Institutional racism in health care

Last week, Sens. Kamela Harris (D-Calif.) and Elizabeth Warren (D-Mass.), both presidential candidates, called attention to the alarmingly high maternal death rates among black women. Both cited institutional racism as the root cause.

Bad as this is, high maternal death rates are only one of many race- and ethnicity-related health disparities. Others include higher rates of chronic illness, premature death and failure to receive appropriate care for pneumonia, heart attacks, pain and preventive measures for post-operative complications. These disparities affect both men and women in ethnic and racial groups. Estimates show health disparities cost the U.S. economy some $230 billion a year in direct medical care expenditures and more than $1 trillion in indirect costs. 

{mosads}Agreeing with Sens. Harris and Warren is not difficult. Research shows that institutional racism is a root cause of poor health outcomes. In addition, data generated since 2004 have consistently shown the ethnic diversity the health-care workforce is directly linked to health outcomes for people of color and that lack of workforce diversity is a root cause of institutional racism. Institutional racism is not about whether an individual health-care provider behaves in a racism manner. 

Rather institutional racism is about how the system is structured and how the stereotypes health-care providers bring to the job become institutionalized in the system. Presence of people of color in the workforce alters the dynamics that allow racist structures to persist.

I’ve been a health-care providers for over 30 years and in all that time, I can’t think of one time I’ve seen another provider say or do something that was overtly racist. However, I can think of many examples of ways the system is “rigged” against people of color.

Recently, for example, I arrived at a clinic for a meeting with another health-care provider. On arriving, I saw an elderly Latina being led from the examination room to the waiting room. The medical assistant pointed to a chair and motioned as if to say “sit down wait.” One hour later, my meeting was over. When I came out, I saw the Latina was still waiting. Finally, a clerk approached and handed her a brochure printed in Spanish. No words were spoken.

It was clear that this elderly Latina had to wait and wait while staff scurried around trying to find educational material written in the correct language. Since the staff bringing the material couldn’t speak the language either, no explanation was offered. The presence of a Latino physician could have changed the dynamic to make language appropriate materials and explanations more available.

Another time, I witnessed an older black man who was not offered post-operative pain medication because the physician believed people of color felt less pain, so “he didn’t need it.” 

Then there was the time, the Native American woman who required complex wound care was discharged from the hospital without home health care because the providers assumed she didn’t have the right kind of insurance coverage. Presence of a black nurse or Native American social worker could have challenged those assumptions. 

To be sure, some might argue that health disparities are explained by poverty, education and whether individuals live in rural or urban areas, but these other factors are not sufficient to explain specific differences in, for example, receiving adequate treatment for pain. Explanations for those types of specific disparities rest in institutional and institutionalized racism.

Our system needs solutions now. 

These could start with small steps, like California’s recent mandate that physicians, nurses judges and police officers receive “implicit bias” training. But what our nation really needs is more attention to diversification of the health-care workforce through more “pipeline” programs.

Pipeline programs such as the National Institute of General Medicine’s Bridges Initiatives facilitate the entry of students of color into undergraduate programs and professional schools such as medicine, nursing and social work. Continued federal support for these programs is essential to end institutional racism in health care.

While it’s good news that political candidates and others are bringing the issues of racial- and ethnic- disparities in health-care quality to the surface, no one is championing the one remedy proven to work: Strategic diversification of the health-care workforce.

The only way we can truly erase institutional racism in health care is by assuring that there is as much diversity among health-care providers as there is among the people they serve.

Linda Phillips is the senior director of research and education at the Geriatric Workforce Enhancement Program at the University of Arizona Center on Aging. She is a Public Voices fellow with The OpEd Project.