Medical Racism: The History Behind It and How It Affects Minorities Today
While we are addressing the issue of racism, it is also very important to discuss racism in the medical field/medical treatment- especially in the United States. In this blog post, I will do my best to explain the history behind medical racism, how it affects minorities today, and what we can do to prevent it.
TW: Abuse
What is medical racism?
Medical racism is prejudice and discrimination within the health care system based on perceived race or ethnicity. Let's talk about the history of racial injustice in medicine.
Myths about physical racial differences were used to justify slavery and are believed by some doctors today. These myths included the ideas that black people did not feel pain and "had weak lungs that could be strengthened through hard work" (1) and allowed pro-slavery physicians to exploit black people and do things to them that would not be accepted by modern society.
Case Study #1 (1845-1849): Gynecology Experiments
The myths about pain tolerance as explained above allowed physician J. Marion Sims, celebrated as the father of gynecology, to use black women as subjects in his experiments. He performed painful surgeries on enslaved women without consent or anesthesia. In his autobiography, "The Story of My Life", Sims described the suffering these women endured as he cut their genitals to try to perfect a surgical technique to repair vesico-vaginal fistula, an extreme complication of childbirth.
In the 1850's, Sims opened up the first women's hospital in New York, where he continued to perform controversial medical treatments on his patients. When any of his patients died, he blamed it on "the sloth and ignorance of their mothers and Black midwives who attended them".
Case Study #2 (1932-1974): The Tuskegee Syphilis Experiments
These were the 40 years in which the "Tuskegee Study of Untreated Syphilis to the Negro Male" by the US Public Health Service took place. It involved 600 black men: 399 had syphilis, and 201 didn't have the disease. The kicker is that none of the participants had informed consent to the study; they just thought they were being treated for "bad blood". Penicillin became a treatment for syphilis in 1947, but the participants were hindered from receiving treatment due to the longevity of the study. Concerns about the study were raised but ignored by the CDC.
Case Study #3 (1954-1962): Contraceptive Trials in Puerto Rico
In 1954, Doctors and researchers picked a village (Rio Piedras) in Puerto Rico to do clinical birth control trials after a small sample size in Boston complained of severe side effects. None of the women involved in the Puerto Rico studies gave consent to participate in the clinical trial. The birth control had major side effects, including depression and death. In 1962, six women from the village died as a result of the trials, and 26 reported severe blood clots from the drug. No autopsies were performed.
There are so many more examples of this (ie STD study on Guatemalan men in 1940s performed by US government-funded doctors). I encourage you guys to read more about the history behind medical racism. More resources will be linked at the end of the article.
Medical Racism in Society Today
Recent data shows that doctors and nurses fail to treat minority (more specifically black) adults and children for many medical issues due to implicit bias. Implicit biases against minorities and stereotypes about their health behavior and systemic factors are common ways healthcare providers negatively influence minority health outcomes.
A 2013 study done by the American Medical Journal of Ethics found that Black and Hispanic people - from children who needed their tonsils taken out to elders in hospice care - received less pain management compared to their white counterparts. The study also found that Black and Hispanic patients were less likely than white patients to receive any pain medication and more likely to receive lower doses of pain medication.
Also, according to a study performed by the University of Albany School of Public Health, white physicians find black and low-income patients less intelligent than white patients and patients of higher income. When doctors and nurses were given an anonymous survey asking them to explain racial inequalities in healthcare, most of them saw black patients as passive and unintelligent and blamed them for not making specific care requests for their providers (3).
Black women have historically had the highest maternal mortality rates.
Researchers don't have a clear explanation for this, but they suspect that a combination of institutionalized racism in the medical care system as well as black women's susceptibility to health conditions such as obesity and hypertension. Black women are also less likely to get prenatal care.
The chart below displays death from coronavirus by race. Even in the current coronavirus pandemic, we are seeing a high mortality rate among African-Americans due to inadequate access to resources and discrimination during treatment.
The number that stands out here is the percentage of COVID deaths that occurred among African-Americans. Black people make up 13% of the population but account for 23% of all COVID deaths in the US.
Why is this happening?
Black people are more likely to live in densely populated urban areas as a result of redlining, making them more susceptible to coronavirus. Also, black people are less likely to have healthcare access, meaning that hospitals are farther away and pharmacies are subpar, leading to more days waiting for urgent prescriptions. Comments from French doctors saying that potential COVID-19 vaccines should be tested on poor Africans contribute to medical mistrust and further enhance racial health disparities.
What can we do?
We can educate ourselves on this issue and understand how we might unintentionally perpetuate it. The novel "Medical Apartheid", by Harriet Washington, provides an understanding and context of the deep distrust African-Americans have toward the medical field. We need to be more sensitive to cultural values and experiences of minority groups to increase medical cultural competency.
Sources:
9. https://www.brookings.edu/blog/fixgov/2020/04/09/why-are-blacks-dying-at-higher-rates-from-covid-19/
Learning more about medical racism-
Books:
- Medical Apartheid by Harriet Washington
- Just Medicine: A Cure for Racial Inequality in American Health Care by Dayna Bowen Matthew
Films:
- La Operación by Ana María García
- Unnatural Causes by Larry Adelman and Llew Smith
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