How race, racism, and discrimination lead to poorer health outcomes in people of color.
Words by Lorenzo Taylor (as seen in the latest issue of DAP Health magazine)
“Of all the forms of inequality, injustice in health is the most shocking and inhuman.”
The Reverend Martin Luther King Jr. made the above call to action against racial disparities in health care nearly six decades ago. While progress has been made since the days of underfunded segregated hospitals and forced medical experimentation, this is one of his dreams that remains elusive.
Life expectancy for a Black baby born today, regardless of income, is only 67.4 years, while a White baby has a life expectancy of 77.5 years. This racial gap is even greater than it was during the 1970s, when Black life expectancy trailed by six years. Race should not determine one’s ability to live a long and healthy life, regardless of whether one’s ancestors came to this country on the Mayflower, a slave ship, wading across a river, or aboard a 747 aircraft.
Experts attribute persistent health care inequities to systemic racism, poverty, distrust of the health care system, lack of insurance, language barriers, overreliance on emergency room care, subconscious bias, and other social drivers of health. These factors contribute to higher rates of diabetes, cardiovascular disease, HIV disease, substance abuse, and mental health disorders. Black and Latina women suffer from inadequate maternal health care, and face elevated rates of unwanted pregnancies and pregnancy-related complications such as pre-eclampsia, gestational diabetes, preterm births, and maternal mortality.
DAP Health Associate Chief Medical Officer Dr. Silas Gyimah notes that a significant percentage of the nonprofit’s clients, primarily Latinos, live below the poverty line and have limited experience with primary care. When he arrived from Ghana at age 14, Gyimah was struck by a system of health care where race and language determine health care outcomes. “When I saw what was happening, I realized that it was not coincidental; it was structural and based on the history of this country,” he says. “We can slowly chip away at it one step at a time, but we need to be aware that inequities exist.”
Studies show that Black and Latino patients have better health outcomes when treated by a physician of their own race. Unfortunately, only 5.4% of all U.S. physicians identify as Black or African American, and less than 6% identify as Latino or Hispanic.
One of the rare Black female physicians in the area is Dr. Ebony King of DAP Health’s Centro Medico Oasis in Thermal. She points to the medical education reforms in the 1910 Flexner Report as a major turning point in Black underrepresentation in medicine. It resulted in the closing of many Black medical schools, which had been a pipeline for physicians serving in then-segregated hospitals and clinics.
King and Gyimah are keenly aware that Black patients’ ailments are often minimized by White primary care physicians, leading to distrust of the motives of health professionals and underreporting of symptoms. The perception of higher tolerance of pain has historical roots in Dr. J. Marion Sims’ brutal gynecological experimentation on enslaved Black women (1845-1853) and the Tuskegee syphilis experiments on Black men (1930-1972). Researchers have long tried to prove theories that people of African descent had larger kidneys, smaller lungs, and bigger heads to justify scientifically unsound race-based adjustments that have led to misdiagnosis and undertreatment of diseases in Black patients.
Nurse Practitioner Emma Bermudez of DAP Health’s Centro Medico Cathedral City links Latino health disparities to a lack of recognition of differing attitudes toward Western medicine, common among her patients and stemming from her own Mexican-American upbringing. She notes a “culture of acceptance” where patients may agree to treatment plans without understanding or intending to follow them, particularly in preventive care for conditions like diabetes. When interpreters are absent, patients’ children are often tasked with explaining complex medical terms that are beyond their comprehension.
In Riverside County, Blacks and Latinos are overrepresented in HIV cases relative to their population size, mainly due to stigma and homophobia. According to the CDC, Black and Latino gay and bisexual men are less likely to receive an HIV diagnosis, use PrEP (pre-exposure prophylaxis) as prevention, or be virally suppressed compared to White counterparts.
Tony Bradford, a Black, HIV-positive DAP Health Community Health specialist, notes, “Palm Springs has been successful in almost eliminating HIV fatality in White gay males by creating a welcoming environment in STD clinics that celebrates gay male culture. However, those spaces may alienate non-gay, sexually active young Urban males.”
Despite these challenges, progress is being made. Many DAP Health sites have frontline staff who speak the language or share the culture of the community being served. Some clinics have Black and Latino artwork that signals patients are in welcoming places. Brothers of the Desert recently initiated a peer-led “Barbershop” discussion group for Black men, and Amigos Coachella Valley convenes weekly to address HIV and various health-related topics among Latino men.
Racism, both overt and implicit, perpetuates health disparities. Seriously bridging the gaps requires more robust policy and programmatic changes, such as expansion of insurance coverage, supporting diversity initiatives, meaningfully engaging people of color in the design of services and spaces, referring patients to nonclinical community health promotion programs, and promoting patient self-advocacy.
To address the minority provider shortage, King recommends dramatically increasing STEM (science, technology, engineering, and mathematics) education for people of color, aggressive recruitment and mentoring, and integrating historic racism in health care into medical school curricula.
Bermudez advises investing in more language interpreters, and adjusting clinic hours to be convenient for working adults. She also recommends culturally appropriate, intergenerational group classes on diet, injection practice, and physical exercise to educate patients on health maintenance in family-friendly settings.
Gyimah stresses the importance of in-service unconscious bias trainings and patient feedback when they feel their issues are not being addressed. “Even if they know the system, they don’t trust the system will lead to better outcomes,” he says. “This culture must change in order to rebuild trust and increase quality of care for all.”
Another quote from MLK expresses the urgency of devoting resources to improving health outcomes for people of color: “We may have all come on different ships, but we’re in the same boat now.”
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