By Jenny Donahue
As a Doctor of Physical Therapy at one of the top hospitals in the country, I see firsthand that clinicians can have ivy league degrees and decades of experience, but very little cultural competency. I often hear providers saying things like, “Ugh, they don’t speak English I don’t have time to call an interpreter” or “It’s always those people who come in to freeload off of the hospital”. This is unacceptable.
“You’re the picture of health” is what we all hope to hear in every doctor’s visit, but health is not always as modifiable as the wellness industry leads us to believe. Eating well, exercising, and taking your vitamins are just slivers of the determinants of health pie. The remainder of the pie includes a person’s genetics, physical environment, social support network, economic status, access to healthcare and healthy food, economic status, and—the one determinant to rule them all—racism.
Racism is a system of structuring opportunity that puts people of color at a disadvantage — it also affects each and every aspect of health. Racism can be obvious, showing up in the form of outright insults, or subtle and deeply embedded in our healthcare systems and structures. Each and every avenue through which racism presents itself ultimately impacts the health and wellbeing of a person of color.
Race-based residential segregation in the U.S. dates back to the late 1800s when immigrants began moving to urban areas. Minority groups were forced to cluster in areas with poor housing options, which led to limited resource availability and easy spread of disease. While outright residential segregation is now illegal, housing patterns continue to show significant discrimination against Black and Hispanic people, which is just one of many factors that contribute to the negative health effects of chronic stress (more on that later).
education and employment
Many people of color have reduced access to education and employment opportunities. While an idealist might think that these opportunities are purely merit-based, connections through family friends or neighbors often give White counterparts a leg up. According to the World Health Organization, low education levels are linked with poor health, increased stress levels, and lower self-confidence.
The U.S. has a dark history of performing experimental procedures and testing unregulated drugs on Black and Hispanic bodies without consent or intention to treat. This history can still be felt in hospitals today, where racial bias can have life-threatening impacts for people of color:
The Black infant mortality rate is more than double that of White Americans.
Black mothers are more than two times more likely to receive late or no prenatal care. Black mothers are also three times more likely to die during childbirth or due to childbirth-related complications than White mothers. A disproportionate number of Black and Hispanic people have high blood pressure, diabetes, pain and heart conditions. Black children are almost twice as likely to develop asthma than their White counterparts.
Many White health providers cannot fathom how a person of color could wait so long before seeking help, dismiss medical advice or fear that they are going to be experimented on. If your ancestors had been used as lab mice, you might be weary of the health care system, too.
Generations upon generations of racial discrimination can take its toll on the nervous system. People of color experience discrimination on a daily basis, and the stress of each experience may actually be cumulative. Think of being in fight or flight mode, but all the time. It’s known that stress hormones like adrenaline and cortisol increase in times of threat, and typically the levels of those hormones should normalize once the threat has passed. Now scientists believe that with the chronic stress of racism, hormone levels may remain high and have a toxic effect on the body. Studies have shown that prolonged spikes in stress hormones can create a constant state of low-grade inflammation.
so, what can we do?
As a woman of color in healthcare, I always strive to first acknowledge my own biases and second, check them at the door. I apologize to patients on behalf of the medical community when they are angry or weary about their care. I share my own experiences of being discriminated against as a person of color with my patients, and hope to play a small part in earning back their faith.
Residential segregation, health disparities and discrimination have a common denominator: racism. Addressing the impact that racism has is central to eliminating the inequalities. Health providers must acknowledge their personal biases, and those deeply-rooted within the medical community to begin to work towards addressing inequalities. Race-conscious coursework needs to be incorporated into medical and public health programs. Public health outreach and education needs to reach communities of color, to begin to rebuild trust and understanding of their unique experiences.
Did anything in this article surprise you? If you have experienced racism, in what ways has it affected your health?