Race & Health: What has changed?

Science has always dealt with race, and consequently also been the source as well as the outcome of racism; whether it is the 20th century's spark of eugenics, the long history of experimentations on certain ethnographic groups, or the invalid conclusions that still play a role in today's society. Follow Amit Singh in this short series of articles, as he breaks down the impact of racism on health and medicine, vice versa, as we are experiencing one of the biggest anti-racism movements in decades. This is the second article in the series.

Race & Health: What has changed?
Data from: Wyatt R, Laderman M, Botwinick L, Mate K, Whittington J. Achieving Health Equity: A Guide for Health Care Organizations. IHI White Paper. Cambridge, Massachusetts: Institute for Healthcare Improvement; 2016

As ugly as the history of race and health may be, to define today’s relationship based on the past would be an injustice. Although it is clear that the relatively overt nature of medical racism in history is not present today, it is vital to understand how it has manifested itself and in what forms it may present itself in today’s society.


Racial disparity in today’s health

Unsurprisingly to many, research clearly shows that modern day racism has a large impact on health. To break down the factors behind it, it’s important to first identify the statistics. In America, compared to white women, Black women have a 22% higher risk of dying from heart disease, 71% higher risk of dying from cervical cancer, and an astonishing 243% higher risk of dying due to pregnancy or birth related issues [1]. Of course it is important to highlight that this is not an issue of gender. A study showed that in Minneapolis 69% of white patients were able to complete a colorectal cancer screening, whereas only 43% of black patients were able to do the same [1]. Undeniably, these issues are prevalent in the United Kingdom as well. Statistics show that black Caribbeans are at 9 times the risk of being diagnosed with schizophrenia than their white counterparts, with black Africans close behind at 6 times the risk of the same diagnosis [2]. Further yet, only 35% of racial minorities receive the appropriate prescriptions for metastatic cancer, in comparison to 50% of non-minorities [3]. A more direct presentation of racial bias can be seen in the use of spirometers – a device used to measure lung functions – as these account for race corrections, and as such provide results based on the race of the patient. It is reasonable to assume that this is a product of the belief – rooted in slavery yet again – that black people have smaller lungs than white people [4].

In addition to cases of direct racism, where a clinician may be unwilling to support a minority ethnic patient, the factors influencing these statistics (and many more) are complex and often hidden. One definitive reason is their averagely lower socio-economic background (especially, but not only due to living in a country with an out-of-pocket model health system). This can present itself through a lack of affordability of care, weaker transport systems in lower-socioeconomic areas making it harder to reach healthcare facilities and much more [5]. Stigmatisation, and at times direct discrimination, of minority ethnic people is also a big factor, and can unsurprisingly present itself in a range of ways as well. The lack of appropriate prescription can easily be related to a study that found that 40% of first and second year American medical students believed that black people had thicker skin than white people [6]. Here, it is clear to see the trickle down impact of the historical belief that black people are more insensible to pain as was discussed in the previous article. The indirect impacts of this are extreme as patients can easily begin to lose trust in their clinicians. Patients who experienced racism had up to 3 times the chance of reporting reduced trust in the healthcare system and its workers as well as a lower satisfaction rate [7].

This clearly shows that the history of racism has found ways to seep into today’s society in ways which may be unexpected by many. More importantly it shows that there is a desperate need for change. The next stage is to figure out what this change may be and, finally, how to implement it individually as well as systematically.



[1] Martha Hostetter & Sarah Klein. In Focus: Reducing Racial Disparities in Health Care by Confronting Racism. The Commonwealth Fund, Sep 27, 2018
[2] Rebecca Pinto, Mark Ashworth & Roger Jones. Schizophrenia in black Caribbeans living in the UK: an exploration of underlying causes of the high incidence rate. British Journal of General Practice, Jun 1, 2008
[3] Kelly M. Hoffman, Sophie Trawalter, et al.. Racial bias in pain assessment and treatment recommendations, and false beliefs about biological differences between blacks and whites. Proceedings of the National Academy of Sciences of the United States of America, Apr 19, 2016.
[4] Lundy Braun. Race, ethnicity and lung function: A brief history. Canadian Journal of Respiratory Therapy, Autumn, 2015
[5] Chris McGreal. A $95,000 question: why are whites five times richer than blacks in the US? Guardian, May 17, 2010
[6] Janice A. Sabin. How we fail black patients in pain. Association of American Medical Colleges, Jan 6, 2020.
[7] Jehonathan Ben, Donna Cormack & Ricci Harris. Racism and health service utilisation: A systematic review and meta-analysis. PLoS One, Dec 18, 2017

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