Medical racism in the United States refers to racial and ethnic disparities in healthcare, including discriminatory medical practices and misrepresentations in medical education. Medical racism is usually driven by biases based on characteristics of patients' race and ethnicity and especially affects vulnerable subgroups such as women, children and the poor. Since the 18th century, examples of medical racism include various unethical studies, forced procedures, and differential treatments administered by health care providers, researchers, and government entities. Medical racism can stem from explicit prejudice, unconscious bias, or structural racism. Government policies allowed for segregated medical facilities, and federal programs have often failed to equitably serve racial and ethnic minorities, contributing to disparities in access to and quality of care. Underfunded safety-net hospitals, low Medicaid reimbursement rates, and inequitable coverage policies—further perpetuate these disparities. Despite legislative efforts like the Affordable Care Act aimed at reducing disparities, gaps in access to care persist, disproportionately affecting racial and ethnic minorities. The enduring influence of structural discrimination in healthcare contributes to these inequities.
History
Medical racism has deep historical roots, including unethical studies, the foundations of medical education, Enlightenment-era racial science and medieval European ideologies which justified racial hierarchies in medicine and influenced how physicians understood disease, pain, and treatment in non-white populations. These ideas were further reinforced by medical institutions that actively participated in slavery and colonization, often conducting experiments on enslaved individuals. The history of medical racism has also contributed to the distrust of health professionals by many people in marginalized racial and ethnic groups. Studies within the last couple decades have elucidated ongoing disparate treatment from health professionals, revealing racial biases. These racial biases have impacted the way in which treatments such as painkillers are prescribed and the rate at which diagnostic tests are given. Black patients have a long history of receiving contrasting medical treatment based on different perceptions of the pain thresholds of Black people. The eugenics movement is an example of how racial bias affected the treatment of women of color, specifically African American women. While studies like the Tuskegee Study of Untreated Syphilis in the Negro Male are widely known, the U.S. Public Health Service Sexually Transmitted Disease (STD) Inoculation Study of 1946-1948 harmed Guatemalan prisoners, sex workers, soldiers, and mental health patients by purposely infecting victims with STDs such as syphilis and gonorrhea. Forcible sterilization of Indigenous women as young as 15 years old occurred from 1970 to 1976 by the Indian Health Service Many other examples exist in American history of the unethical actions of health care providers, researchers, and government entities. Racial minorities have faced constant and significant barriers to entering and advancing in the medical profession. African American medical professionals, in particular, encountered systemic exclusion, discrimination, and limited access to training opportunities. Until 1940, the American Medical Directory—compiled by the American Medical Association—marked Black physicians with a "col." notation, reinforcing professional marginalization and restricting their inclusion in medical institutions, professional organizations, and fair insurance practices. These historical inequities have shaped patient distrust in the healthcare system and limited the diversity of the medical workforce.
Contributing factors
Cultural competence Physicians who are not culturally competent can harm patients due to poor relationship dynamics, contributing to medical racism. While physicians may consciously condemn racism and negative stereotypes, evidence shows that doctors exhibit the same levels of implicit bias as the greater population. Racialized minority groups report experiencing both overt and covert racism in healthcare interactions. Implicit bias is also seen in mental health services, Healthcare providers may not consciously have biases on racial stereotypes. These tend to occur automatically. Psychological studies have demonstrated that "...persons who do not see themselves as prejudiced will make health care allocation decisions…". Based on this research, several authors argue that there is an intense need for cultural competence education in healthcare for explicit racism and implicit biases. Cultural incompetence exists for a number of reasons, such as lack of diversity in medical education and lack of diverse members of medical school student and faculty populations. This leads to marginalization of both minority healthcare providers and minority patients.
Medical education There is a lack of medical education about minority groups. In a 2016 study, White medical students incorrectly believed that Black patients had a higher pain tolerance than White patients. These beliefs were rooted in unfounded notions, such as thicker skin or less sensitive nerve endings in Black individuals, echoing racist ideologies. Minority patients report feeling unjustly reprimanded and scolded by healthcare staff, as noted by African American women. Furthermore, research reveals disparities in pain medication prescriptions, with White male physicians prescribing less to Black patients, fueled by perceptions of biological differences in pain reactions between races. African Americans are disproportionately subjected to less desirable healthcare services, like limb amputations, highlighting systemic inequalities. In medical schools in the US, within assigned textbook readings, there exists a disparity between the representation of race and skin color in textbook case studies relative to the US population. This is true for both visual and textual lecture materials. A group of studies done on the representation of race and gender in course slides for the University of Washington School of Medicine, preclinical lecture slides at the Warren Alpert Medical School of Brown University and case studies used at the University of Minnesota Medical School simultaneously showed associations of race as a "risk factor" and a lack of racial diversity.
… excerpt ends here. Continue reading the full article.
