Systemic Racism in Health Care | theSkimm
Systemic Racism in Health CareKelsey Tyler

The Story

People of color face a disproportionate level of health risk compared to White people in the US. 

Why, though? 

Because systemic racism. This answer can be applied to so many inequities people of color face—education, housing, incarceration, and more—so it shouldn’t come as a shock that health care is also biased.

How did this happen? 

The US health care system was segregated well into the 20th century—as in, many hospitals and clinics were completely separated by race, or required Black people to use different wings of medical facilities with subpar care. Fast forward to today, and while segregation isn't as explicit, there is still implicit bias that permeates the health care industry. A study found that on average, White Americans spent 80 minutes waiting for or receiving care, while Black Americans spent 99 minutes and Hispanics 105 minutes waiting for that same care. In 2017, 75.4% of White Americans had private health insurance, compared to 55.5% of Black Americans. Lower quality of care combined with a higher rate of health issues creates a system that fails many people of color.

Let’s talk specifics. 

These disparities affect many health issues. We’ve broken down some of the numbers and reasons why there’s such a gap.

Chronic disease:
  • Minorities are up to twice as likely to have most major chronic diseases (think: asthma, diabetes, hypertension, obesity, and more).
  • Why is that? In part, because it's harder for people of color to get the recommended seven to nine hours of sleep. That’s due to things like economic stress and living in neighborhoods with more noise and violence. And the issues start long before hitting the sheets. Studies have shown that perceived discrimination—everything from workplace to housing—can impact mental and physical health, and cause chronic disease at higher rates.
Cancer:
  • The cancer mortality rate is 25% higher for Black Americans than White Americans. And Hispanics are more likely than White Americans to be diagnosed with cancer at an advanced (and more life-threatening) stage. In one study, Black children were between 38 and 95 percent more likely to die of cancer, and Hispanic children were between 31 and 65 percent more likely to die.
  • Why is that? In many cases, socioeconomic status. Studies have shown that this can play out in a lot of different ways: more frequent exposure to cancer-causing carcinogens, inability to afford transportation and take off work for screenings or treatments, and less access to insurance, to name a few.
Infertility:
  • In a review, 12% of Black women, 10% of Asian women, and 9% of Hispanic women experienced infertility, compared to only 7% of White women. Though people of color experience infertility more, they receive less treatment—11% of Black women and 12% of Hispanic women receive treatment, compared to 16% of White women. 
  • Why is that? Cost. Infertility treatments are often pricey. IVF, for example, costs an average of $20,000—and people of color are less likely to be insured and able to afford treatments. That’s in part because of wage disparities between White people and people of color in the US. In 2016—the most recent year data is available—you’d have to combine the net worth of 11.5 Black US households to get to the net worth of one average US White household. A lack of communication and stigmatization around the issue of infertility also plays a role. For instance, Black women wait twice as long on average as White women before getting help with infertility.
Childbirth:
  • Black, Native American, and Alaska Native women are about three times more likely to die from pregnancy-related causes than White women. 
  • Why is that? In part, because people of color are less likely to have access to quality prenatal care. And they’re more susceptible to conditions like obesity and heart disease hypertension, which can complicate pregnancy and childbirth. 
COVID-19:
  • Black and Latino Americans are three times as likely to get COVID-19 and twice as likely to die from the virus. 
  • Why is that? Most of the serious and life-threatening COVID-19 cases involve underlying conditions, like chronic diseases, which are more common in people of color. People of color are also more likely to hold at-risk jobs—about 43% of Black and Latino workers have service jobs that cannot be done remotely, while only about 25% of White American workers hold these kinds of jobs (and are more likely to be able to stay socially distant while making a living). In addition, housing disparities play a part: people of color are more likely to live in crowded urban communities that make physical distancing harder. 
Mental health: 
  • Only one in three Black Americans who need mental health treatment actually receive it. And Native Americans and Alaskan Natives report higher rates of post-traumatic stress disorder and alcohol dependence than any other racial group. 
  • Why is that? Health insurance doesn’t always cover therapy and people of color are less likely to have insurance that covers it and less likely to be able to pay out-of-pocket. In terms of substance abuse, Native Americans and Alaskan Natives have high rates in part due to their history of trauma in this country—such as being forced off their land and separated from their families. The toll that takes on mental health can trickle down and span generations. 

What can be done about all of this? 

The US can try and turn lip service into legislation. In 2011, the Dept. of Health and Human Services launched an action plan that included things like increasing data collection for minority populations, diversifying the health care workforce, and providing more incentives to physicians to provide quality health care. Now, there’s a bill being discussed that aims to help people of color in the fight against COVID-19. It would require targeted testing, contact tracing, and public awareness campaigns in minority communities. These ideas are on the table—so the biggest way you can make a difference is by voting for policy makers who represent the changes you want to see.

theSkimm

This year has shown, with painful clarity, that systemic racism is alive and well in the US—everywhere from the boardroom to the waiting room. Health care is just one issue that can stand to gain from the nation’s racial reckoning. But fixing a centuries-old system that fails many people of color starts with policy. Here’s your reminder to vote.