Bias in medicine means that women and people of color have historically been neglected by the health care system, leading to worse outcomes.

You can’t get quality care if your doctor doesn’t see you as human.

Being a Black Woman who has been a Registered Nurse for over thirty years, I have played many roles, including:  wife, mother, daughter, educator, student, healthcare provider and patient. It was because of my first experience as a hospitalized patient, that led me to become a nurse.

My first childbirth experience left me fearful of doctors and nurses, humiliated and vowing that I would never return to any hospital. For my second pregnancy I was referred to a young Black female doctor, who compassionately listened intently to my story. She did not dismiss my feelings, concerns, or experiences. Together we decided what my next steps were and  Health care’s bias problem starts with what students learn in medical school.

Being a healthcare provider is a unique role. It involves knowing some of the most intimate things about a person, but not really knowing them as a person at all.

The patient’s job is to be transparent about their health, and the doctor’s job is to listen objectively to symptoms and fears to choose the most logical diagnosis.  Racial bias in the medical field disrupts the trust needed for this relationship to function. 

A biased doctor might disbelieve symptoms or their severity and misdiagnose a condition. A patient may come to mistrust the doctor, not attend appointments, not follow instructions, or stop sharing key information because history tells them they aren’t taken seriously. 

Reducing bias is critical to eliminating health disparities especially for Black women.

Subtle Racism

When Black people share instances of racism, it’s often disregarded as playing the ‘race card’ or as an isolated incident. It’s much more difficult to explain subtle racism than it is to explain blatant acts like burning crosses and racial slurs. 

Medical institutions aren’t the only ones where implicit bias and racism affect the relationships required to provide quality care and service. For Black people, the inability to trust whether someone sees you as a human being affects relationships with doctors, teachers, and other authority figures like the police. 

Substandard care

Receiving substandard medical care is dehumanizing. It can also jeopardize our lives and those of our loved ones. According to the CDC Pregnancy Mortality Surveillance SystemTrusted Source, the maternal mortality rate for Black women in the United States in 2016 was 42.4 deaths per 100,000 live births. The rate for non-Hispanic white women was 13 deaths.

That means Black women are 3.25 times more likely to die in pregnancy than white women.  And the infant mortality rate for Black infants is reported at 2.3 times that of non-Black infants. 

The Cost

Because of the historical vestiges of redlining, or the practice of excluding entire geographic areas from receiving resources, many Black, indigenous, and people of color  in urban and rural areas live in medically underserved areas (MUAs) and lack access to consistent, quality healthcare.

“Community clinics and federally-qualified health centers who take Medicaid will take new patients with multiple complaints and throw them into a 15-minute appointment. This disproportionately affects people of color,” 

Systemic racism and inequality produce lower quality healthcare when patients aren’t given enough time to discuss their symptoms. On top of that, doctors may not be able to truly hear the issues through the filter of their biases.

Cutting off bias at the root

Although uprooting medical bias is a large undertaking, it can begin with simple actions. 

First, doctors need to affirm the voices of women of color. It’s essential to not dismiss feelings, concerns, or experiences as isolated incidents. 

Second, medical schools need to begin including anti-bias training as part of their curriculum. Exposure to the concept can help raise awareness and allow medical professionals to avoid it in their own practice. 

Finally, healthcare organizations should conduct internal audits to objectively track and avoid medical bias. The internal audit could utilize demographic and health information to track symptom resolution. 

Data like this would show unexplained differences based on race, gender, or weight in terms of patient health outcomes. Internal audits can also focus on investigating complaints and why patients leave a medical practice. 

Changing Our Communities

The way communities are born, grow, live, work, and age determines their overall health and wellness.

These factors are known as the social determinants of health and they affect everything from nutrition to employment opportunities. They set the stage for overall well-being. Unfortunately, many Black people don’t have access to healthy environments in which to thrive.

ECONOMIC STABILITY

Economic stability means access to money and regular income to support your needs.

According to data based on adults of different ethnic groups who were working before and after the pandemic, less than half of Black people in the nation are employed. This means debt, rents, mortgages, and other bills are more difficult to pay.

There may also be limited opportunities for support for Black people, and unemployment may not be enough to cover expenses. It’s still unknown what the impact of a mass economic shutdown will have in America, but evidence already shows that Black people will once again be disadvantaged.

NEIGHBORHOOD AND PHYSICAL ENVIRONMENT

Your neighborhood and physical environment provide a healthy place to live.

Healthy places are safe. They have parks with playgrounds, limited crime, and reliable transportation, along with high rates of homeownership. Many Black neighborhoods have only one or two hallmarks of a healthy physical environment.

With documented widespread cases of police brutality, Black people and protestors are calling for an end to police departments in cities, schools, and neighborhoods. There is a myth that more policing means safer neighborhoods, but this isn’t the case for everyone.

The idea is that investing in the social determinants would dramatically increase the health outcomes of Black communities. Evidence suggests that healthy communities experience less crime.

EDUCATION

Education starts from preschool to college.

Schools in mostly Black neighborhoods aren’t funded like schools in mainly white neighborhoods. White neighborhoods statistically have more homeownership and more expensive homes. Education funds come from taxes, and taxes on more expensive homes lead to more money for schools in the neighborhood.

Many Black Americans don’t have access to owning a home. Banks often offer Black people higher interest loans than white people, or they won’t lend money to Black people at all.

When Black people can’t own homes, it makes it more difficult to build wealth for their families. Without wealth, college education isn’t a possibility for many Black people. Poorly funded K-12 schools in Black communities provide students with fewer opportunities to be prepared for, learn about, and apply to four-year colleges and scholarships.

FOOD

Access to healthy food where you live is vital.

Black neighborhoods are often food deserts, which means they have no grocery stores within a reasonable traveling distance. Residents must resort to liquor stores, fast food, or have reliable transportation to get to a grocery store.

COMMUNITY AND SOCIAL CONTEXT

Community and social context include being accepted and valued by your community.

We know what stress can do to physical and mental health. For Black people, there’s an additional invisible layer of stress due to police brutality, discrimination, microaggression, stereotyping and racism.

Black people often hide their feelings around the current injustices toward Black people while at work, especially in corporate settings. This can stem from fear of being viewed negatively by non-Black colleagues, as well as the fear of being relied on to educate others about racism.

THE HEALTHCARE SYSTEM

The healthcare system provides access to care, hospitals, and insurance.

Due to factors like subpar housing and lack of access to healthy food and culturally competent care, Black people experience more chronic illness. 

Implicit Bias in some healthcare providers, affects how much and what type of care is provided to Black patients.

There are also fewer Black healthcare providers. “Black female doctors have to deal with student loans, a limited number of Black peers, and non-Black doctors who don’t understand you and treat you unfairly.”

This connects to the social determinants of education and economic stability. Since there’s a higher possibility that Black families are unable to provide generational wealth, Black medical students are faced with taking on hundreds of thousands of dollars in debt. So, they choose to work and live-in places where they earn enough to pay off their loans.

Even when we have access to healthcare, Black people still don’t have what we need to thrive.

What you can do to help

This is where you come in. 

1. It’s important that Black people learn our history not only for context but to understand the power we have and how to support one another. 

2. That we promote healing in our communities.

3. Accept the fact, that the responsibility of leveling up is ours.

“Black people deserve humanity, equality, and a chance to thrive in this country".