By Maeji Gi
The United States was built on racism and the oppression of minorities. Racism was, and still is, at the core of the division throughout the country. A consequential domino effect stems from the implicit and explicit racism many of us turn a blind eye to. Some people will stereotype and say African Americans “chose” a life of suffering when in reality, those very people are the cause of the disadvantages African Americans and other minorities face every single day. All of these unfair disadvantages that have solely been based on skin color play a huge role in the declining well being of minorities. This country has institutionalized racism in every aspect of its existence and “success”, including its healthcare system. Structural racism is the leading cause of poorer health in people of color that have no choice but to rely on a healthcare system that doesn’t seem to fully care about their health.
A Domino Effect
It is clear that African Americans fall behind other minorities and white people when it comes to wealth and health. Financial instabilities within the majority of black homes are the main cause of why they experience more health disparities and issues than white homes. The core of the financial issues African Americans face begins within the workforce, where African Americans are paid less than white Americans for doing the same job. Unfortunately, it is common for minorities, especially those that belong to the black community, to face microaggression in the average workplace.
Microaggression is defined as the subtle intentional or unintentional behaviors towards historically marginalized groups that can imply racism and prejudice. This modern form of racism can eventually build up into inconsistencies between racially differing employees performing the same job and their salaries. Companies will often avoid and aim their microaggressions towards minorities based on false stereotypes. They make assumptions that minority employees are from another country and therefore “aren’t educated”. Keeping a job and earning enough money from it is already hard enough, let alone the struggle other black people have just securing a stable job. Microaggressions and inherent racism causes fewer job offers and call backs, leading to less income.
A cascading domino effect is then put into motion when racism causes African Americans to have less income than those of the white American population. Since they cannot secure a job without having to navigate racial bias, they are often unable to earn as much as white people. Not bringing in enough income because workplaces are implicitly racist mean issues with acquiring proper housing for the average African American and minority family. Having to live in poor conditions ultimately leads to health problems. If they are challenged with a serious health issue, they won’t have enough money to afford the subsequent medical bills that are bound to keep piling up. In some cases, not having the proper resources forces minorities to partake in a life of crime just to support their own families. Structural racism, whether it be intentional or not, is at the root of the cause of the steep decline in the health of black America.
Health Insurance and the Affordable Care Act (ACA)
Staying on the topic of financial instability and imbalance, the Affordable Care Act was implemented to combat rising health issues in poorer communities in America. This act helps provide proper health care coverage for millions of Americans because it is what every human being deserves. The numbers have shown how the uninsured rate of African Americans has made a decline, but in comparison to the uninsurance in white Americans, the difference is stark. Black people make up 13% of the entire U.S. population and 9.7% are uninsured whereas there are only 5.4% of uninsured white citizens (in 2018). Since the black community is so small compared to other races in America and considering the proportions, more black people struggle with uninsured healthcare than white people. Without health insurance, if there is a need that requires medical attention, the costs could be very overwhelming. Additionally, the cost for proper health care is 20% of the average African American household’s income, which is a lot considering most have to settle for minimum wage jobs that don’t pay near enough to pay off medical bills.
For those who enroll in public healthcare insurance programs, such as Medicaid, they are granted affordable healthcare and as a result have healthier outcomes. These types of programs seem to be a great solution, right? Sadly, most African Americans fall into the coverage gap for Medicaid. This means that they earn too much income to qualify but not enough for marketplace premium tax credits (basically tax credits that can be refunded by lower income families to help afford healthcare). Despite all these efforts to ease the stress of healthcare costs, the racism that started it all still makes the lives of black America harder than it should be.
Bias in the Healthcare System and Algorithms
Racial bias can be seen in other aspects of the healthcare system besides the finances and insurance. Racism is perpetuated by healthcare workers within hospitals and healthcare facilities on a day to day basis. The National Academy of Medicine stated in their studies that providers tend to deliver less effective treatment to people of color in comparison to white patients despite the two possessing similar characteristics regarding wealth, insurance, health behaviors, and social class. This proves that the healthcare providers are basing their judgement on the race and ethnicity of the patient at hand rather than the severity of the illness or injury. Black patients are much more likely to have their limbs amputated than their white counterparts. Black women are less likely to receive mastectomies, let alone radiation therapy alongside a mastectomy which is what most white women receive. These are examples of how racial bias, whether it be implicit or explicit, influences the quality of care provided for patients that are not white. Physicians will prescribe less desirable or effective treatments to racial groups which causes a higher mortality rate in African Americans and other minorities.
Another way structural racism is ingrained in the American healthcare systems is through their use of algorithms. Algorithms in healthcare are essentially guidelines that assist nurses and other emergency healthcare providers evaluate and decide on the best path to use to properly tend to the patient’s condition. Sometimes these algorithms help healthcare providers prioritize cases (especially in emergency or trauma) based on the severity of the patient’s injuries or illnesses. They help decide which patients are in more need of extra care and can also help cut costs. These algorithms can be extremely helpful within the healthcare system because it makes care much more efficient and effective when there are several patients that require medical attention simultaneously. However, algorithms can be biased because they use medical costs as a proxy (“representative”) for actual healthcare needs. The algorithm sees that black people tend to generate less medical costs than those of white people and makes the false conclusion that black people are healthier than white people who are equally as ill. This is because the socioeconomics (employment, education, etc.) in the United States prevent black Americans from earning enough income to afford medical attention. Some African Americans can’t pay for healthcare, so the algorithm assumes they are healthier because not as many black patients are admitted. There is more than enough evidence to show that racism is present throughout our lives, including the healthcare system where everyone should feel safe and welcome. Hopefully as a nation we can come together and acknowledge that racism is a major problem that plagues our society.
Sources:
“2019Q3-Q4: State Unemployment by Race and Ethnicity.”Economic Policy Institute, www.epi.org/indicators/state-unemployment-race-ethnicity/.
BLS. “Composition of the Labor Force.”U.S. Bureau of Labor Statistics, U.S. Bureau of Labor Statistics, 1 Oct. 2019, www.bls.gov/opub/reports/race-and-ethnicity/2018/home.htm#:~:text=The employment–population ratio was,and 63.2 percent for Hispanics.
“Institutional Racism in the Health Care System.”AAFP Home, 23 July 2019, www.aafp.org/about/policies/all/institutional-racism.html.
Obermeyer, Ziad, et al. “Dissecting Racial Bias in an Algorithm Used to Manage the Health of Populations.”Science, American Association for the Advancement of Science, 25 Oct. 2019, science.sciencemag.org/content/366/6464/447.
Strauss, Becky. “Battling Racial Discrimination in the Workplace.”D.C. Policy Center, 22 Apr. 2019, www.dcpolicycenter.org/publications/battling-racial-discrimination-in-the-workplace/.
“What Algorithms Tell Us About Structural Racism in Health Care.”National Nurses United, 24 June 2020, www.nationalnursesunited.org/blog/what-algorithms-tell-us-about-structural-racism-health-care.
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