Whether you’re a high profile athlete, a medical professional, or just an average person, if you’re a black woman there’s a good chance your doctor will ignore, underestimate or under treat you. When you live in a society embedded with systemic racism, racial bias infiltrates every aspect of society, including health care.
In 2018, Serena Williams spoke out about her mistreatment during childbirth. “If Serena Williams with all her money, power, access, and reach had her voice IGNORED – what do you think happens to poor, immigrant black women?” asks activist Leslie Mac. In 2019, Medical Tiktok blew up when health care providers jumped on a trend, posting videos showing their suspicion of their patients, starting with tiktok user D Rose when she posted on her Twitter.
We know when y’all are faking 😂😂 pic.twitter.com/uBV9LjXN3W
— D Rose (@DamnDRoseTweets) November 19, 2019
Activist and writer Imani Barbarin ended up creating the hashtag #PatientsAreNotFaking to counteract the trend with many others voicing their concerns over the distrust this type of content breeds. If you’re feeling unwell, your doctor should provide a safe space for you to communicate with them, not somewhere you expect to be ridiculed or mocked.
That video of the nurse dancing not believing patients has stirred up a lot of trauma for many in the disabled community and BIPOC communities.
— Imani Barbarin, MAGC | Crutches&Spice ♿️ (@Imani_Barbarin) November 22, 2019
People get killed because of that mentality. You did a whole video to tell us you’re bad at your job.#PatientsAreNotFaking
In 2020, Dr. Susan Moore, a black female medical doctor in Indianapolis died from Covid-19 after her complaints of pain were downplayed. Despite obviously having in depth medical knowledge, Dr. Moore was still treated with suspicion when asking for treatment. In a video on her Facebook page while in hospital, she said “I was crushed… he made me feel like I was a drug addict…I put forth and I maintain if I was white, I wouldn’t have to go through that.”
Back to Leslie Mac’s question, if inequality in health care is prevalent even for knowledgable, wealthy black women, imagine what it’s like for the average black woman. In America, black women are three to four times more likely than white women to die from pregnancy related complications. According to the CDC, the infant mortality rate for Black babies is double that for white babies, regardless of the mother’s income or education level.
In Canada, data isn’t collected by race but similar health disparities are here too. A study in 2015 by McGill University found that Black women in Canada have substantially higher rates of premature births than white women. In a 2003 study by Women’s Health in Women’s Hands, a health care clinic in Toronto, one in five women reported encountering racism in the health care system, including “cultural insensitivity or ignorance from doctors, name calling or racial slurs, receiving an inferior quality of care and being overcharged for services”.
Canada’s universal health care system doesn’t mean equal access to health care. Black women in Canada are more likely to face barriers to access, resulting in inequalities in care, like lower screening rates for breast cancer, cervical cancer.
Racism in health care
According to the Physicians for Human Rights “Language barriers, lack of cultural competence, unconscious racial bias, inaccessible/culturally inappropriate screening services, and inappropriate or unfounded beliefs in race-based biological differences all produce racial inequities in the delivery of health care and in health outcomes. “
“Language barriers, lack of cultural competence, unconscious racial bias, inaccessible/culturally inappropriate screening services, and inappropriate or unfounded beliefs in race-based biological differences all produce racial inequities in the delivery of health care and in health outcomes. “
Physicians for Human Rights
Social forces, rooted in historical legacies of social oppression, drive racial disparities in health. According to a 2011 Review, “Racism is viewed as a broader sociocultural ideology that produces distinct patterns in disease emergence along racial lines via a number of mechanisms, including historical processes, institutional forces, and personally mediated as well as internalized forms of racism.”
The Review mentions a socio-psychobiological framework for examining racial disparities in health.
The key point to note in the framework is the importance of factors at the social level that impact health, not just at the individual level. Access to health resources and exposure to health hazards isn’t the same for everyone and for non-white people “contextual factors influence health beyond that which could be explained by individual-level variables”. In other words, when the whole system is against you, you’re fucked one way or another.
Levels of racism
A study in 2000 identified three levels of racism:
- institutionalized,
- personally mediated,
- internalized
Institutionalized racism shows up in education, housing, politics, employment, and medicine. Medicine shows unequal treatment of racial minorities, whether it’s access to health care or differences in the quality of care.
