Deeper Than Access: Black Folks and Healthcare

The abuses Black Americans[i] have experienced in the name of medical advancement outpace that of any other people group. Often limited to prominent examples such as the Tuskegee Syphilis Experiment, some people attempt to describe the medical injustices against African Americans as situational or episodic rather than a well-documented practice throughout the history of the United States. The impact of these abuses, dating as far back as enslavement and as recent as the 21st Century,[ii] are deeply engrained in the sociocultural framework of the country. The United States has a long history of government-approved abuses in the name of scientific research. These abuses have led to a deep distrust of the health care industry by many within the African American community. [iii]

Throughout history, many in the Black community felt used as expendable objects to be probed and prodded as a means of improving societal health with no consideration for their well-being. The plethora of examples of nontherapeutic research exacerbates this narrative, hence deepening the distrust. Documented examples as early as the 1800s support that the bodies of Black enslaved women were used to master “dozens of exquisitely painful, distressingly intimate vaginal surgeries.”[iv] The doctor who performed these experimental surgeries, James Marion Sims, was the president of the American Medical Association and is celebrated across the globe for his work in the area of women’s health. The enslaved were often accused of feigning illness, having biological differences that made them more tolerable of pain, and immune to certain diseases.

A peripheral review of recent examples includes, a Baltimore physician preferring to use poor Blacks for his radiation research, or the Black and Hispanic boys in The New York State Psychiatric Institute who were given the cardiotoxic drug fenfluramine. On-going debates surround the pedaling certain contraceptives (e.g. Norplant, Depo-Provera, and vaccinations (e.g. HPV) to poor communities of color before distribution to the masses. These and other examples create a challenging lens through which African Americans experience the health care system. It is arguable that “the lack of objectivity and sensitivity with which African American fears are often greeted, and the social and cultural reasons for the lack of common ground,”[v] continue to perpetuate an environment of African American distrust of the medical system. “The troubled history of medical experimentation with African Americans – and the resulting behavioral fallout causes researchers and African Americans to view each other through jaundiced eyes.”[vi]

Although disproven, false health narratives are rooted in the fabric of American society and continue to influence healthcare practices. For example, current pain research supports that African American and Hispanic patients are more likely to be undertreated for pain than white patients. Arguably, this practice links to deeply rooted false narratives. Further, many African Americans argue that their health experiences are delegitimized[vii]. For example, Tennis star Serena Williams revealed that shortly after her emergency c-section she experienced a pulmonary embolism. Williams, who has a history of blood clots, was off her prescribed medication because of the emergency procedure. Shortly after delivering her daughter she noticed a shortness of breath. Having experienced similar symptoms in the past she notified medical personnel and requested a CT scan and a blood thinner. According to the article, Williams’ concerns were dismissed as confusion, perhaps a reaction to pain medication. Instead of the scan, she received an ultrasound on her leg that revealed nothing. When she finally received the requested CT scan and blood thinner several small clots had settled in her lungs.[viii]

Similarly, Shalon Irving, a highly educated African American Lieutenant Commander in the U.S. Public Health Service Commissioned Corps and a CDC epidemiologist who spent her career working to improve the health or marginalized groups, died suddenly because of complications just three weeks after giving birth. Irving, who following the delivery of her daughter made repeated visits to her physician, joins the disproportioned number of African American women who die from pregnancy-related complications.[ix] According to the CDC, black mothers in the U.S. die at three to four times the rate of white mothers; and while a medical explanation for this enormous disparity is unclear many would assert that unconscious bias adds to this troubling statistic.[x] In both instances, although Williams and Irving had social and economic advantages, they still became a part of the enormous disparity linked to African American women and maternal health. Further exacerbating levels of distrust, The Washington Post recently reported on the use of a medical algorithm that interferes with Black patients receiving high-quality care.[xi]

Health disparities run much deeper than socioeconomics and access. It’s clear that implicit bias, institutional racism, and outright ignorance have a significant impact on health practices. So, what do we do? What are the best practices leading to improved health outcomes? Let me know your thoughts in the comments below!

Implicit-Bias-Picture

Sources:
[i] Black and African American are used interchangeably in this proposal. The terms are referring to enslaved Africans and their descendants.
[ii] Washington, Medical Apartheid: The Dark History of Medical Experimentation on Black Americans from Colonial Times to the Present, (New York: Anchor House, 2006) 1& 6.
[iii] Washington, Medical Apartheid: The Dark History of Medical Experimentation on Black Americans from Colonial Times to the Present, 8.
[iv] Washington, 10 &11.
[v] Washington, 8
[vi] Washington, 5.
[vii] Newton et al., “A narrative review of the impact of disbelief in chronic pain,” Pain Management Nursing 14, no. 3 (2013): 162.
[viii] Rob Haskell, “Serena Williams on Motherhood, Marriage, and Making Her Comeback,” Vogue, January 10, 2018, accessed January 14, 2019,
https://www.vogue.com/article/serena-williams-vogue-cover-interview-february-2018 para. 11
[ix] Nina Martin and Renee Montagne, “Black Mothers Keep Dying After Giving Birth. Shalon Irving’s Story Explains Why,” NPR, December 7, 2017, accessed January 19, 2019, https://www.npr.org/2017/12/07/568948782/black-mothers-keep-dying-after-giving-birth-shalon-irvings-story-explains-why, para. 6.
[x] Centers for Disease Control and Prevention, para. 12.
[xi] Carolyn Y. Johnson, “Racial bias in a medical algorithm favors white patients over sicker black patients,” Washington Post, October 24, 2019, accessed October 26, 2019, https://www.washingtonpost.com/health/2019/10/24/racial-bias-medical-algorithm-favors-white-patients-over-sicker-black-patients/

 

5 Comments

  1. One of the ways to improve health outcomes and aid in “compliance” among people of color is to increase the cultural competence of professionals. As medical professionals are able to acknowledge and respond sensitively to the patient; better outcomes may result.

    Liked by 1 person

  2. Another way to improve is to get aPCP & have a good rapport with them. It’s essential if you have chronic conditions. We have to advocate be persistent. I had pain in my RLQ of abdomen and doctor sent to surgeon the CT from ER showed a mass. That ER dismissed when I had CT. Surgeon appt was 2 weeks out. Went to see PCP to him, he said no you wont wait that long. One phone call from him I was in 2days later. Thats the difference of have a good rapport with your doctor.

    Liked by 1 person

  3. Wondering: How does treatment vary between care providers and patients who look the same? How do we begin the process of holding providers accountable for their culturally insensitive practices?

    Liked by 1 person

    1. This is an awesome question. There is some research on this area. I will try to post what I have. I am also working with a group called Patients R Waiting that is trying to address some of these issues.

      Like

  4. Very enlightening article. In addition to having a good rapport with your PCP, it’s important to know your body. You should be able to articulate what’s wrong, when you noticed the difference, side effects from medications, etc. Going to the doctor and saying “I don’t feel well, but I don’t know what’s wrong”, leaves it completely up to the doctor to TRY to give an accurate diagnosis.

    Liked by 1 person

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