Systemic racism is so engrained in our nation that the fight is far from over in making the United States an inclusive and diverse nation regardless of skin color, sexuality, or gender identity.
When Officer Derek Chauvin knelt on George Floyd’s neck for nearly nine minutes, resulting in Floyd’s death on May 25, 2020, activists around the country were sent into a rage. Floyd’s final words, “I can’t breathe,” were written on posterboard and marched down streets across a nation which refused to ignore police brutality.
Nine months later, windows have been replaced and rubber bullets have been picked up off the ground, but most importantly, states have begun receiving legislation targeting police brutality.
Systemic racism impacts virtually everything around us, such as law enforcement, education, housing and more. However, one of the most detrimental aspects of systemic racism is found in health care.
Occasionally, the effects of systemic racism in health care affect people of color, or POC, patients before they even have the chance to be seen by providers.
In some cases, barriers such as transportation and affordability can decrease access to health care for marginalized people from low-income households. For those seeking assistance, there are some local resources in place to help overcome these barriers.
“In Joplin we have the Joplin Community Clinic, a free health clinic for people who are uninsured. Access medical care offers income passed healthcare and both major hospitals locally have financial assistance programs. Food Not Bombs Joplin provides monthly trolly cards to people who are living unhoused,” said Flake.
Accessibility is only one aspect of the struggles marginalized people face. Health care workers have a tendency to respond differently to POC. Through these implicit biases, Flake has recognized situations where POC were more frequently flagged for hotlines.
“POC are known to be viewed more negatively in American society and be less trusted. I find that when questionable issues related to abuse and neglect of a child, POC seem to be more likely to be flagged,” said Flake.
Flake explained that there is a lot of research indicating that POC are more frequently and harshly disciplined, and she has witnessed this in health care settings. Flake also expressed that national data suggests there are differences in quality of care for POC in health care settings and overrepresentation of POC in social service hotlines.
The lack of care regarding mental health and biases against providing Black Americans with prescription drugs are notable problems faced each day by Black Americans in health care settings. There are several other ways systemic racism is prevalent in health care.
“Systemic racism in health care manifest itself in various ways. Here are a few: The number of POC represented in hiring data and leadership roles, less diagnostic testing given to POC, low rates of flu vaccination due to education and access gaps, and much higher death rates during pregnancy for women of color believed to be related to implicit biases. When mothers are cared for by providers of color, the death rate disparity gap between white and black closes significantly,” said Flake.
According to the CDC, women of color are two to three times more likely to die from pregnancy related deaths than white women in the United States. However, standardized protocols could be implemented to decrease the astronomical morality rate of pregnant women of color.
“Some standardized protocols could be related to ensuring a woman of color has access to a provider of color when possible. Also increasing Diversity, Equity, and Inclusion training among providers so they will be more aware of how implicit biases are impacting outcomes for women of color and become more aware of need to be intentional about closing the disparity gaps for women of color,” said Flake.
Health care is necessary throughout all stages of life, perhaps most importantly in the final seasons. However, systemic racism in health care is present for those seeking long-term care and for those living in assisted care facilities, often before POC even have access to the facilities.
“Long term care coverage is expensive and not usually considered standard. I find that rarely individuals in poverty purchase this coverage. If a person needs long term care without the coverage, Medicaid will be needed. This often requires the patient to forfeit assets, including their homes, to receive the care with Medicaid,” said Flake.
Receiving Medicaid is only half the battle. By forfeiting assets to qualify for Medicaid, POC are opening themselves up to financial difficulties which could impact their entire families.
“This contributes to generational poverty because building wealth is very difficult in these scenarios. Another consideration is that POC have not had access to insurance coverage need as long. There is a learning curve for families to learn to navigate coverage and health care systems effectively,” said Flake. “This justifies increased education to family who represent from underrepresented groups or those in poverty.”
Although it is clear that systemic racism and implicit biases exist in health care settings, acknowledgement is the first step in the fight towards equality and inclusivity. Not all hope is lost, for POC who feel as though their health care needs aren’t being met or are being blatantly neglected. Flake offers some words of advice.
