By Kevin Robinson, guest blogger, in honor of Black History Month
Several years ago, while visiting Washington, D.C., my traveling companion and I took an African-American Heritage bus tour of the city, including Frederick Douglass’ home, Ben’s Chili Bowl, the Lincoln Memorial, and the National Museum of African American History and Culture. Only two other white people were on the tour.
On the bus, I struck up a conversation with a retired orthopedic surgeon, roughly the same age as my parents, perhaps late 70s. I asked him a few questions about where he went to medical school, etc. He did his undergraduate and medical degrees at Howard University, in Washington, D.C. He also completed all of his medical training there. Naively, I was surprised at this fact. His response: “When I was in school, there wasn’t much else for me.”
And with that remark, I came face-to-face with the history of racism in healthcare.
photo by Ben Schumin, cropped
Throughout much of the 20th Century, healthcare, like much of American society, was segregated. White hospitals and clinics refused to treat people of color. The American Medical Association refused to admit Black physicians, and hospitals refused to grant them medical staff privileges.
In response, the Black community built its own hospitals and medical schools, including Howard University and Mehary Medical College in Nashville. But it wasn’t enough, and few Black Americans had access to healthcare. Even in Boston, hospitals refused to treat Black patients or allow Black physicians to practice. (https://www.baystatebanner.com/2012/04/11/bostons-black-medical-community-thrived-in-the-mid-19th-century/)
Photograph of Meharry Medical College Students, Date Unknown; (https://texashistory.unt.edu/ark:/67531/metapth573499/: accessed February 7, 2024), University of North Texas Libraries, The Portal to Texas History, https://texashistory.unt.edu; from the Private Collection of T. B. Willis.
Segregation officially ended in 1965, but its legacy still haunts us. According to the Kaiser Family Foundation (https://www.kff.org/policy-watch/how-recognizing-health-disparities-for-black-people-is-important-for-change/), people of color are
- More likely to be uninsured and to skip medical care because of its cost
- More likely to live below the poverty line
- More likely to experience food insecurity
On average, Black Americans’ lives are almost six years shorter than white Americans. Infant mortality in the Black community is roughly twice that of white America, and maternal mortality for Black women is shockingly high — nearly 70 deaths per 100,000 births, compared with 26 deaths for white women.
Why?
More than 50 years after segregation officially ended, why are Black Americans still in an uphill climb for equal life expectancies and access to quality care? The answer includes systemic racism, economic issues, the rightful feeling of mistrust many African Americans have after events like the Tuskegee Experiment https://www.cdc.gov/tuskegee/timeline.htm), and medical concepts rooted in racist misconceptions, such as racial differences in pain tolerance, among others.
What’s Next?
As with inequality everywhere, correcting it means confronting it and understanding it as a systemic problem.
One of my close friends is a white emergency physician. Recently I had a long talk with her about racial disparities in medicine. She said, “I don’t think the way I practice is racist. I’m sure that none of my colleagues think that the way they practice is racist. But I don’t know.” She explained how difficult it is to see the biases we have, whether acquired through our education or our environment.
“If I am treating patients unequally,” she added, “I want to know about it, so I can change my practice because I want to give my patients the best care possible.”
And this is exactly why many of the major health organizations in the U.S. are now dedicated to working on this problem to provide the best care to every person who needs it, no matter who they are, who they love, or where they’re from.
I encourage you to read more about racial disparities in healthcare. Here are a few resources for you, but don’t stop there, seek out your own resources through the internet.
Racism and Health https://www.cdc.gov/minorityhealth/racism-disparities/index.html
Structural Racism in Historical and Modern US Health Care Policy https://www.healthaffairs.org/doi/10.1377/hlthaff.2021.01466
Community Voices for Health 