Personally mediated racism is when attitudes and beliefs about the inferiority of racial groups (prejudice) results in the treatment of people differently based on their race (discrimination).
Internalized racism refers to the acceptance of negative sociocultural beliefs about the worth of your own racial group.
Discrimination in health care
Discrimination in health care is prevalent, whether it’s direct and overt or more subtle. “Laissez-faire” discrimination is based on assumptions about the work ethic, habits, and dispositions of racial groups, and doesn’t have an intentional motive. A person’s race plays a role in clinical decision-making, based on preconceptions about medication adherence, tolerance, and effectiveness, using racially based notions of behaviour and biology.
A 2016 study found that 50% of white medical students and residents endorsed false beliefs about biological differences between black and white people, like believing black people’s skin is thicker than white people’s skin. Participants with these beliefs rated black patient’s pain lower and made less accurate treatment recommendations. A 2012 U.S study, over 20 years of data, also found that black patients were 22% less likely than white patients to receive any pain medication.
In the case of mental health, Black Canadians have difficulty accessing services until conditions have significantly progressed. According to Dr. Christopher Morgan, founder of the Black Health Alliance, “people outside of the Black community with similar conditions have typical access points to mental health services within 3-6 months. In the case of Black folk, it’s often 16-18 months and it’s often through police incarceration.”
History of racism in health care
Beliefs in biological racial differences are long standing from pre-confederation times in Canada when attitudes about racial inferiority were popular and what became known as “scientific racism” helped establish the notion that there were measurable differences in intelligence, barbarity and morality between races. On top of that, it was argued that “less valuable races” needed to be managed so their characteristics wouldn’t spread and “undermine civilization”.
“racism” is not merely a set of discriminatory attitudes or a belief in the inferiority of certain identifiable groups of humans: it is a call to action, to resist at every turn the possibility of inferior people destroying the accomplishments of superior people.”
Canadian History: Pre-Confederation
Where do we go from here?
Racism in health care is complex, intersectional and systemic. There is no silver bullet to just fix this but many experts argue the first step to addressing this is with accurate data. Living in an evidence based society without data can in some cases, provide an excuse to deny the existence of the problem. Because Canada doesn’t collect statistics by race, there’s little data on Black women specifically.
The argument as to why racial data isn’t collected in Canada is interesting. Technically race is a social construct. Genetically there’s nothing that differentiates a black person from a white person. Not dividing the population by race for medical studies when looking at impacting genetic factors makes sense. Some experts have argued that race shouldn’t be a factor for these studies because it perpetuates the idea that humans are different, when we’re not, which can strengthen racist views. But, because racial identity can impact so many areas of life from socio-economic status to health care, it’s an important social factor to gather data and study.
How this data is collected and used though is important. Studies have shown that the collection of racial data in a health care setting can lead to anxieties and anticipated harm.
According to Dr. Onyenyechukwu Nnorom, Associate Program Director of the Public Health and Preventive Medicine Residency Program at the University of Toronto, if Canada were to collect race-based data “it’s important to have representatives from the Black community at the decision table. So that the way data is interpreted and collected is either shared with Black leadership or owned by Black leadership.”
“it’s important to have representatives from the Black community at the decision table. So that the way data is interpreted and collected is either shared with Black leadership or owned by Black leadership.”
Dr. Onyenyechukwu Nnorom, Associate Program Director of the Public Health and Preventive Medicine Residency Program, University of Toronto
We clearly have a long way to go, not just in health care in Canada but across all facets of society and we need to start yesterday. This isn’t something that can be ignored or swept aside, people’s lives are literally on the line.
The Bailey Rating
Disclaimer: Research cited is in reference to general trends, it does not accurately reflect the diversity of individual experiences within health care, but I think it’s safe to say that it’s not good. This post is intended to serve as a log of my rambling opinions and tracker of information gathered on a topic. I aim to present accurate, well researched information, citing facts presented to the best of my ability. However, some information may prove to be inaccurate and I encourage you to do your own research on the topic. I’m always open to hearing new information or perspectives on topics posted and aim to keep this post accurate with updated information once discovered or presented to me. Feel free to comment below if you have anything to add 🙂
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