Flake said, “know your rights. Ask questions until you understand. Secure a white ally to attend health care appointments with you and know resources within the health care entity such as patient advocates and social workers. Know compliant processes and lean into the discomfort of trusting white providers to encourage accurate sharing of history and needs.”
Systemic racism in health care panel
A panel of Missouri experts gathered on Feb. 2, to discuss systemic racism’s impact on health care. Missouri Health Care for All representatives Rebecca Johnson and KJ McDonald asked the panelists several questions about the implicit biases found in health care and what could be done to decrease systemic racism in a health care setting.
The panelists consisted of Licensed Master Social Worker, Dola Flake, who is the diversity transition and support coordinator at Missouri State University and co-founder of Joplin For Justice; Anthony Franklin, mental health clinician at Missouri State, Dr. Kimberly Martin, director of multicultural programs for Missouri State; and Nurse Marshall, a registered nurse for Springfield’s NAACP.
COVID-19's effect on people of color, POC, communities
Nurse Marshall explained the lack of testing opportunities being a barrier, especially for those who didn’t have access to technology in the early stages of the virus because they didn’t know it was an issue.
With COVID-19 playing such a major role in everyone’s lives for the past year, there probably isn’t a soul in the United States who hasn’t heard about it at this point. Now one of the biggest obstacles for POC regarding the coronavirus is the low rate of COVID-19 vaccinations being administered to POC.
Martin believes the lack of vaccinations among POC are due to mistrust and distribution methods. The coronavirus vaccines aren’t being evenly distributed throughout communities. In rural areas, additional barriers are transportation and insurance.
Mistrust stems from a lack of explanation from health care providers and a historical tragedy of Black Americans being used as “Guinea pigs” in medical treatments, said Martin. Some examples of a medical experiments on Black Americans include a 40-year Tuskegee study where the doctors allowed syphilis progression in Black sharecroppers from Alabama, and also when researchers stole cells without permission in 1951 from an African American cancer patient named Henrietta Lacks.
Martin also mentioned another way COVID-19 negatively affected POC communities when schools shut down in March. Martin was among many other school faculty members nationally who had to scramble to provide low-income students with technology resources, such as hotspots and computers, to access their online schooling.
Quality of care for POC
Another focal point of the discussion was about how the long history of systemic racism affects quality of care for POC. Martin said there aren’t enough POC being trained in health care roles and there isn’t enough diversity training to ensure POC are being accurately represented in health care settings.
Martin gave an example of false ideologies surrounding POC in health care, which is the idea that POC are “drug seeking” when requesting pain medication. In Martin’s experience, she has noticed Black Americans having to spend more time proving they are in need of pain medication, even if there is no medical history suggesting they may have a prior drug abuse problem.
Not only are there toxic stigmas regarding Black Americans requesting pain medication, but Martin said there are fabricated and dangerous misconceptions about Black Americans having a higher pain tolerance to justify withholding necessary pain medications.
Systemic racism in health care is present for POC whether they are involved as a patient or as a care provider. Marshall reflected on instances during her career as a nurse where patients were rude and disrespectful to her based solely on the color of her skin. There were even instances where patients refused to receive care from Marshall.
Flake noted an experience she had while accompanying her friend to see a doctor. A woman Flake knew had fibroids and she was told by the emergency room doctor that she would need a full hysterectomy without any hint of empathy in their delivery. “Would the doctor have been more thoughtful if she weren’t a black, gay woman?” said Flake.
Easing doctor appointment anxiety for POC
Franklin mentioned anxiety can be eased by becoming aware of where the anxiety stems from. Other methods of reducing anxiety include finding a way to challenge beliefs, finding comfort, and utilizing breathing techniques. Flake added that anxiety would likely reduce if more diversity could be found in health care. Until then, Flake recommends joining black friends to their doctor appointments as a white ally who can recognize mistreatment and advocate for their friends.
The panel addressed POC and allies who were advised on how to ensure they are receiving a proper level of care while explaining judgements and implicit biases to white allies who haven’t personally experienced the harsh reality of systemic racism in health care.