Racial Disparity in Healthcare

By Lauren Porter

The foundation for Black History Month as we know it goes back to the early 20th century, when Carter Woodson was troubled while working on his PhD in history at Harvard and found that accomplishments and events around black Americans were rarely included in his readings and never discussed in his classes. He is regarded as one of the first historians who studied African-American history. He founded the ASALH in 1915 and introduced “Negro History Week” in 1926. At the time, it gained little momentum aside from increasing the inclusion of black Americans in some states’ curriculums. During the 1960s Civil Rights Movement, it transformed from being a week-long event to being recognized during the entirety of February. Then, in 1976, on its 50th anniversary, it became nationally recognized, in a presidential proclamation by President Ford.

“In celebrating Black History Month,” President Ford said in his proclamation, “we can seize the opportunity to honor the too-often neglected accomplishments of black Americans in every area of endeavor throughout our history.” President Reagan later added to this proclamation, stating that it is also a time “to make all Americans aware of this struggle for freedom and equal opportunity.”

One area of an ongoing struggle for the BIPOC community is racial disparity in healthcare. 18 years ago, the National Institute of Medicine released a report: Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. This report reviewed a large body of research and found that, even when taking into account variables like location, age, and health insurance status, racial minorities were less likely to receive preventative care, were more likely to receive low-quality care, and had worse health outcomes for the same illnesses. After this report, the Institute pushed for “equity” to be added to the list of goals for the US healthcare system but this has been overshadowed by goals of improving general quality and reducing costs.

Countless studies have been done and time and time again show the disparities clearly. Things like life expectancy, cancer, diabetes, hypertension, routine screenings, preventative healthcare quality, time spent with a patient, wait times for treatment, and regular blood tests have all been studied. Even when controlling outside variables, such as the arguments that black individuals are simply more predisposed for worse health outcomes, the research still points to the fact that racial disparity in healthcare is prevalent, and it is often deadly.

The conversation around this disparity is impossible to fit in one short blog post, so I will highlight three issues in the area of healthcare disparity: infant and maternal healthcare, the history of gynecology, and COVID-19.

Infant and maternal mortality rates are one of the measures used to measure healthcare quality across countries, as it points to factors such as healthcare access, availability of prenatal care, and the quality of prenatal, delivery, and postpartum care. A study in 2015 black women had a 70% higher rate of birth problems compared to white women after examining over two million births in a four year span (Admon, 2015). Infants born to black mothers are twice as likely to die in the first year of life (Pruitt, 2020). Pregnancy-related deaths are a startling four times higher for black women (Petersen, 2019) and most of these deaths are deemed preventable. These statistics are even more terrifying after taking into consideration that black people only make up 13% of the US population (2016 Census Bureau).

Looking back about 150 years ago, we find the “Father of Modern Gynecology” - James Marion Sims. He was also known for performing procedures necessary to keep black women reproducing for their slave-owners.He developed medical instruments and surgical techniques through his time as a physician in the late 19th century to further this cause and to treat general reproductive healthcare issues that arose among patients.

What we know more recently is that Sims used enslaved black women to test these tools and procedures without anesthesia and any regard for medical ethics, reminding us of other experiments like the Tuskegee syphilis experiment, Henrietta Lacks, and studies done during the Holocaust. His belief was that black women did not feel pain, and therefore were good medical test subjects that were available at anytime. We know about three of the women from his records: Lucy, Anarcha, and Betsey, who he describes as experiencing “extreme agony” during the procedures. Black midwives were blamed for any patients that died during his research.

After utilizing black enslaved women as his test subjects, he started to use them on white women, but with anesthesia. This idea that black individuals do not feel pain in the same way as white people still exists today. A study in 2016 found that half of medical students believe that black individuals feel less pain or feel pain differently (Hoffman, 2016). This leads to less utilization of anesthesia for painful procedures, less prescribing of pain medication when needed, and complaints about pain being ignored.

Sims was regarded highly in the medical community and was even named president for both the American Medical Association and the American Gynecological Society. He is the author of books and his research is still discussed widely. Yet, his unethical practices on black women and children have been left almost entirely unspoken. In 1941, Dr. Kenney wrote in a journey that he wished for a “a monument to be raised and dedicated to the nameless Negroes who have contributed so much to surgery by the ‘guinea pig’ route.”

Today, disparity in healthcare continues, and one rise we see clearly is the disproportionate rates of COVID in BIPOC. The CDC has identified disparities in chance of exposure, chance of complications, treatment quality, and deaths to name a few. Take for example, the state of Maine, where the black population makes up less than 2% of the state, yet accounts for 25% of the COVID cases. This is the worst state for racial disparity, but it is not just Maine alone. The CDC has released research that black individuals are 1.4x more likely to contract COVID and almost 4x as likely to die from the virus (CDC 2020).

The causes of healthcare disparity lie in part to implicit bias, racism, and at times, improper medical education. Yet, factors such as poverty, access to healthcare, transportation, location, food security, income, and employment also contribute. So what do we do? The Unequal Treatment report tells us that one of the most important things we can do is to continue to talk about it and bring light to the issue. We can also push for better medical policies, education, and accountability. Advocacy around other factors are critical too, such as fighting for increased access to accessible, affordable healthcare and measures to reduce poverty.