The intersection of classism and racism has created a disparity in Black health. What steps have we made toward healthcare progress and what more can we do to progress how we treat the impoverished Black community?
How Racism Impacts Treatment
In an article titled Poverty, Racism and the Public Health crisis by the University of Houston, Laurie Fickman explains that racism’s link to health inequalities goes back to the 1800s when Dr. James McCune Smith, America’s first Black physician wrote about the early inequities and disparities in America, citing racism as the root cause.
“He explained the health of a person “was not primarily a consequence of their innate constitution, but instead reflected their intrinsic membership in groups created by a race structured society,” Fickman said.
This pattern of racism afflicting the treatment of patients can be seen as far back as textbooks given to medical school students. In an article by Refinery29, Malone Mukwende, a student at the University of London stated that within his first few weeks as a student he realized that his textbooks did not show how conditions would look on Black or Brown skin, in turn impacting diagnosis for conditions such as skin cancer. “Black Americans are three times more likely than white Americans to receive a late stage diagnosis for skin cancer. This may be because doctors are not trained to recognize how skin cancer presents on darker skin tones,” Patricia Louie, PHD told Refinery29.
Mukwende put together a manual called Mind The Gap: A Handbook of Clinical Signs in Black and Brown skin, which is free and depicts conditions on a variety of skin tones.
Matthew Kincaid, who is the founder and CEO of Overcoming Racism, an anti-racism consulting firm, stated that some of the generational impacts of this care is generations where mistrust and fear has been cultivated, along with a lack of diversity in access to Black providers.
“There is kind of this cyclical relationship that happens where- policies have been written, they create this disparity, the disparity engenders mistrust, and then, we kind of find ourselves backing into that cycle.”
Not only can this be seen with Mukwende going out and creating his book, but with the doubt that this problem even existed when he came across it when speaking to doctors and friends.
“So many people don’t think this is a problem, and they don’t realize the impact of the problem. Many people ignore it and didn’t see why it was so relevant,” Mukwende said.
The concept of a cyclical relationship where disparities are further backed can be seen in a statement by clinical professor Bettina Beech for University of Houston, where she argues that racism further contributes to inequality, which in turn lessens the health of the disenfranchised.
“Racism contributes to and perpetuates the economic and financial inequality that diminishes prospects for population health improvement among marginalized racial and ethnic groups. The U.S. has one of the highest rates of poverty in the developed world, but despite its collective wealth, the burden falls disproportionately on communities of color,” Beech said.
Kincaid does not necessarily believe that the biased health care being provided is a result of just the physicians, but rather rooted in the system itself.
“I don’t think that they do those things, because they want to cause harm. I think that they do those things, because they want to help people. And I think that it’s a very important lesson for all of us. And it’s not just doctors and healthcare providers, as teachers, as law enforcement officers and policymakers, the list goes on, is that you can have good intentions, but it doesn’t necessarily mean that you have the outcomes that you’re seeking. And so that’s why it’s critically important that we look at this from a broader perspective, and say, hey, well, you know, maybe the problem isn’t at the individual level, maybe the problem is rooted in some of the structures, systems policies, some of the training or lack thereof, that folks are exposed to, before they engage with patients, or students, or citizens,” Kincaid said.
Poverty and Its Impact on Health
The disparity in healthcare towards the underserved has gained more attention over the years, not only with the rise in interest for a Medicare for all system proposed by politicians like Alexandria Ocasio Cortez and Bernie Sanders. What further juxtaposed healthcare for more wealthy white residents was the handling of the COVID-19 pandemic. According to Kincaid, not only did it highlight the lack of healthcare access, but the impact of the medical community’s racist history with the Black community.
“The pandemic was an exposure of the fact that we’ve had these major issues of lack of access to health care that have happened in our country. And I think as long as there’s this illusion, that that was at least somewhat equitable along the lines of race, then it’s a conversation that we perhaps don’t have to have. What the pandemic did was expose the fact that there are communities that are cut off from a lot of institutions where you receive critical care, there are communities where there has been historical mistrust.
When it comes to how to address the root of this issue, Kincaid stated that it starts with education and diversifying the medical field pipeline.
“I think it starts with diversifying our medical force, starts with diversifying the pipeline that we have for doctors, especially black doctors. I think that it starts with us reviewing who gets health care and what kind of healthcare and how we go about health care, and making obviously critical care that people need to be more accessible. Someone shouldn’t have to face some massive health crisis because they can’t afford it,” Kincaid said.
From what Kincaid can see, there is progress being made to improve the healthcare system in terms of racism. This progression can be seen with work like Mukwende’s and with the recognition by the American Medical Association has identified racism as a national health crisis. But, there is still more that needs to be done to offer patients the proper care that they are entitled to.
“Have things gotten better? Sure. But there’s a market difference between getting better, and being the type of care that doctors want to give, as well as patients deserve. I think that there is a ways to go, but obviously nothing can change until we face it. It does, at the very least feel like, these are the conversations that are starting to happen in some hospital systems. I think we have to hold ourselves accountable. And I think we have to hold each other accountable to say that these are the types of conversations that have to happen within all of our hospitals systems, because it truly can be a matter of life and death for a patient or, for a person who goes into a doctor and has a bad experience,” Kincaid said.
In terms of resources and education that people can use to stay informed on the impact of classism and racism on Black health, Kincaid recommends Medical Apartheid by Harriet A. Washington as well as the story of Henrietta Lacks. What he also encourages is working to have conversations with your healthcare provider.
“I think that these are the types of conversations we should be having with our healthcare providers. I think that folks are much more open now than perhaps they’ve been in the past to engage critically, in thinking about how we can be intentional about creating a healthcare system that works for all people. It took a lot of intentionality to craft the policies that have created these barriers, whether it be policies that limit people’s ability to access wealth, like redlining policies and housing, whether it be policies that make it challenging for people to access health care, the list goes on. We have to be as intentional when we talk about how we dismantle this. And so that’s going to require work from all of us,” Kincaid.
Ways To Help
Questions that a healthcare provider can ask themselves and be asked can be found on patientbond.org.