I implore my colleagues to not only take time to recognize the contributions of Black people in the United States, but also to acknowledge the many ways Black bodies have involuntarily contributed to medical advances we take for granted. Only then can we begin to change the health-care system and our role in perpetuating biases within it - Dr. Zia Okocha
Racial discrimination has shaped so many American institutions that perhaps it should be no surprise that health care is among them. Put simply, people of color receive less care — and often worse care — than white Americans.
Reasons includes lower rates of health coverage; communication barriers; and racial stereotyping based on false beliefs.
Predictably, 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, vast research shows. They are also less likely to receive treatment for cardiovascular disease, and they are more likely to have unnecessary limb amputations.
As part of “The 1619 Project,” Evelynn Hammonds, a historian of science at Harvard, told Jeneen Interlandi of The New York Times: “There has never been any period in American history where the health of blacks was equal to that of whites. Disparity is built into the system.”
African-American men, in particular, have the worst health outcomes of any major demographic group. In part, research shows, this is a result of mistrust from a legacy of discrimination.
Tuskegee and lower life expectancy
At age 45, the life expectancy of black men is more than three years less than that of non-Hispanic Caucasian men. According to a study in the Quarterly Journal of Economics, part of the historical black-white mortality difference can be attributed to a 40-year experiment by the U.S. Public Health Service that shook African-Americans’ confidence in the nation’s health system.
From 1932 to 1972, the Public Health Service tracked about 600 hundred low-income African-American men in Tuskegee, Ala., about 400 of whom had syphilis. The stated purpose was to better understand the natural course of the disease. To do so, the men were lied to about the study and provided sham treatments. Many needlessly passed the disease on to family members, suffered and died.
As one scholar put it, the Tuskegee study “revealed more about the pathology of racism than it did about the pathology of syphilis.” In fact, the natural course of syphilis was already largely understood.
The study was publicized in 1972 and immediately halted. To this day, it is frequently cited as a driver of documented distrust in the health system by African-Americans. That distrust has helped compromise many public health efforts — including those to slow the spread of H.I.V., contain tuberculosis outbreaks and broaden provision of preventive care.
According to work by the economists Marcella Alsan and Marianne Wanamaker, black men are less likely than white men to seek health care and more likely to die at younger ages. Their analysis suggests that one-third of the black-white gap in male life expectancy in the immediate aftermath of the study could be attributed to the legacy of distrust connected to the Tuskegee study.
Their study relies on interpreting observational data, not a randomized trial, so there is room for skepticism about the specific findings and interpretation. Nevertheless, the findings are consistent with lots of other work that reveals African-Americans’ distrust of the health system, their receipt of less care, and their worse health outcomes.
The Tuskegee study is far from the only unjust treatment of nonwhite groups in health care. Thousands of nonwhite women have been sterilized without consent. For instance, between the 1930s and 1970s, one-third of Puerto Rican women of childbearing age were sterilized, many under coercion.
Likewise, in the 1960s and 1970s, thousands of Native American women were sterilized without consent, and a California eugenics law forced or coerced thousands of sterilizations of women (and men) of Mexican descent in the 20th century. (Thirty-two other states have had such laws, which were applied disproportionately to people of color.)
For decades, sickle cell disease, which mostly affects African-Americans, received less attention than other diseases, raising questions about the role of race in how medical research priorities are established.
Outside of research, routine medical practice continues to treat black and white patients differently. This has been documented in countless ways, including how practitioners view pain. Racial bias in health care and over-prescription of opioid painkillers accidentally spared some African-Americans from the level of mortality from opioid medications observed in white populations.
“While African-Americans may not have died at similar rates from opioid misuse, we can be sure needless suffering and, perhaps even death, occurred because provider racism prevented them from receiving appropriate care and pain medication,” said Linda Goler Blount, president and chief executive of the Black Women’s Health Imperative.
Black patients and black doctors
Of course, health outcomes are a result of much more than health care. The health of people of color is also unequal to that of whites because of differences in health behaviors, education and income, to name a few factors. But there is no doubt that the health system plays a role, too. Nor is there question that a history of discrimination and structural racism underlies racial differences in all these drivers of health.
Reinforcing the fact of racial bias in health care, a recent study found that care for black patients is better when they see black doctors. The study randomly assigned 1,300 African-Americans to black or nonblack primary care physicians. Those who saw black doctors received 34 percent more preventive services. One reason for this, supported by the study, is increased trust and communication.
The study findings are large. If all black men received the same increase in preventive services as those in the study (and received appropriate follow-up care), it would reduce the black-white cardiovascular mortality rate by 19 percent and shrink the total black-white male life expectancy gap by 8 percent, the researchers said.
