In honor of Black History Month, we focused on the prevalence of medical racism and what can be done to achieve health equity in the U.S.
At the beginning of 2023, the American Society of Human Genetics apologized for its past members promoting eugenics ideals that "harmed people of minoritized groups."
Eugenics, a theory that humans can be improved through selective breeding, gained popularity in the 20th century, especially in Nazi Germany. Finding its place in the U.S., eugenics brought tragic consequences, such as involuntary sterilizations, primarily affecting women of color.
Today, eugenicists have no place in mainstream academia, despite recent warnings that this scientifically unproven theory is returning. But racism in medicine persists, albeit in more subtle forms.
What is medical racism?
John M Hoberman, M.A., Ph.D., a researcher at the University of Texas at Austin, says that one of the definitions of medical racism is the abuse of Black patients by medical staff.
"Another form of medical racism is simply ignoring the Black population, including in terms of research," he tells Healthnews. "There are big funding disparities between what is invested in the research on sickle cell disease, a disorder which almost entirely affects the African American population, and cystic fibrosis, which attacks the white population much more."
Hoberman says that medical professionals in the U.S. pay inadequate attention to their own peer-reviewed medical literature that shares evidence on Black populations being underserved in healthcare.
And most importantly, many white doctors — who account for the majority of practicing M.D.s in the U.S., — are not concerned about medical racism, he adds.
The Black community has higher rates of diabetes, heart disease, uterine cancer, endometriosis, shorter lifespans, and much more. Medical doctors especially ignore Black women. Tennis world champion, Serena Williams, ignored her demands for a CT scan after giving birth. Later, she would almost die from blood clots found in her lungs. This bias isn't unique to Williams — it was only shared in the spotlight because of her fame.
In fact, Black women are three to four more times more likely to die pregnancy-related complications than white women. And data shows racial disparities in maternal care have increased over the last 30 years.
However, Kecia Gaither, M.D., M.P.H, double board-certified in OB/GYN, notes it is worth asking whether they really increased or there is more transparent awareness on the issue due to the evolution of various media platforms.
Advances in reproductive technologies have changed the metrics "in regards to what is now defined as an adverse outcome," magnifying a distinct disparity, she adds.
Gaither says that healthcare providers who don't place equitable value on the life and well-being of a pregnant woman of color compared to a white woman also play an important factor in adverse outcomes.
"It seems to be an important common denominator in poor outcomes of Black women — no matter their socioeconomic status — when compared to white women. It's the melanin content that ultimately determines how care is rendered, the type of care rendered, or even if care is rendered," she tells Healthnews.
Is education enough?
Hoberman says that government-sponsored healthcare, similar to the U.K.'s National Health System, would be a "tremendous advance" in achieving health equity.
Gaither says universal health care may reduce the inequitable access to care and addresses the entire spectrum of Women's Health issues and services: "It would eliminate financial and social barriers — and afford coverage equity for all women. I believe it would be a great framework for the improvement, if not the obliteration of disparate birth outcomes," she says.
To put this hypothesis into a test, in 2020, researchers compared ischemic stroke outcomes, such as administering medicines helping to break up a blood clot, in-hospital mortality, and length of hospital stay of patients in civilian and military healthcare. In the latter, every member has access to the same healthcare benefits. The study concluded that "universal healthcare mitigates racial disparities in ischemic stroke admissions."
When the Affordable Care Act was signed into law in 2010, the uninsured rate among Black people dropped. Of the 20 million people who have gained coverage under the ACA, 2.8 million were Black.
In 2020, the American Heart Association and American College of Cardiology laid out concrete steps to help fight racism in health care, including requiring first-year medical students to take a course in social justice, race, and racism. In their report, organizations said trainees should spend time immersed in the communities they serve.
While eugenics seems to be a thing of the past, certain myths about biological racial differences still persist in the medical community. A 2016 study found that half of the medical students, all white, believed that Black people's skin is thicker or they feel less pain. They also thought that Black people felt less pain than white people. Believing such myths led to bias in treatment. Racism and prejudice prevent medical professionals from providing appropriate care to Black populations.
Speaking at a panel discussion organized by the American Medical Association, Rupa Marya, M.D., an associate professor of medicine at the University of California, San Francisco, said it is "shocking" that up to 40% of certified dermatologists cannot diagnose common skin problems in Black skin.
Hoberman says that besides the crucial education on race issues, there is a tremendous demand in a Black population for Black doctors.
A large number of African Americans would be more comfortable seeing a Black doctor than white because alienation, the estrangement of the black population in this country from the medical establishment from the past 100 years, have been so enormous.- John M Hoberman, M.A., Ph.D.
Gaither also emphasizes the necessity to increase the number of physicians of color. That involves recognizing the need for a pipeline to medical schools, such as increasing STEM programs and assisting in taking the enrollment test.
Non-White students remain a minority in medical schools, but the number is growing. For example, Black or African American students made up 11.3% of first-year students in 2021, up from 9.5% in 2020.
Other steps, according to Gaither, would include increasing insurance coverage for care, particularly with recognition of the "fourth trimester" — the 12-week period immediately after giving birth: "This is the period where some of the highest adverse outcomes are had, yet when most insurances — like Medicaid — run out."
Increasing and recognizing the benefits of perinatal support staff like midwives and doulas could also help to reduce disparities, Gaither says, as well as having alternate types of medical organizations within the Black community that specifically are aligned with ensuring a culturally sensitive type of care is rendered.
And while more attention is being paid to acknowledging historical injustices affecting healthcare today, changing technologies may pose new challenges. In February, a group of researchers demanded the FDA create a regulatory pathway for AI-driven medical devices, as they have the potential "to amplify healthcare bias and further exacerbate racial and ethnic health disparities."
For now, education is key for bridging the gap of racism and prejudice in all areas of the world — not just in medicine. Implementing and requiring a curriculum centering on people of color can work towards abolishing racism, investing in Black and brown communities, and expanding access to resources that can save lives.
However, Hoberman, an author of books on medical racism, is pessimistic: "We are not going to live long enough to see health equity in the U.S."
- Obstetrics & Gynecology Pregnancy Related Mortality in the United States, 2011-2013
- National Library of Medicine. Does race matter in universal healthcare? Stroke cost and outcomes in US military health care.
- The American Heart Association. These 'concrete steps' could help fight racism in health care
- Proceedings of the National Academy of Sciences. Racial bias in pain assessment and treatment recommendations, and false beliefs about biological differences between blacks and whites.
- Association of American Medical Colleges. 2021 medical school class sees enrollment diversity grow.
- U.S. COMMISSION ON CIVIL RIGHTS. Racial Disparities in Maternal Health.