Racism in the U.S. Health Care System Is Costing Black Lives
Why you can trust us
As the COVID-19 pandemic swept across the U.S., the virus hit African Americans . African Americans are still contracting the illness鈥攁nd dying from it鈥� as would be expected based on their share of the population.
, African Americans are only 14% of the population, but account for one-third of the state鈥檚 COVID-19 cases and 40% of its deaths.
In some states, the disparities are even more stark. have infection and mortality rates three or more times greater than expected based on their share of the population.
African Americans receive poorer quality care than White patients across all medical interventions and routine health services.
Speculation has suggested these disproportions are : African Americans are more likely to live in poor neighborhoods, work at riskier occupations, and have more underlying health conditions and limited access to health care. But in African American communities with above-average wealth and health care access. occurred in Prince George鈥檚 County, Maryland鈥攖he nation鈥檚 wealthiest African American enclave. Comparable White communities were .
As experts in and , we know this elevated risk for African Americans is not uncommon. This is true regardless of income, education level, or health care access. And it is true for other things besides COVID-19. African American women are to die from childbirth than White women. Even if the African American women were educated and wealthy, they were from childbirth than uneducated and poor White women.
Racism: the root cause
found African Americans receive poorer quality care than White patients across all medical interventions and routine health services鈥攅ven when insurance status, income, age, co-morbid conditions, and symptom expression were equal. as a root cause for these disparities. Indeed, the American Academy of Pediatrics how racism affects health outcomes for African American children. We suggest the same is true for COVID-19 outcomes among African American adults.
Other barriers negatively affect the health of African Americans. That includes 鈥攁ttitudes, thoughts, and feelings existing outside of conscious awareness鈥攁s patients and providers communicate with each other.
When it comes to ineffective patient-provider interactions, African Americans suffer the most.
Implicit bias from a doctor or nurse affects the shared with the patient about health conditions and treatment plans. : when providers withhold critical information about a health condition; when they don鈥檛 include the patient鈥檚 voice during decision making about care; and when they don鈥檛 refer the patient for further tests or specialty care. Implicit biases from health care workers can result in , which is necessary for patients to manage an illness effectively.
with physicians lead to long-lasting consequences for the patient, including unequal treatment and disparate health outcomes. And when it comes to ineffective patient-provider interactions, African Americans suffer the most.
Location, location, location
The location of hospitals, clinics, and other health care facilities are often a barrier to care. Transportation鈥攐r the lack of it鈥� to receive services. African American patients have noted the frustration when health care facilities are not close to their homes. To get there, many of them rely on public transportation. The result: missed or canceled appointments, sometimes because of policies regarding late arrival times by patients.
Differences also exist between African American and White patients in the for appointments and the ability to . This can result in delayed health care鈥攚hich leads to poorer health outcomes for illnesses, including COVID-19.
Recommendations for addressing racism
Consumers who are well-informed about their health and confident in have better outcomes virtually across the board: in , cancer, diabetes, cardiovascular disease, and such as schizophrenia.
That said, here are three recommendations to address racism and reduce racial disparities in health care services:
鈥� Health care professionals need to become more aware of their implicit bias. Identify the problem, as the saying goes, and you鈥檙e halfway to solving the problem. One way to become more aware: take the implicit bias test .
鈥� Doctors and nurses need to be attentive and collaborative when communicating with patients. Empower the patient by encouraging questions and letting them express opinions. When patients believe the providers are there to support them, they manage their illness better. They also have a better perception of quality care. Ultimately this leads to .
鈥� Hospitals, clinics, and doctor鈥檚 offices should provide more flexibility in delivering services. Telehealth鈥攚hen doctors and patients communicate online, instead of an in-person visit鈥攕hould be among those services. They should also restructure scheduling policies, emphasizing shorter wait times and more slack if patients are late.
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.
This article was originally published by . It has been published here with permission.
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Tamika C.B. Zapolski
is an associate professor in the Department of Psychology at Indiana University Purdue University in Indianapolis.
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Ukamaka M. Oruche
is an associate professor at the Indiana University School of Nursing.
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