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Historical Context
The medical inequalities faced by the Black community in America starts at the beginning of colonization in the United States. Since 1619, enslaved Black Americans, specifically Black women, endured cruel medical mistreatment by means of experimentation against their will. In the 19th century, medical students depended on Black bodies as “anatomical material” and commodified their bodies by advertising “having an abundance of bodies to practice on” to recruit students. This experimentation was done as punishment for simply being Black as well as to spark curiosity with the notion pushed by Samuel Norton, who claimed that Black people deserved to be enslaved due to having “smaller skulls” and therefore were inferior to their White counterparts.
Modern day gynecology relied on the experimentation performed by James Marion Sims on enslaved Black women. These Black women also served as his domestic workers and nurses in his practice after enduring inhumane practices in the name of science. This history of targeting women of color worked its way well into the 20th century with the forced and coercive methods of sterilization in overwhelming quantities due to the eugenics laws put in place. The first compulsory sterilization laws were put in place in 1907 in Indiana and gained more traction across the country over the next two decades. We see present day implications of the medical neglect faced by communities of color with their overwhelmingly high rates of COVID-19 infection and mortality. COVID-19 has brought up conversations of the systemic racial policies against Black Americans and the neglect they have faced within the medical community.
How Doctors are Taught to Care for Patients of Color
Racial biases and misinformation continue to leave their mark on American medical education in the current day, and serve as a major contributing factor toward disparities in outcomes for patients of color. Historically, medical education has been plagued by a high and pervasive degree of racist attitudes, which has consequently resulted in a lack of proper insight and knowledge by practitioners in treating their communities. Medical schools tend to teach a curriculum which is beset with a high degree of misinformation regarding the needs of communities of color, and typically demonstrates material which is centric towards the demands of White Americans. The ramifications of such deep-rooted institutional prejudices are immensely detrimental in regards to the attitude practitioners demonstrate towards working in communities of color, as revealed by a New England Journal of Medicine study exposing that the majority of U.S physicians hold an implicit bias favoring White Americans during patient visits. False beliefs inspired by such implicit biases continue to be present in the medical field, with numerous studies demonstrating that physicians are misled into believing that Black Americans have a greater pain tolerance than Whites. Consequently, patients of colors are often less likely to be prescribed the medication they need as a result of such implicit bias. Furthermore, practitioners continue to falsely associate the prevalence of certain conditions with an individual’s racial identity, rather than the actual objective health status of the person. As a result, practitioners demonstrating implicit bias have a higher potential for misdiagnosing certain medical conditions. For instance, lecturers in medical schools tend to correlate numerous conditions with certain racial groups, resulting in doctors overlooking the potential for the presence of diseases such as cystic fibrosis in patients of color.
Working in the Field: Nurses of Color vs. White Nurses
Nearly half of the population in the National Commission to Address Racism in Nursing reported that there is widespread discrimination in nursing, which represents a substantial problem within the profession itself. It describes the impact on patients, nurses, communities, and even healthcare systems to encourage all nurses to confront the implementation of systemic racism. According to over 5,600 respondents, discriminatory acts are perpetrated by colleagues and those in positions of power. More than half of nurses surveyed say that they personally have experienced racism from the transgressors being either a peer or a manager/supervisor. “Civil rights and social movements throughout history offer the blueprint, which demonstrates that diligent allyship is key to progress. To the nurses that challenge racism in the workplace, do not get dismayed by inaction, but continue to raise your voice and be a change agent for good,” said Commission Co-Lead and National Coalition of Ethnic Minority Nurse Associations (NCEMNA), President Debra A. Toney, PhD, RN, FAAN.
When looking at the percentage of each race in the field it is very different. According to the National Library of Medicine, 83.2% of nurses are White with only 5.4% being Black and 3.6% being Hispanic. These statistics are very concerning because there is such a lack of diversity in this work field. Not only do we see an underrepresentation of diversity in the nursing workforce but the wage difference is also very prominent. An article from the National Library of Medicine states that RNs who are White make $33.05 whereas Black nurses make $31.93 and Hispanic nurses make only $30.79. These nurses are all doing the same amount of work, but because of their race, we see a severe difference in their pay.
Black Maternal Mortality
When studying the injustices faced by Black Americans on a daily basis, a huge problem often overlooked is the discrimination and racism many experience when receiving medical treatment. A prime example of this is Black maternal mortality: Black women are three times more likely than White women to face a pregnancy-related death. Some factors that play a role in the higher rates of mortality are the inconsistencies in quality healthcare, pre-existing conditions discovered too late, structural racism, and unconscious bias which all hinder racial minority groups from having quality healthcare.
Congresswoman Cori Bush has a history of trauma regarding her own pregnancy as a Black woman. During the U.S. Oversight and Reform Committee in May 2021, she said “Every day, Black women die because the system denies our humanity.” The real problem lies in how common these issues are. Many Black women have been victims of this inherently racist system that should be saving lives – not harming them. The maternal mortality crisis should not be overlooked. CCP’s Tina Suliman writes that “it is racism, not race, that is killing America’s Black mothers and babies.” Looking at a 2016 survey of White medical students, almost half were not properly educated on the biological differences between black and white patients. Additionally, a 2020 study concluded that if Black babies are taken care of by a Black physician, they are more likely to live. Physicians must become aware of any bias and racism in the system and fight to end it in their clinics. The struggles of Black women and minorities should be seen and treated as a universal struggle.
There are a few different ways that families and medical workers can actively work to prevent pregnancy-related deaths. For example, for pregnant women, it is advantageous to take note of any urgent maternal warning signs, some of which include severe headache and trouble breathing. Another approach is by continuing to receive healthcare treatment all throughout the pregnancy even including before and after to keep the mother and baby safe. Healthcare providers play a significant role in the pregnancy process. This might be where racial bias can occur. The providers should be able to remain professional and separate any unconscious bias that they may have to properly care for their patients. They should also make sure to be respectful with all patients regardless of what race they originate from. Outside of the direct individuals involved, the CDC uses state perinatal quality collaboratives to try and help reduce the racial disparities in healthcare. The importance of Black maternal mortality should not be diminished and we should keep trying to counteract it.
A Call for Action
In a world where every single human being is deserving of quality medical care, it is a fatal flaw that our current healthcare system has decided that certain lives matter more than others. Black women’s deaths from the healthcare systems' failures are being ignored on a national scale. One in four Black Americans have at least one disability, while the rate for White Americans is 1 in 5. For these very reasons, and many more, we cannot examine the issues that the healthcare systems still have today without also examining the intersectionalities that these structures continue to marginalize. All the smaller instances of racial biases that appear from place to place within this industry all connect to a bigger systemic issue. What steps can be taken to change this?
For one, we need more racial and ethnic minorities within the healthcare industry, working all different - kinds of jobs. The underrepresentation and oppression of minority healthcare workers only further contributes to the racial disparities in healthcare.
More funding and resources should be allocated for departments that focus on healthcare and civil rights both within the government and from third party organizations.
Healthcare procedures need to be carefully reviewed and revised in order to remove issues of implicit bias.
Trust must be rebuilt between healthcare providers and patients, and reach out to communities that have previously been turned away or are underserved.
On a more individual level, we can stay informed and try to get our voices heard through nonprofit organizations, petitioning, and lobbying.