Do black lives matter in healthcare?

Ask any healthcare worker and they will say yes, of course they do. But the evidence shows a systemic bias both in the healthcare industry and in society as a whole.

At Out-of-Pocket, Nikhil Krishnan writes about the issues facing black patients. He says:

We need to recognize where and how these biases manifest. These are just a few, but more studies done to understand these systemic issues is important. To me this kind of racial inequity in healthcare is really pernicious because there are rarely extreme catalyzing events like George Floyd’s for people to react to and demand change. This kind of inequity grows slowly and kills more silently.

There is ample evidence that people of color, especially black patients, are treated differently than white patients. This may come as a surprise to many people because we’ve always been lead to believe that healthcare workers are free from bias and willing to help anyone who enters their treatment room. This simply isn’t always true and recognizing that is the first step towards change.

Khiara Bridges, professor of law at Boston University, writes about implicit bias and racial disparities in health care. Put succinctly, she says “Black people simply are not receiving the same quality of health care that their white counterparts receive.” Her piece looks at implicit bias in physicians and whether black people’s concerns are taken as seriously as white patients. This leads to under prescribing pain medication to African Americans and over prescribing to whites.

A viral Tik Tok video from Dr. Jennifer Lincoln talks more about this belief that black people somehow feel less pain than white people. This is a holdover from the days of slavery when African slaves were viewed as less than human. It also jumps into the world of law enforcement where black teenagers are frequently seen as much stronger and bigger than the police who end up shooting them.

And finally, this study from the Center for Medicare Advocacy provides a detailed, scientific look at disparities in care for racial and ethnic minorities.

So, if the evidence shows a disparity in treatment, what can we do about it? The standard response from many health systems has been to send out diversity education to their employees and assume that will fix any problems. But that’s not good enough. This isn’t something we can educate our way out of, we must make concrete, trackable changes.

This study at the NIH says the racial gap in healthcare outcomes needs to be looked at from at least three angles: the physician, the patient, and the organization. Each recommendation is good but the one with the most promise is for large providers to begin work on treatment standardization. This might go against physicians’ desires for a patient-centered focus but standardization will do much to control for implicit bias on the part of healthcare workers.

Another NIH study says that interventions outside of healthcare can do much to improve the health of black and other minority communities. Early childhood education, poverty reduction through programs like food stamps and welfare, increasing the Earned Income Tax Credit, and decentralization of public housing are but a few ways to improve healthcare inequalities.

At The Commonwealth Fund, Martha Hostetter and Sarah Klein show how cancer treatment completion rates were equalized between black and white patients in Greensboro, SC. The healthcare provider created nurse navigator positions who would guide patients through the process and help them with common issues, including financial problems, insurance, and juggling family responsibilities. The provider also increased colorectal screening rates by proactively reaching out to patients and offering tests that are less invasive than traditional colonoscopies.

Courtland Miloy at the Washington Post says the solution is right in our faces, we just need the political will to actually do something about it. Basically, we need to address economic inequalities in order to improve health. We need to fix the water problem that plagues cities like Flint, MI. We need to look at where fresh food is available and to whom. Basically, we need to make changes to the American system as a whole.

Finally, a study at the Brookings Institution looks at inequality in health and housing and offers some solutions to bridge the gap. One that stands out to me is the executive branch using the full extent of the EPA by fully implementing Executive Order 12898. This would require a presidential administration that is interested in addressing racial inequalities and environmental regulations; time will tell whether the current administration is interested in such a thing.

Addressing health inequality is not a Utopian project that can’t be achieved. There are plenty of solutions that only require funding and a desire by those in power to actually do something. In the current political climate it seems that we might see some movement on this. Change also requires healthcare providers acknowledging there is an issue and implementing solutions.

Do black lives matter in healthcare? Ask any healthcare worker and they will say yes, of course they do. But the evidence shows a systemic bias both in the healthcare industry and in American society as a whole that suggests otherwise.