Racism is based on an ideology in which humanity is divided into social groups called “races.” These groups are assigned different ranks so that a dominant race (the European, White Race) is allowed to use its power to devalue and disenfranchise people. It is an organized social system that uses social resources and opportunities to classify other defined groups (African, Asian, Native Americans) as inferior. Slavery and segregation have been abolished, but racism still plagues people and institutions around the world, including health care systems and those who work in them.
When the topic of racism comes up, people usually think of discrimination or abuse in various fields, but we rarely address racism in medicine. Although it may be difficult to admit, the first step to eliminating or addressing racial discrimination in medicine is to understand that it goes beyond personal bias or prejudice on the part of health care providers. Data from the National Center for Health Statistics (1998) indicate that over the past 50 years, the health status of both blacks and whites in the United States has improved, as evidenced by increased life expectancy and declines in infant and adult mortality. Yet blacks continue to have higher morbidity and mortality rates than whites on most physical health indicators. Hispanics and Native Americans also have increased rates of illness and mortality for several diseases.
Barriers to seeking health care often include long wait times, complex bureaucratic procedures, and undignified treatment of patients, which typically discourage individuals from using the health care system. Over the years, Black and other communities around the world have had poorer access to health care. Its poorer quality, is also reflected in inequalities in morbidity, mortality and overall health.
Discrimination in medicine and science has been around for a number of years. In the 20th century, Africa was turned into a living laboratory by Western scientists during the sleeping sickness pandemic. As the disease began to spread in Africa, European colonial masters feared that it would sap the African labor force, which in turn would affect colonial projects and revenues.
To contain the spread, the German scientist Robert Koch conducted medical experiments on Africans, who were considered too dangerous for Europeans. Many of the remedies Koch tested on Africans contained toxic substances such as arsenic. He set up numerous “concentration camps” to isolate the sick from the healthy. The method used had devastating consequences for the colonized, but benefited the sovereignty of the German Empire and contributed to its industrial rise. The practice of colonial science exposed the colonized to early death, and these deaths were of value to the colonial presence because these practices were based on violent conquest and a brutal political system.
The experiment deprived people of their existence, as the body of the colonized was reduced to its social and economic value. Atoxyl was administered to subjects at full dose, although it resulted in poisoning, blindness, and even death. When these people returned to their villages and their health improved, they were arrested and sent back to concentration camps to continue the experiments. These colonized people were constantly dehumanized and treated like animals, their health brutally attacked and their rights violated. Through medical experiments, people were tortured and treated in an inhumane way.
The data collected in these camps was eventually passed on to British officials who were also trying to control outbreaks of sleeping sickness in their colonies.
Robert Koch was a brilliant scientist, and it is likely that he really wanted to cure sleeping sickness in those who suffered from it. Others consider him a racist and a symbol of colonial suffering whose impulsive drive to achieve his own glory led to the humiliation and deprivation of the dignity of Africans. Whatever his intentions, his methods were extreme and led to imprisonment and murder. Not only did he poison thousands of people, but he also contributed to the notion that different rules apply to Africa than to Europe in terms of medical ethics, which has had serious consequences that affect the way Western scientific communities treat Africa to date.
Over the years, some awareness has emerged that has led to a decrease in bias, but subtle forms of disparate treatment still exist. Most health care providers still seem to practice some form of discrimination in the form of a positive attitude toward whites and a negative attitude toward blacks. Providers may take more time and pay more attention to White patients than to Black patients. Furthermore, the degree of cooperation may vary. It is common for them to address patients in a tone that makes them feel unheard and unappreciated by their providers. Often, interpreters are not provided even when needed. In addition, doctors, nurses, and therapists readily grant special privileges to White patients, e.g., allowing some families to visit for hours at a time and restricting other families from visiting.
To effectively address inequities and discrimination in health care, all other sectors of society must be involved, as some health care providers are not even aware that they are discriminating against patients. New initiatives must be taken to adequately train and hire more service providers from disadvantaged populations. If medical professionals want to actively reach out to patients where they are, they should come from all walks of life. This should be followed up and extended to the municipalities. Job training and health care opportunities offered to community members, especially youth, contribute significantly to development and economic security, which in turn promotes stability and health for people in Black communities. When these youth are trained, they are better able to provide valuable services to their communities in more accessible and affordable ways.
When community residents and institutions are equipped with the knowledge and skills necessary to follow or choose a healthier lifestyle, the long-term benefits are numerous, so it is necessary that people are empowered by these opportunities so they can thrive. A study using variations in the federal Earned Income Tax Credit (EITC) and the presence of state EITCs found that EITC income reduced rates of low birth weight and increased average birth weight, with larger associations among blacks than whites.
Because a significant factor of these health disparities is due to racism as a result of institutional policies, people, laws, and practices, health care providers have an obligation to eliminate racism by making a conscious effort to prevent racism, however it is manifested.
In addition, equitable distribution of health resources paves the way for equity in health services. This requires that the needs of society be thoroughly considered to ensure that every member of society has an equal opportunity to receive medical services.
Patients should be offered supportive social services to help them improve their health. A study of 1059 low-income families in a U.S. children’s clinic found that families most often had needs for employment (25%), housing (14%), child care (13%), health insurance (11%), and food assistance (10%).
A recent U.S. study found that an increase in the minimum wage in each of the 50 states between 1980 and 2011 led to an improvement in the birth rate per month. It was found that raising the minimum wage by one dollar above the federal minimum wage was associated with a 1 to 2% decrease in low birth rate and a 4% decrease in postpartum mortality. It was estimated that a $1 increase in the minimum wage in 2014 would result in a 2790 decrease in low birth weight births and a 518 decrease in postneonatal mortality. The living conditions of people in society should be improved to promote the quality of health, as a better living environment also leads to a healthy lifestyle, which has a positive impact on health.
Racism is a global evil that must be eliminated by all. If the quality of our health or our life expectancy depends on a factor like “race,” that’s a really terrible way to live.
Author, Judith Adorsu