Racism in US healthcare system costs African Americans lives
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Tamika C.B. Zapolski,Β IUPUIΒ andΒ Ukamaka M. Oruche,Β IUPUI
Racism in the US healthcare system costs African Americans lives
Due to racism, African Americans receive poorer quality care than white patients across all medical interventions and routine health services.
As the COVID-19 pandemic swept across the U.S., the virus hit African AmericansΒ disproportionately hard. African Americans are still contracting the illness β and dying from it βΒ at rates twice as highΒ as would be expected based on their share of the population.
In Michigan, African Americans are only 14% of the population, but account for one-third of the stateβs COVID-19 cases and 40% of its deaths.
In some states, the disparities are even starker.Β Wisconsin and MissouriΒ have infection and mortality rates three or more times greater than expected based on their share of the population.
Speculation has suggested these disproportions areΒ due to several factors: 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. ButΒ similar inequities existΒ in African American communities with above-average wealth and health care access.Β Staggering rates of COVID-19Β occurred in Prince Georgeβs County, Maryland β the nationβs wealthiest African American enclave. Comparable white communities wereΒ relatively unaffected.
As experts inΒ clinical psychologyΒ andΒ psychiatric nursing, we know this elevated risk for African Americans is not uncommon. It is true regardless of income, education level, or health care access. And it is true for other things besides COVID-19. African American women areΒ more than twice as likelyΒ to die from childbirth than white women. Even if the African American women were educated and wealthy, they wereΒ more likely to dieΒ from childbirth than uneducated and poor white women.
Racism: the root cause
An analysis by the National Academy of SciencesΒ found African Americans receive poorer quality care than white patients across all medical interventions and routine health services β even when insurance status, income, age, co-morbid conditions, and symptom expression were equal.Β Experts point to racismΒ as a root cause for these disparities. Indeed, the American Academy of PediatricsΒ has outlinedΒ how racism impacts health outcomes for African American children. We suggest the same is true for COVID-19 outcomes among African American adults.
Other barriers negatively impact the health of African Americans. That includes implicit bias β attitudes, thoughts, and feelings existing outside of conscious awareness β as patients and providers communicate with each other.
Read more:Β Racism and depression β the insidious link
Implicit biasΒ from a doctor or nurse affects theΒ quality and quantity of informationΒ shared with the patient about health conditions and treatment plans.Β The worst-case scenarios: when providers withhold critical information about a health condition; when they donβt include the patientβs voice during decision making about care; and when they donβt refer the patient for further tests or specialty care. Implicit biases from health care workers can result inΒ patients being less likely to understand their health conditions, which is necessary for patients to manage an illness effectively.
Averse interactionsΒ 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 β or the lack of it βΒ impacts the patientβs abilityΒ to receive services. African American patients have noted 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 due to policies regarding late arrival times by patients.
Differences also exist between African American and white patients in theΒ length of wait timeΒ for appointments and the ability toΒ schedule follow-up appointments. This can result in delayed health care β which leads to poorer health outcomes for illnesses, including COVID-19.
Recommendations for addressing racismΒ in US healthcare system
Consumers who are well informed about their health and confident inΒ managing their careΒ have better outcomes virtually across the board: inΒ HIV-AIDS, cancer, diabetes, cardiovascular disease, andΒ mental health conditionsΒ such asΒ schizophrenia.
That said, here are three recommendations to address racism and reduce racial disparities in health care services:
- Health care professionals need to become more aware of their implicit bias. Identify the problem, as the saying goes, and youβre halfway to solving the problem. One way to become more aware: take the implicit bias testΒ here.
- 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 toΒ improved health outcomes.
- Hospitals, clinics, and doctorβs offices should provide more flexibility in delivering services. Telehealth β when doctors and patients communicate online, instead of an in-person visit β should be one of those services. They should also restructure scheduling policies, emphasizing shorter wait times, and more slack if patients are late.
Health inequity for African Americans isΒ not a new phenomenon. COVID-19, however, shined a light on the problem. Racism is not isolated to health care services, and itΒ remains pervasive throughout our society. But by taking the tangible steps outlined here, providers can begin to solve the problem.
Tamika C.B. Zapolski, Associate Professor of Psychology, IUPUI and Ukamaka M. Oruche, Associate Professor & Director of Global Programs, IUPUI
Racism in US healthcare system costs African Americans lives is republished from The Conversation under a Creative Commons license. Read the original article.

The Conversation
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Caption:
Mortality rates for COVID-19 are two to three times higher for African Americans than whites.