Racism and Bias at Root of Health Inequities
David R. Jones, The Urban Agenda
A shocking reminder that low-income people of color face devastating inequities in the delivery of health care is the subject of a state Department of Health investigation of Lincoln Hospital which in 2014 “lost track” of a patient, a handyman named Angel Rivera.
Rivera was “found” in a waiting room, unattended for nine hours. A waiting room video showed him slumped over, bleeding from the mouth as a bump on his head turned into a fatal brain hemorrhage. At one point the emergency room staff decided he had left the hospital. Rivera, 53, languished in an irreversible coma and died of a heart attack two years later. His family is suing.
Plain and simple, Mr. Rivera was a victim of racial bias in medical care. This must end. Medical schools, clinicians, students and hospitals must openly discuss racism as a root cause of racial disparities in the delivery of health care. It is an undeniable, well-documented fact that the unemployed, the under-educated, the poor, and those from lower socioeconomic status groups – who are disproportionately people of color -- receive substandard care even when they have adequate insurance coverage.
The time has come for medical professionals who willfully deny equal care, such as in the case of Angel Rivera, to have their licenses revoked. What is more, in cases where there was a clear racial dimension in inferior care, the New York Legislature should amend the criminal codes to make available criminal prosecution. That’s certainly a tough step but worth considering given the enormous stakes involved – life and death.
There’s been ample debate over the years about the root cause of health care inequities. Some say it’s a lack of cultural competency training. Others say language differences are a factor. Still others say it’s an unwitting bias held by doctors. There is clearly a problem, but no one involved – regulators, medical schools, trade organizations or hospital groups – seems willing to call out racism as the issue and offer concrete steps towards improving outcomes.
Health equity is the topic of a panel discussion my organization is sponsoring next week. The event features the leading voices on the reasons people of color have poorer access to quality care and suffer worse outcomes than white people in New York and the nation. (For more information on CSS’s Oct. 11 “Health Equity” panel go to: www.cssny.org)
One of the panelists, Dr. Mary T. Bassett, NYC’s Commissioner of Health and Mental Hygiene, co-authored a new article in The Lancet that calls out the problem in plain language: “Public discourse remains resistant to identify racism as a root cause of racial health inequities.”
A Divide in Care Going Back to the 1950s
We all have stories about friends and family who didn’t receive the medical care they deserved. Angel Rivera’s case deeply touched me. It unearthed painful memories of my beloved babysitter from when I was growing up in Crown Heights, Brooklyn. It was the 1950s and she became pregnant during the bad old days, two decades before Roe v. Wade legalized abortions.
She opted to have an illegal abortion. The procedure was botched and she began to hemorrhage. The young black woman with an infectious smile went to the St. John’s Episcopal Hospital (now known as Interfaith Medical Center) emergency room, where she was placed on a gurney, rolled into a hallway, and left to bleed out before ever seeing a doctor. Rivera’s, and my babysitter’s fate six decades earlier, illustrate the wealth of empirical evidence supporting the enduring fact that people of color and the poor face life-threatening inequities in the delivery of health care, including everything from flu shots to breast cancer screenings.
The divide has continued even since the passage of the Affordable Care Act, which greatly expanded the number of black and Latino people with medical insurance.
A JAMA study, for example, found racial differences in breast cancer screenings were related to the services insurance plans offered and how many black patients were insurance plan subscribers.
Other studies identified the patient-physician interaction as another factor, and that many racial and minority ethnic groups feel more comfortable interacting with physicians of their own background. Health plans are not required to track race data or designed to take the patient-doctor relationship into consideration when making providers available. Indeed, the government rarely tracks performance on health equity measures.
Further complicating matters is the dearth of black and Latino medical students. Only 6.5 percent of medical school graduates are black or Latino, according to the Association of American Medical Colleges. The archetype physician is a white male from suburbia who likely has no contact with people of color, particularly the poor.
Here’s the bottom line: health plans and government agencies need to take race and ethnicity into account when monitoring the quality of care and to track inequalities so they can be identified and corrected. Equally as important is educating young physicians to resist applying their individual biases and stereotypes in the delivery of services to people in their care.