Rethinking Medicine
On October 6th of last year, I stood in the way of a shot during field hockey. As soon as the shot hit me, my foot hurt so badly that I knew something was wrong. My athletic trainer brought me to the hospital, where x-rays revealed that my bones had been chipped by the shot. I was put in a boot and given crutches to keep weight off my foot. Doctors called my athletic trainer daily to check in on my progress; when I told my athletic trainer that I was still in pain, new x-rays and an s MRI revealed that the chips in my bone had continued to crack. Now there were multiple fractures in my foot that were causing my pain. Doctors casted me the day after my MRI results returned and have been monitoring my progress since I was casted. It’s been a long and arduous process.
It’s also one that would have been much different (and even more difficult) if I was a person of color.
The healthcare system in the United States is filled with inequalities that have impacts on marginalized groups. These inequalities contribute to unequal access to medical services, a lesser chance of having health insurance and overall poorer health outcomes overall if you are a person of color. This then leads to certain marginalized groups experiencing illness and infirmity at higher rates and having lower life expectancies because of it. It is a domino effect that is systemic and purposeful, set in motion by a systemof structures, politics, practices based in inequity.
Medical racism is particularly problematic in that it pervades a space that is one of the most important when it comes to humans living long and healthy lives. Assigning value and determining opportunity based on the color of one's skin in a space like that leads to misdiagnoses and ignored warning signs that can have catastrophic results. An example of the medical racism can be seen in Washington State, where Black people are twice as likely to be uninsured as white people. Hispanic people are four times less likely to have health insurance. In states like Texas, where that lack of insurance is then compounded by restrictions on reproductive rights. The maternal mortality rate in Texas is higher than the national average, something that again affects women of color more severely.
This is also something that doesn’t just need to be fixed in places like hospitals and doctor’s offices. Medical racism begins outside of the healthcare system; Black women have been made less healthy by things such as increased levels of homelessness, unsafe housing; Black people are also much more likely to develop health conditions, like asthma, due to high polluting industries in and close to Black neighborhoods. Black people also suffer from higher levels of stress and hypertension, driven by the racism that they experience. According to Dr. Michele Andrasik at Fred Hutch, toxic stress caused by racism contributed to the disparity in stress levels between white and Black people. These disparities are also part of the reason why people of color generally have higher mortality rates from COVID-19, as they are more likely to have comorbidities that COVID-19 would exacerbate.
Sadly, there is rampant discrimination even when Black people have access to healthcare. It has long been the case that white healthcare workers tend to treat Black women with skepticism rather than care when they express needs. This had been further compounded by the COVID-19 pandemic. A 30 year old teacher named Rana Mungin had a medical emergency that was ignored by urgent care workers, EMTs, and doctors when she told them she wasn’t able to breathe. After she was denied care, she became fatally ill and died of complications that had been caused by COVID-19 after struggling for a month. Another example (and maybe the most prominent one) of Black women’s needs being ignored shows up when it comes to childbirth. The most famous example is likely Serena Williams, who nearly died after doctors ignored her request for a CT scan to discover blood clots in her lungs after she gave birth. Experiences like Williams’ occur with many Black women every year, to the point that they are three times more likely to die in pregnancy than their white counterparts. (Williams’ story is also important for another reason- no amount of money, fame and success can counteract being black and the racism that comes with it.)
To build a healthier nation, the systems and policies that have resulted in generational injustice need to be challenged. Physicians operate in a fundamentally racist system, full of subconscious prejudices that many might not even realize are there. The belief that Black people experience pain differently than white people is still prevalent. The myth that people go to healthcare institutions to seek medication (due to a perceived addiction) rather than care is still around. On top of this, there are past examples of the medical system maliciously affecting black people that have sown distrust in the community towards doctors. Combatting fallacies and rebuilding the relationship between Black people and medicine is critical to ensuring equitable healthcare for everyone. Things like affordable housing, proper access to clean water, and closing the racial wealth gap will create better environments for Black people to live in, both physically and psychologically.
There’s plenty more to talk about, plenty more dots to connect, plenty more context to give. We’ll continue doing so next week at 2 PM.
