a discriminatory society accounts for the racial health disparities.” (American Bar Association, 2012). It has also been shown that the current healthcare system has “built-in incentives that encourage unconscious discrimination” (American Bar Association, 2012). Additionally, experiencing racism can place people of color under greater risk for mental and physical health conditions (Gee & Ford, 2011).
The primary way to end racism in healthcare is to confront it head-on. Racism should be called out and staff should be educated on treating all patients with respect and compassion. Nursing, as a profession, states it values diversity, yet the workforce only has 17% of registered nurses identifying as racial/ethnic minorities with Hispanic nurses only represent 3.6% and Black nurses represent 5.4% (Villarruel, Bigelow, & Alvarez, 2014). This is far below the national population percentage rates of minorities. It is well known that having a diverse workforce in the healthcare field will encourage students and will benefit patients. “racial and ethnic diversity of health professions faculty and students helps ensure that all students will develop the cultural competencies necessary for treating patients in a diverse nation” (Villarruel, Bigelow, & Alvarez, 2014, p. 38). Minority nurses can contribute ideas and models of care that “address the unique needs of racial/ethnic minority populations” (Villarruel, Bigelow, & Alvarez, 2014, p. 38). Therefore, educating about systemic racism, especially in the healthcare field, can facilitate awareness and a direct response to implicit bias within healthcare facilities. The American Public Health Association posits that the best way to address systemic racism within the healthcare setting is to address it and not cover it up. Racism should be discussed and the discussion should include the knowledge that racism is “a force determining the social determinants of health.” Policies and practices should be examined to determine inequitable conditions, and conversations should be initiated by discussing the impact of racism on the health of minorities within the United States (American Public Health Association).
Erika Bracken Probst writes about civic responsibility and engagement. Her children’s book, Friends on my Street: A Celebration of Diversity tells the story of her neighborhood.