To the Editor:
Despite passage of the Civil Rights Act in 1964, racial discrimination in the American health care system remains devastating, which we are witnessing first-hand during the 2020 coronavirus pandemic with unsettling clarity. As more disturbing data arrives, a recent study published by the Journal of General Internal Medicine reports Black Americans are 3.5 times more likely to die from COVID-19 than white Americans. Most Americans are not aware of the racial discrimination in American health care. Two key components drive the discrimination: a lack of funding in health systems serving predominantly Black neighborhoods, and a general lack of diversity training in medical schools and the health care industry.
Funding remains a controversial subject within the health care system. Most hospitals run on razor thin profit margins, and government funding is a necessity to ensure proper health care treatments to patients. During this Covid-19 pandemic, America has witnessed a distinct lack of proportional funding from the government to hospitals serving traditional African American communities. In an October 2020 study published by The Journal of the American Medical Association, researchers found that although hospitals serving predominantly African American communities had slightly more funding per patient, these hospitals were proportionally underfunded to a significant degree on a Covid-19 incidence basis. In others words, health systems serving minority populations with a greater incidence of Covid-19, were allocated less funding than hospitals serving nonminority communities. Put simply, more Covid-19 medical funding needs to go to health systems serving minority populations to lower the mortality rates that are skyrocketing across underserved minority communities.
American doctors receive some of the most rigorous education and training to obtain their medical degree and license to practice. However, recent studies are increasingly demonstrating their education doesn’t contain enough diversity training to overcome bias, cultural differentiation, and inherent racism. The medical and health care education systems that prepare doctors and health care professionals to obtain medical licenses and practice medicine are not adequately preparing them to overcome racial bias and inherent racism in the health care system.
In a study conducted by the National Academy of Sciences (PNAS) on false biases held by medical students, the study reported the students made more assumptions concerning Black health characteristics than that of white patients. During the study, medical students were given a survey with statements about biological comparisons between white and Black patients, and were asked to indicate whether they felt the statement was, True or False. Some of the statements included phrases like: “Black people have a better sense of smell than white people” (False) or “White people are less likely to have a stroke than Black people” (True). On average, about 12% of the false statements were labeled as true by the students, and at least 50% of the students surveyed indicated a false statement to be True. The study also found that medical students underestimated the pain of Black patients almost 50% of the time compared to white patients 30% of the time. Clearly, more diversity and sensitivity training for doctors and health care professionals is needed to help reduce and eliminate racial bias and inherent racism in health care.
Doctors are generally believed to be some of the most trusted members of communities, but not every member of a community shares the same comfort levels surrounding this common belief. For example, some past experiences continue to haunt some communities like the Tuskegee Experiment (which was a medical study in 1932 that involved a lack of informed consent and resulted in African Americans not receiving proper syphilis care in a federal effort to cure the disease), or even because of the current pandemic, some people question the legitimacy of health information they are constantly receiving. Simply put, when a patient is sick, they are at their most vulnerable, and they want to be able to trust their health care professionals to be well-trained, and looking out for their best interests!
While systemic racism has sunk its teeth into the institutions that we hold most sacred in this country, we need to work diligently to remove all negative biases in our education and training of health care professionals. There needs to be better access to health care to medically underserved communities. The health care system needs to point more of its funding and data collection efforts to deliver best outcomes and bring problems to light in real time, so we can rigorously change our education in the health care system to improve health outcomes for the diverse members of this country.
For the past 18 months, I have been an intern supporting Equity First, a non-profit organization formed to champion fair school funding across Pennsylvania’s 500 school districts. Before the internship, I had no idea racial discrimination was so pervasive in Pennsylvania, and I was not aware of the vast funding disparities in our state. Racial discrimination is a disease. Because of the severity, duration, and range of the disease of racial discrimination in our American system, it begs the question: What can I do to help? Some general things include donating (your time and money to African American organizations), signing petitions, voting, and most importantly, educating yourself and others. With more people becoming aware and demanding positive change, it will encourage change.
You can quickly do three things to help end this brutal truth of racism in U.S. health care.
1. Share this article with three friends that you believe will help end racism.
2. Share this article with your federal, state and local officials.
3. Share this article with your doctor, and two others you know in health care.
Action is needed as soon as possible. As the vaccine rolls out to Americans across the country, it is important to consider that a study done by the Pew Research Center reported by the LA Times in June, 2020, concluded that a mere 32% of African Americans felt comfortable with receiving the vaccine. This is a disconnect of abysmal proportions. We need to bolster our efforts for equality to improve our health care system for all people to feel safe as we combat this pandemic.
I am writing this article to share it with policy makers and legislators. I hope after reading this article you will share it with policy makers, legislators, friends, family and colleagues so we can all work together to eliminate unfairness and racism in health care, and education funding! Thank you.
Matt Sherman, Pharmacy Student and MBA Candidate