But it is unlikely all black men could see black doctors even if they wished to. Although African-Americans make up 13 percent of the U.S. population, only 4 percent of current physicians — and less than 7 percent of recent medical school graduates — are black.
This study does not stand alone. A systematic review found that racially matched pairs of patients and doctors achieved better communication. Other studies found that many nonwhite patients prefer practitioners who share their racial identity and that they receive better care from them. They view them as better than white physicians in communicating, providing respectful treatment and being available.
Racial bias in health care, as in other American institutions, is as old or older than the republic itself.
Title VI of the 1964 Civil Rights Act stipulates that neither race, color nor national origin may be used as a means of denying the “benefits of, or be subjected to discrimination under any program or activity receiving federal financial assistance.” As nearly every facet of the American health system receives federal financing and support, well-documented and present-day discrimination in health care suggests the law has not yet had its intended effect.
Source: Austin Frakt, Race and Medicine: The Harm That Comes From Mistrust, The Upshot, The New York Times, January 13, 2020.
To dismantle racism in medicine and promote the health, well-being, and self-determination of people of color.
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Black Health Matters will provide information about health and well-being from a service-oriented perspective–with lots of upbeat, positive solutions and tips.
Health inequity for African Americans is not a new phenomenon. COVID-19, however, shined a light on the problem. Racism is not isolated to health care services, and it remains pervasive throughout our society. But by taking the tangible steps outlined here, providers can begin to solve the problem.
When receiving healthcare people would think this is a time that all people would be treated equally however this is not always the case. To understand the division in healthcare certain factors, need to be explained, starting with implicit bias and history.
Higher rates of infection and death among minorities demonstrate the racial character of inequality in America.
Racism in the health care system is part of the reason that the NMA exists. The American Medical Association, which set standards for the profession, repeatedly denied membership to Black doctors — so in 1895, they founded a group of their own, “conceived in no spirit of racial exclusiveness, fostering no ethnic antagonisms, but born out of the exigency of the American environment.”
As more data reveals the disproportionate rate at which African-Americans are being infected with and dying from the novel coronavirus, Dr. Hildreth sees opportunities missed and warnings ignored.
First acknowledged in the UK in 1987, Black History Month has always been somewhat celebrated and recognised as a core part of British history. However, this year has forced the world to see the reality of black history and racism like never before. This change has been propelled forward by a series of catalytic global events such as the Black Lives Matter movement, the Windrush generation, the seismic global call for action since the death of George Floyd in May 2020, and of course the number of black people dying disproportionately in the pandemic.
By now the world knows coronavirus disproportionately affects black and brown communities in the US.
Healthcare workers are also joining the protests because they're combating the same disparities they see in their work. Both the novel coronavirus and police brutality have disproportionately affected people of color.
Gaps while living, gaps while dying
It is well documented that African-Americans experience excess mortality, or deaths beyond the expected mortality rate. However, even if disparities in the mortality rate for African-Americans were rectified tomorrow, the fact remains that we will all eventually die. And how we die matters.
For black Americans who do have access to health insurance, going to the doctor is not always a smooth process as there has been a long-standing distrust between black patients and medical professionals. This distrust, according to many experts, is linked to the Tuskegee Syphilis Experiment in 1932 where the U.S. Public Health Service used black men to conduct a secret study on the progression of the deadly syphilis disease in order to find a treatment.
For most of their lives, many African-Americans don’t get enough medical care. At the end, they get too much.
Valerie Montgomery Rice, head of Morehouse School of Medicine, on training the next generation of physicians, and how to bring more Black men into the field
Public health experts hope that the vast scale of the crisis will prompt meaningful political action to counter health inequities, which have been persistent in America for well over a century.
The demonstrations sparked by the killing of George Floyd in Minneapolis have prompted a reckoning over racism and police brutality. But, among those in the medical communities, there have also been calls for urgent action to address the role that systemic racism plays in health disparities among Black people.
Cash would not only be a form of repayment, it would also undeniably improve people's health.
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Has the country done enough to overcome its Jim Crow health care history?
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The first bloom appeared in the crease of my right elbow, an itchy cluster that I ignored. It was well into summer, so I wrote it off as heat rash, or something similarly seasonal.
But then it started to spread. The topography of my body transformed into a foreign mess of hives and scaly patches.
Does the blood of black people clot more readily than that of white people? Does a black person's skin generally have more collagen--is it thicker--than a white person's? Are black people better at detecting movement than white people, and do they age more slowly?
If you are white and said yes -- or even maybe -- to any of the questions above, you are not alone in falling prey to false beliefs about physiological differences between white and black people.
