ARCC News – The Impacts of Racism in American Healthcare Systems

December 2022

Many Americans have either long been aware of or have recently learned about deeply rooted forms of structural racism in our national systems, policies, and legislation. Just one major example of this is the ways in which racism and healthcare are intertwined and how racism in medicine negatively impacts the health and life expectancy of people of color. Here are some essential things to know about the origins of systemic racism in healthcare and how this worsens health outcomes for already-vulnerable communities of color.

The History and Current Realities of Racism in Healthcare

Racism in the healthcare system has a long history. Unlike many other wealthy nations, the US left the creation and management of medical administration up to state governments until the 1930s. In doing so, it left the health of non-white Americans vulnerable to regional beliefs and practices regarding race and human rights. Since then, the federal government has taken few steps to ensure racial or economic equality in its national healthcare policies. Here are some key points in history that shaped structural racism in healthcare today.

The Jim Crow Era (1875-1968) in Medicine

Until the institution of slavery was legally ended in 1865, enslaved Americans of color were wholly reliant on white plantation owners for even crude forms of medical care. Afterward, freed slaves and their descendents were barred from high-quality “white” medical facilities. As a result, in some states, non-white populations died at double or triple the rate of white ones. Hospitals were not legally required to integrate until the 1960s, and many doctors and hospitals found ways to refuse care to patients of color long after the civil rights movement ended.

The Advent of Medicare and Medicaid

During the civil rights era, the federal government created the Medicare and Medicaid programs we know today. These provided funding incentives to healthcare facilities to serve economically disadvantaged communities, in which Black Americans and other non-white populations were (and are) vastly overrepresented. However, medical centers could use discriminatory practices and loopholes to deny care to people of color without legal or financial penalties. Today, many states continue to underfund Medicaid or make it difficult for people of color to qualify for it.

Medicine Today: Barriers for Physicians of Color

Racial inequities create many barriers to higher education and professional influence for aspiring physicians of color. This inhibits their ability to enter medical fields, fill major gaps in medical research, advocate for the health of non-white patients, and enjoy lucrative and rewarding careers.

Medicine Today: Barriers for Patients of Color

Some of the most significant and prevalent challenges that prevent Americans of color from utilizing essential healthcare services include:

• Access to health coverage. Throughout modern American history, people of color have been and continue to be disproportionately employed in low-income jobs that don’t offer full health insurance coverage. This leaves them with prohibitively high out-of-pocket healthcare costs, which causes many individuals to go without essential preventive or interventional care. The 2010 Affordable Care Act (ACA) helped to make health insurance more affordable, but the lower-tier plans offered limited quality and value.
• Access to medical centers. Low-income communities—which people of color are statistically more likely to inhabit—are often also medical deserts (large geographical areas without adequate medical facilities or care providers). This makes physical access to healthcare centers difficult for residents. The challenge is even greater for people who rely on public transportation, have a physical disability, or lack childcare supports.
• Distrust in healthcare systems. Because of how structural forms of racism have shaped medical failures and deliberate abuses (such as forced sterilization) for people of color, many non-white communities have a deep distrust of US healthcare systems. This led to lower vaccination rates among Black Americans and people of color during the COVID-19 pandemic, along with barriers to vaccine access for people who wanted them. Undervaccination has caused thousands of needless hospitalizations and deaths.

• Access to same-race physicians. Barriers that prevent physicians of color from being proportionally represented in medicine also prevent many patients of color from being able to choose same-race care providers. This can negatively impact patient care insofar as some patients may be more comfortable with and trusting of same-race care providers. In addition, physicians of color may better understand, empathize with, and advocate for patients with regard to race-related health indicators.
• Implicit racial bias in care providers. Implicit bias in healthcare frequently leaves non-white patients vulnerable to under- and misdiagnoses. Studies show that Black patients have worse overall health and shorter lifespans than white patients, even accounting for insurance coverage, income, age, and condition severity. In particular, Black individuals are more likely to die from cancer, heart disease, and diabetes than white people as a direct result of inferior care driven by racial biases.

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