Racism in Healthcare

So let's begin.

As you can see, I have decided to title this

presentation Racism in Healthcare, an un exhaustive introduction.

And this is because there is so much more to

talk about in terms of racism in our system than

anything that I could mention in just this short presentation.

So I first want to give a historical perspective, and

in this case, it is a historical perspective with regard

to American obstetrics and gynecology.

Until the mid 18 hundreds, women cared for women through

pregnancy, childbirth and postpartum.

However, when the importation of slaves to America was banned

in 18 08 slave masters and physicians began to work

together to invest in the reproductive health of enslaved women,

which would in turn provide them with more slaves.

As the Children's group, the Children grew up and began

to work for them.

By the early 19 hundreds, doctor said, pathologize pregnancy and

use poor women as training subjects.

Now, with a look at the progress and gynecology at

the expense of black women, there's a doctor named James

Marien Sims, who was white, and he is often credited

as the father of gynecology.

He made several discoveries, like the successful procedures, a fistula

surgery and the invention of the speculum.

However, he operated on black enslaved women without their consent

or anesthesia.

And he claimed that black women are intolerant to pain,

an idea that has been sustained even until today, where

often black patients are even recent textbooks, as we'll see

in a few minutes claimed that black people experience pain

differently or that they have thicker skin, which is simply

not true.

Another great example is that of Henrietta Lacks, who was

born in 1920 died in 1951 off cervical cancer.

Henrietta began to feel some pain in her abdomen that

was sort of abnormal.

So she went to her doctor at Johns Hopkins Medical

Center, and while she was there, her doctor collected two

cells from her service like what has done typically during

a path without her knowledge.

And these cells, which turned out to be cancerous, were

replicated and distributed for research after her death.

Henrietta's immortal cell line, which is known as HeLa, lead

to key discoveries in medicine, including the development of the

polio vaccine, cancer treatments and AIDS research.

Despite her great contribution to the field, of medicine and

science. Her family continued to live without equitable, equitable access

to health care due to racism and classism in American

society. In the book The Immortal Life of Henrietta Lacks

by Rebecca Skloot, Skloot goes into much more detail about

this case.

Now I want to move on to patient provider interactions.

First, we can acknowledge that all individuals have implicit biases.

There, there, in uh, implicit biases are ideas that affect

how we interact with others subconsciously.

But however, when providers have these biases, it affects the

quality of care that their patients receive.

Bridges says black patients are less likely to receive life

saving treatments and more likely to receive less desirable treatment

due to biases of their provider.

Yeah, here's a text book from 2017 that goes into

detail about how different individuals from different backgrounds experience pain.

Some of the claims are Jews, maybe vocal and demanding

of assistance.

Native Americans may prefer to receive medications that have been

blessed by a tribal shaman.

Blacks often report higher pain intensities than other cultures.

Indians who follow Hindu practices believe that pain must be

endured in preparation for a better life in the next

cycle, and Hispanics may believe that pain is a form

of punishment and that suffering must be endured if they're

to enter heaven.

These statements or stereotypes represented as factual information to inform

our providers, contributes to racism within the whole system.

A close friend of mine who is a young black

woman experienced terrible menstrual periods for several years, each time

throwing up for three days and enduring intense cramps.

Several doctors minimized her experience and told her it was

normal. She self diagnosed herself with endometriosis while studying in

Japan, where endometriosis endometriosis is common, she sought out medical

care and determined that she had ovarian cysts for many

years that were untreated because of her doctors unwillingness toe

help dig into her case a little bit deeper.

As a result, she avoids the doctor at all costs

and does not trust medical professionals.

This is more than just a couple Ah, handful of

racist doctors.

This is a whole system that collaborates and contributing to

racist racism In health care.

There are many tools and re sources that are often

used to determine treatment options, which are adjusted to account

for race.

However, instead of accounting for genetic difference, which is been

deemed insignificant in most cases.

The result has been to direct medical resource is away

from black patients and to deny some black patients treatment

options on available toe white patients.

Additionally, while we're seeing drastic improvements in staff diversity in

hospitals and clinics in many areas around the country, the

higher level positions like CEOs and medical directors are still

largely white, which is really problematic.

Here's some examples provided by Gina Kolata from an article

written just this year in 2020 kidney filtration rates are

adjusted for black patients, resulting in better rates than white

patients. This disqualifies black patients for kidney transplants and referrals

to specialists.

Also, osteoporosis risk calculators calculates less risk for black black

patients, making them less likely to receive osteoporosis medications compared

with white women of similar condition.

So when all other factors like income, education or housing

are equal, black people still experience worse health outcomes when

compared to those of white people, Chiara and Bridges says.

For example, one study of 400 hospitals in the United

States showed that black patients with her disease received older,

cheaper and more conservative treatments than their white counterparts, black

patients were less likely to receive coronary bypass operations and

angiography after surgery.

They're discharged earlier from the hospital than white patients at

a stage when discharges inappropriate.

She goes on to say that the rates at which

black patients have their limbs amputated is higher than those

for white patients.

Additionally, black patients suffering from bipolar disorder are more likely

to be treated with anti psychotics, despite evidence that these

medications have long term negative effects and are not effective.

All of this and so much more contributes toe worse

health outcomes and a lack of trust in providers that

creates a barrier to healthcare for future complications.

This also goes back to We also see this going

back to medical school, where people of color are considered

for high honors less frequently, despite equal or better performance.

And even providers experience racism that continues to force individuals

out of positions.

I personally know someone who was a high performing pathologist

who was Jewish.

She frequently received death threats and other forms of discrimination

that forced her to move states.

Now it's not just the system that's hurting people, it's

not now.

It's not just the health care system that is hurting

people of color and their health.

Now it's not just the health care system that is

causing these disparities in health for black people and other

people of color.

The cost of racism itself causes extreme issues.

It now It's not just the health care care system

itself that is causing extreme disparities in the way people

access healthcare.

Now. It's not just the health care now.

It's not just the direct racism that occurs in the

health care system.

It's also racism in everyday life that is impacting the

health of individuals.

Daily microaggressions and overt racism, which are omnipresent in our

current society, cause the body to continuously exhibit a stress

response. This leads to inflammation that raises risks for chronic

illnesses and compromises.

Thean immune system The AL a static load, which could

be described as the cumulative wear and tear of the

body systems, is far greater in people of color and

especially in black Americans.

Now we all know that there are disparities in health

care and largely due to social determinants of health.

So in this section we're going to go through some

of the ways that our society is contributing to differences

in health through racism, So the first topic is environmental

racism. When comparing predominantly black neighborhoods with predominantly white neighborhoods,

we find fewer hospitals and health clinics, fewer grocery stores

with fresh produce and more convenience stores and fast food

chains. Less strict environmental protections implemented like factories and water

systems and landfills in the area that are largely unregulated

and fewer green spaces, which, when present, helped to decrease

the heat in the summer and filter out pollutants in

the air.

I also want to point out that many American indigenous

populations experienced similar barriers to health care.

There are often far fewer hospitals and clinics and less

financial support given to these centers.

In the Cova 19 pandemic, we have seen massive devastation

to the Navajo Nation due to limited resource is including

insufficient PP, ventilators and beds and more.

The Cares Act provided disproportionately less funding to the Navajo

Nation. During this hard time named general, indigenous people often

experienced similar discrimination by providers due to implicit or explicit

biases. The following video dives deeper into environmental racism and

how it impacts our health today,

Racism in Healthcare

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