Unlike other diseases, the mortality rate from sickle cell disease is on the rise. When you consider that the majority of these patients are African-American, perhaps we shouldn’t be surprised.
The experience of African-Americans, like Ms. Lewis, and other minorities illustrates a problem as persistent as it is complex: Minorities tend to receive less treatment for pain than whites, and suffer more disability as a result.
To explain the persistence of lower rates of breastfeeding among black mothers, we should look to systemic and historic factors rather than individual choice.
Yes, Americans can legally vote in elections, go to school or assemble in groups to peacefully protest. However, true equality goes beyond laws and policies. From inadequate access to fresh food and clean water, to screening in early stages of disease or the inability to rent an apartment because of discriminatory housing practices, these long standing systemic inequities for some black Americans can have long lasting effects on health.
Blacks face alarming differences compared to all other racial and ethnic groups.
A growing literature shows discrimination raises the risk of many emotional and physical problems. Discrimination has been shown to increase the risk of stress, depression, the common cold, hypertension, cardiovascular disease, breast cancer, and mortality.
Healthcare is a human right.
No one should be denied the opportunity to see a doctor because of how much money is in their pocket or where they live.
Our loved ones shouldn’t die from easily curable diseases simply because they can’t afford medicine.
Black lives matter.
Racial disparities in maternal health have not improved in three decades. Regardless of educational attainment and income, Black women and their children are at risk.
New studies show just how seriously racial disparities continue to manifest in healthcare—and what can be done.
The American health care system in beset with inequalities that have a disproportionate impact on people of color and other marginalized groups. These inequalities contribute to gaps in health insurance coverage, uneven access to services, and poorer health outcomes among certain populations. African Americans bear the brunt of these health care challenges.
When it comes to medical research, informed consent is a touchy subject among African-Americans. This essential component of research, which basically says, “I understand the work you are doing and agree to take part in it,” was long ignored for African-Americans. Many in the research community have worked tirelessly to make medical research less suspicious and more engaging for this community.
Enduring personal and institutional racism means that African Americans and other ethnic minorities are faring worse than white people. For those groups, even a high income can’t buy better health, according to other new research.
How America’s deteriorating work conditions contribute to skyrocketing infant mortality in the black community.
In an ideal world, the race of the patient or physician wouldn’t matter; we would all treat each other strictly as individuals. But we’re quite a ways from reaching that exalted goal. For now, we have to attack the problem of racial health disparities from as many angles as possible. Black doctors are an important part of this mission.
“It’s better than it used to be” may have been good enough after the Civil War ended 150 years ago but it’s not good enough now. Any report or article that addresses disparities in mortality between African and white Americans should consist of a single sentence: “There are no disparities.” Anything less is a national disgrace
Why do we have these tremendous disparities? There are multiple reasons. These include less access to health care, lower quality hospitals and medical personnel in areas where black people live, bias in the health care system, as well as some distrust of the medical community.
Medicine’s dark history helps explain why black mothers are dying at alarming rates.
Garner may have been the victim of the stress of trauma and poor health care for black women.
Black women are often dismissed or ignored by medical care providers. Williams wasn’t an exception.
Black mothers are particularly at risk. Better basic care could help.
The country is in a state of health care denial. Politicians, pundits and executives proudly declare America’s medical care is the best in the world. But it isn't.
The U.S. lags behind other industrialized nations in many important health measures – partly because citizens of certain races, ethnicities and incomes experience poorer versions of U.S. health care than others. The disparities are glaring.
Racial bias still affects many aspects of health care.
This lack of access to insurance coverage combined with poorer treatment outcomes contribute to shorter life expectancies for black Americans and other people of color.
Here are the realities of receiving health care while black that McCullough might want to consider:
Gone are the days of the fad diets and impossible workout regimes. OK, maybe not entirely, but there’s definitely been an evolution in the way we view our health. A vast majority of people today are in search of wellness, the kind that requires less of an external quick fix and more internal healing and sustainability. The holistic health movement is a vital part of this transformation. From practitioners and doctors to educators and healers, here are nine black women redefining what it means to be healthy — and they all do it with style.
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We are sharing knowledge and tools for data justice and for data access for equity. Our project aims to help movements for justice and to support trusted modes of community health and safety.
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The African American Wellness Project was organized to respond to the inequities in health care delivery that exists between African Americans and the rest of America. It is our belief that while good health begins with diet and exercise, once you enter the health care system, you must be organized to get the most out of it.
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The inequalities African Americans battle are plenty and severe — but the widening health gap is arguably among one of the most crucial and inadequately addressed concerns.
Better Black Health hopes to help change that.
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Every racial or ethnic group has specific health concerns. Differences in the health of groups can result from
•Access to care