• Home
  • Opinion
  • Quizzes
  • Redistricting
  • Sections
  • About Us
  • Voting
  • Independent Voter News
  • Campaign Finance
  • Civic Ed
  • Directory
  • Election Dissection
  • Events
  • Fact Check
  • Glossary
  • News
  • Analysis
  • Subscriptions
  • Log in
Leveraging Our Differences
  • news & opinion
    • Big Picture
      • Civic Ed
      • Ethics
      • Leadership
      • Leveraging big ideas
      • Media
    • Business & Democracy
      • Corporate Responsibility
      • Impact Investment
      • Innovation & Incubation
      • Small Businesses
      • Stakeholder Capitalism
    • Elections
      • Campaign Finance
      • Independent Voter News
      • Redistricting
      • Voting
    • Government
      • Balance of Power
      • Budgeting
      • Congress
      • Judicial
      • Local
      • State
      • White House
    • Justice
      • Accountability
      • Anti-corruption
      • Budget equity
    • Columns
      • Beyond Right and Left
      • Civic Soul
      • Congress at a Crossroads
      • Cross-Partisan Visions
      • Democracy Pie
      • Our Freedom
  • Pop Culture
      • American Heroes
      • Ask Joe
      • Celebrity News
      • Comedy
      • Dance, Theatre & Film
      • Diversity, Inclusion & Belonging
      • Faithful & Mindful Living
      • Music, Poetry & Arts
      • Sports
      • Technology
      • Your Take
      • American Heroes
      • Ask Joe
      • Celebrity News
      • Comedy
      • Dance, Theatre & Film
      • Diversity, Inclusion & Belonging
      • Faithful & Mindful Living
      • Music, Poetry & Arts
      • Sports
      • Technology
      • Your Take
  • events
  • About
      • Mission
      • Advisory Board
      • Staff
      • Contact Us
Sign Up
  1. Home>
  2. race>

Institutional racism exists in American health care

Robert Pearl
https://twitter.com/robertpearlmd?lang=en
October 05, 2021
Patients being treated for Covid-19

A registered nurse cares for a Covid-19 patient as another patient rests at Providence Holy Cross Medical Center in Los Angeles. Minority patients have received a lower quality and quantity of Covid care compared white Americans, writes Pearl.

Mario Tama/Getty Images

Pearl is a clinical professor of plastic surgery at the Stanford University School of Medicine and is on the faculty of the Stanford Graduate School of Business. He is a former CEO of The Permanente Medical Group.


This is the first entry in a two-part op-ed series on institutional racism in American medicine.

The story of American medicine is one of incredible scientific advancements, from the use of penicillin to treat syphilis and other bacterial infections to the countless biomedical breakthroughs made possible by cell-line research.

Too often, however, these stories ignore an uncomfortable truth: Some of our nation's most significant medical discoveries were made possible through the mistreatment of Black patients — from the exploitation of African American farmers during the Tuskegee syphilis experiments to the tragic case of Henrietta Lacks, a Black patient whose cells were stolen by doctors and used for decades of cell-line research.

Racism is woven into our nation's medical past but is also part of our present, as evidenced by the Covid-19 crisis. From testing to treatment, Black and Latino patients have received a lower quality and quantity of care compared white Americans.

The biases of individual doctors and researchers aren't always the biggest barriers to equitable health care. Often, the problem is institutional.

Sign up for The Fulcrum newsletter

Institutional (or systemic) racism is invisible yet omnipresent. It is woven into the fabric of American health care, embedded into the practices, policies and perceptions of the entire industry.

At some point during medical school, all future doctors are instructed to treat everyone equally, regardless of a person's race, ethnicity, gender, religion or sexual orientation. Studies have shown just how difficult this edict proves in practice.

Even when physicians have the best of intentions, their actions are beset by unconscious prejudices. Researchers have found that two out of three clinicians harbor what is called an "implicit bias" against African Americans and Latinos. These are biases that exist outside the doctor's awareness but are nonetheless harmful to minority patients.

In one example, epidemiological data demonstrate that Black individuals have experienced a two to three times higher likelihood of dying from Covid-19 than white patients.

Physicians attribute this discrepancy to the "social determinants of health," a phrase that encapsulates the many aspects of life that influence our health, including where we live, work, play and socialize. But before we accept this explanation and let health care professionals off the hook, consider what we learned early in the pandemic: According to national studies, white patients who came to the emergency room with symptoms likely to be Covid-19 were tested far more often than Black patients with identical symptoms.

A distressing example of institutional racism involves childbirth. Most Americans don't realize it, but the United States ranks last among all developed nations in maternal mortality (the measure of how often mothers die during or soon after childbirth).

Most of these deaths could be prevented, and yet the maternal mortality rate has been increasing in the United States since 2000. Two decades after The Journal of Perinatal Education first described the issue of racial disparities in maternal care as "alarming," Black women remain three times more likely to die from childbirth than white women.

Obstetricians know the most common causes of maternal death are (a) unrecognized bleeding and (b) uncontrolled high blood pressure. What they can't explain is exactly why a woman's skin color has such a significant influence on her risk of dying. Ask doctors what's going on and they'll list a number of contributing factors, ranging from the higher risk of hypertension in Black patients to greater life stresses to differences in diet and education.

