Systemic racism makes people of color more susceptible to diabetes, hypertension and obesity. As a result, many people die from nonfatal diseases. Rather than questioning the system many observers put the blame on the victim by asking: “Why didn’t they just go to the doctor?”
To understand why people of color make the decision to stay away from the doctor, you must first understand the history of oppression that severed the relationship between people of color and their doctors.
In 1951, doctors at John Hopkins Hospital found the first cell to infinitely reproduce - the “HeLa” cell. Named, “He” for Henrietta and “La” Lacks, after the owner of the cells. Henrietta went to John Hopkins Hospital for treatment of cervical cancer. The HeLa cells discovered during procedure would help to make some of the most significant discoveries in biology and medicine. However, all of this was done without Henrietta’s knowledge.1
John Hopkins Hospital was one of the few hospitals at the time that treated poor Black patients. Unfortunately, Henrietta Lacks was not the only person to have their cells stolen. John Hopkins hospital was notorious for illegally collecting and distributing their patients' cells. According to John Hopkins medicine, “For years, Dr. Gey, a prominent cancer and virus researcher had been collecting cells from all patients who came to The Johns Hopkins Hospital with cervical cancer.”
Henrietta's story is one of many that lead to the distrust between people of color and their doctors. This mistreatment of people of color stems from implicit bias. Implicit bias is an attitude a person holds towards a group of people or associates stereotypes with them without our conscious knowledge.2
In the medical field, this leads to patients not getting the proper care that they need. For example, there is a history of doctors not giving patients of color the medicine that they need due to fear they will sell them.3 In addition, there are myths that people of color can sustain more pain than other people, so they are treated last.
April, a woman in Cleveland, shared her story of dealing with multi sclerosis that runs in her family. Multi sclerosis is a disease in which your brain and spinal cord are attacked by your immune system affecting the speed of messages sent in your central nervous system.4
A few years ago April and her father were both diagnosed with this disease. In the beginning, they shared the same doctor and neurologist for treatment. Although they shared the same doctor, April and her father scheduled separate appointments on different days.
The doctor prescribed a medicine for April that worked really well for her. Out of curiosity, April asked if the doctor had prescribed the same medicine for her father. “No” replied the doctor
April asked the doctor, why didn’t they prescribe the same medicine to her father? April, Recalled that the doctor replied, “you know you father.” Meaning the doctor didn’t believe April’s father would take the medicine if it was prescribed.
Then April asked if the doctor offered the medicine to her father. “No” they replied again.
April stresses the importance of “having a doctor that is willing to fight for you” and be an advocate for your health. Because “if you don't have an advocate there with you or you are not the advocate yourself. Then that increases the disparity.”
After that incident, April’s mother has started to go with her father to the doctor. This way her mother can advocate for her father and make sure that the doctors treat him correctly during the appointment.
In the Tuskegee Experiment in 1932, 600 Black men were tested for Syphilis. The men that tested positive were not properly treated for the disease. Even after the discovery of penicillin, the preferred drug to treat syphilis, the drug was still not provided for the men in the study. In fact, the doctors did not inform them that it was an option.5 Sound familiar?
“While the majority of Cuyahoga County has access to health care, but lack of culturally competent doctors leads people of color to avoid seeking medical help,” says Francis Mills, Director of the Cleveland Office of Minority health.
This is another way lack of access leads to health disparities. In this case, it is not a lack of access to a hospital, but a lack of access to culturally competent doctors. Cultural competency as defined by Dr. Ciara Dennis Morgan, Clinical Coordinator at the Minority Behavioral Health Group (MBHG), is being able to understand the values and practices of other cultures and having the ability to interact with people of other cultures.
“You can have access to health care but if your physician is not culturally competent then that is still a lack of access to the appropriate health care that you need.” says Tamiyka Rose, the Heath Equity Ambassador for the City of Akron.
So, let’s stop asking the question: Why didn’t they go to the doctor? Instead ask: Why does our healthcare system and professionals continue to fail communities of color?
What can healthcare professionals do? A lot actually. At MBHG Dr. Ciara Dennis Morgan and her colleagues have cultural competency to be able to better interact with the patients. In the training they learn skills aligned with cultural groups and values.
In addition, University Hospital (UH) started to address the issues of implicit bias in the institution and began a conversation about how to be anti-racist. University hospital, “established a team called social equity and justice team,” according to Dr Larkin Pettigrew, a doctor at UH. The team is system wide, with a core team made up by the top leaders at UH. Underneath the core team are six pillars, which identify the large entities within the hospital. The pillars include to educate, to innovate, to investigate, to advocate, to evaluate and to invigorate.
Dr. Pettigrew says that by creating the pillars “we can actually look at what policies and procedures and what behavior that we have that may be rooted in racism that we can call out and we can change.”
These are just a few examples of places actively trying to create health equity by increasing access to culturally competent doctors, however, it’s not seen nearly enough. Hospitals and doctors need to acknowledge implicit bias that occurs within their institutions. Then, make the effort to actively disrupt the system of racism and start to build a more equitable society.
References
Butanis, B. (2020, March 09). The Legacy of Henrietta Lacks. Retrieved October 07, 2020, from https://www.hopkinsmedicine.org/henriettalacks/
Society, N. M. (2019, March 08). What Is MS? Retrieved October 07, 2020, from https://www.nationalmssociety.org/What-is-MS
Implicit Bias Explained. (2017, May 17). Retrieved October 07, 2020, from https://perception.org/research/implicit-bias/
Holpuch, A. (2016, August 10). Black patients half as likely to receive pain medication as white patients, study finds. Retrieved October 06, 2020, from https://www.theguardian.com/science/2016/aug/10/black-patients-bias-prescriptions-pain-management-medicine-opioids
Tuskegee Study - Timeline - CDC - NCHHSTP. (2020, March 02). Retrieved October 07, 2020, from https://www.cdc.gov/tuskegee/timeline.htm
Ramirez, R. (2020, July 06). The Importance Of Black Doctors. Retrieved October 07, 2020, from https://www.npr.org/2020/07/02/886686990/the-importance-of-black-doctors
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