But none of those factors help explain this: When the treating clinician is Black, the disparity in deaths between white and Black mothers all but vanishes.

The problem in understanding this discrepancy isn't a lack of data. Almost all U.S. hospitals have comprehensive inpatient electronic health records that provide a rich tapestry of details about the women giving birth and the care they receive. And as of 2017, all 50 states were required to add a standardized "maternal mortality checkbox" to their data reporting systems.

And yet we still don't know why the race of the doctor makes such a difference or how to close the gap when the physician is white. We also don't know if the race of the nurses providing the care matters. We also don't know whether the frequency of blood-pressure monitoring or care checks varies based on the patient's race, the staff member's race or both.

Most medical research focuses on the causations or correlations between two easily isolated data sets (like the race of doctors and the mortality of patients). Addressing systemic racism in medicine requires that we analyze far more data (all at once) than we do today.

In my next writing, I will explore how artificial intelligence might be the perfect application for this task but also how predictive health care algorithms used in AI can, themselves, have design flaws that result in unintended discriminatory biases.

From Your Site Articles
  • Democrats must seize the moment or risk losing Black voters - The ... ›
  • Democracy requires us to work on our biases — all of them - The ... ›
  • Racism is the greatest threat to democracy today - The Fulcrum ›
  • How to get the health care we think we're paying for - The Fulcrum ›
  • Video: Unbreaking America's Healthcare - The Fulcrum ›
  • Seeding systems change through the vital conditions for health and well-being - The Fulcrum ›
  • Understanding systemic discrimination to address inequality - The Fulcrum ›
Related Articles Around the Web
  • Racism, Inequality, and Health Care for African Americans ›
  • Understanding and Addressing Racial Disparities in Health Care ›
  • Racism in healthcare: Statistics and examples ›
  • Racism and discrimination in health care: Providers and patients ... ›
race

Want to write
for The Fulcrum?

If you have something to say about ways to protect or repair our American democracy, we want to hear from you.

Submit
Get some Leverage Sign up for The Fulcrum Newsletter
Confirm that you are not a bot.
×
Follow

Support Democracy Journalism; Join The Fulcrum

The Fulcrum daily platform is where insiders and outsiders to politics are informed, meet, talk, and act to repair our democracy and make it live and work in our everyday lives. Now more than ever our democracy needs a trustworthy outlet

Contribute
Contributors

To advance racial equity, policy makers must move away from the "Black and Brown" discourse

Julio A. Alicea

Policymakers must address worsening civil unrest post Roe

Sarah K. Burke

Video: How to salvage U.S. democracy from the "tyranny of the minority"

Our Staff

What "Progress" should look like, and what we get wrong

Damien De Pyle

The long kiss goodnight: Nancy Pelosi and the protracted decay of public office

Kevin Frazier

Demanding corporate responsibility for food system challenges

C.Anne Long
latest News

The show must go on

Amy Lockard
19h

Constitution Day conversation with Jamie Raskin: Preserving democracy today and tomorrow

Rick LaRue
Jamie Raskin
20h

Meet the Faces of Democracy: Stephen Richer

Michael Beckel
Ariana Rojas
20 September

The alchemy of laughter

Pedro Silva
20 September

Work/family balance should be a top tier policy area

Dave Anderson
20 September

Learning to make “the right call” in the right moments

Lisa Kay Solomon
19 September
Videos
Video: Expert baffled by Trump contradicting legal team

Video: Expert baffled by Trump contradicting legal team

Our Staff
Video: Do white leaders hinder black aspirations?

Video: Do white leaders hinder black aspirations?

Our Staff
Video: How to prepare for student loan repayments returning

Video: How to prepare for student loan repayments returning

Our Staff
Video: The history of Labor Day

Video: The history of Labor Day

Our Staff
Video: Trump allies begin to flip as prosecutions move forward

Video: Trump allies begin to flip as prosecutions move forward

Our Staff
Video Rewind: Trans-partisan practices and the "superpower of respect"

Video Rewind: Trans-partisan practices and the "superpower of respect"

Our Staff
Podcasts

Podcast: How states hold fair elections

Our Staff
14 September

Podcast: The MAGA Bubble, Bidenonmics and Playing the Victim

Debilyn Molineaux
David Riordan
12 September

Podcast: Defending the founding principles of our government

Our Staff
07 September

Podcast: The continuing effects of summer heat and student loan repayments

Our Staff
05 September
Recommended
The show must go on

The show must go on

Big Picture
To advance racial equity, policy makers must move away from the "Black and Brown" discourse

To advance racial equity, policy makers must move away from the "Black and Brown" discourse

Big Picture
Constitution Day conversation with Jamie Raskin: Preserving democracy today and tomorrow

Constitution Day conversation with Jamie Raskin: Preserving democracy today and tomorrow

Big Picture
Meet the Faces of Democracy: Stephen Richer

Meet the Faces of Democracy: Stephen Richer

State
The alchemy of laughter

The alchemy of laughter

Comedy
Work/family balance should be a top tier policy area

Work/family balance should be a top tier policy area

Contributors