Medical racism in the United States

A doctor is seen drawing blood from a patient who was unwittingly a test subject in the Tuskegee Study of Untreated Syphilis in the Negro Male. This study is controversial for its violation of ethics in the name of science.

In a modern context, medical racism and its history has created a deep distrust of health professionals and their practices in certain racial and ethnic groups. Studies within the last couple decades have elucidated varied treatment from health professionals still occurring that reveal racial biases. These racial biases have impacted the way in which substances such as painkillers are prescribed or the rate at which diagnostic tests are given.[1] Black patients in particular have a long history of contrasting medical treatment based on different perceptions of the pain thresholds of Black people.[3][4] However, medical racism has not been limited to Black people in the United States. While infamous studies like the Tuskegee Study of Untreated Syphilis in the Negro Male may be known, the U.S. Public Health Service Sexually Transmitted Disease (STD) Inoculation Study of 1946-1948 notably impacted Guatemalan prisoners, sex workers, soldiers, and mental health patients in a detrimental fashion by purposely infecting victims with STDs such as syphilis and gonorrhea.[1] The push to forcibly sterilize Indigenous women as young as 15 years old occurred from 1970 to 1976 by the Indian Health Service as revealed in researcher Jane Lawrence's paper "The Indian Health Service and the Sterilization of Native American Women."[1] These are only a few examples of the many that exist in American history of the unethical actions of health care providers, researchers, and government entities pertaining to the health services of minority groups.[1]

Black Americans have faced innumerable obstacles to equal access to healthcare due to medical racism and the consequence of this has been poor health outcomes. Within this paradigm, American doctors and institutions have historically played a large role in perpetuating scientific racism, denying equal care to black patients, and committing acts of violence against black people.[3][10]

Ideas about black people's relationship to primates and their biological and intellectual inferiority to white people, in the US, were just a few ways in which chattel slavery was justified.[4][11] Following this was the introduction of the belief that black people have much higher pain thresholds or the introduction of the belief that they don't feel pain at all.[3][4] Proponents of ideas such as this also proposed that black people had thicker skulls and less sensitive nervous systems, and they also proposed that black people contracted diseases which were linked to their darker skin color. Some proponents of these racist ideas even believed that black people could go through surgery without any pain medicine and they also believed that when black people were punished, during their enslavement, they felt no pain.[4] White American physicians also operated on the assumption that poor health was the status quo for black people which meant that they'd naturally die off due to syphilis and tuberculosis, a situation which was detrimental to the quality of the healthcare which they then provided to black people. The high rate of syphilis among black people was used to reinforce this notion.[3][11] However, racial myths also have negative impacts on the health outcomes of black Americans, starting from infancy. Beliefs in the "supernormal health" of black babies and children fosters ignorance and leads to the avoidance of the health issues which black children face in their early lives. With a large role in the perpetuation of such widely believed ideas, oral traditions can be highly influential, even when they are not explicitly included within medical curriculum.[3]

When false ideas of pain tolerance based on race are present within people's minds, they lead to detrimental consequences even if those who believe in them have no explicitly prejudiced beliefs, as was discovered by researchers.[4] In a study on racial bias in pain assessments, a demonstrated correlation between racial bias in pain assessment and subsequent pain treatment suggestions was found. It was also found that in both a significant number of laypersons and those with medical training, incorrect beliefs about differences between black and white people on a biological level were held.[4] Beliefs such as these can lead to the differential treatment of patients on the basis of their race. In a research paper which was written by Staton et al., doctors were shown to have a higher probability of underestimating the pain intensity that black patients were feeling.[4] In the early 2000s multiple studies were able to demonstrate discrepancies in the pain treatment of black patients as compared to the pain treatment of white patients. From children to adults, differences were as much as black patients only taking half of the amount of pain medications as white patients were taking.[1]

Freedom from slavery did not stop the impacts that slavery had on black people, such as the impacts which existed in the field of healthcare; the denial of access or equal access to healthcare was able to recreate the experiences of slavery by exposing black people to many infectious diseases.[10] A notable difference between the services which were offered and rendered to black patients and the services which were offered and rendered to white patients has been observed in the American healthcare system even with the presentation of the same severity of symptoms and the same insurance.[3]

This photo shows "HeLa cells" that originated from black woman and cancer patient, Henrietta Lacks. Lacks was unaware of her stolen cells that have been used for many decades now in medical advancements such as the development of the polio vaccine.

Along with unequal access to medical care, medical racism has contributed to violence perpetrated against black Americans throughout history. Including the use of "resurrectionists" to retrieve newly buried bodies of deceased black people for medical study use, the bodies of black people were abused for forced medical experimentation for many years. As noted in writings on the American medical field's history of medical racism, "American medical education relied on the theft, dissection, and display of bodies, many of whom were black."[10] This is especially true for women, such as was the case for Henrietta Lacks. The nonconsensual experimentation on enslaved black women was used to help further the field of gynecology.[10] Following this, due to the history of eugenics in the United States, this same population once again fell victim to forced procedures, in this case sterilization. This went on in the US as late as the 1970s and 1980s as is documented in Killing the Black Body.[1][10] For black Americans, the involuntary sterilization of black women was so well known it began being referred to as the "Mississippi Appendectomy".[1]

The violence which was perpetrated by American physicians and institutions has a long, documented history. Including the Tuskegee syphilis study, there are many other instances of experimentation on black populations without their knowledge or consent.[1][4] In 1951, the US Army intentionally exposed large numbers of black citizens to Aspergillus fumigatus to ascertain whether they were more susceptible to this fungus. In the same year, black workers at a Norfolk supply center in Virginia were exposed to crates contaminated with the same fungus.[1] Journalist Richard Sanders reported that from 1956 to 1958 the US Army intentionally released mosquitoes in poor black communities of Savannah, Georgia and Avon Park, Florida. Many people subsequently developed fevers for unknown reasons and some of them died, it is theorized that the mosquitoes were infected with a strain of yellow fever. Pulitzer-prize winning author of The Plutonium Files, Eileen Welsome wrote on how the US secretly injected thousands of Americans with plutonium while it was developing the atomic bomb. A number of these victims were black and they were completely unaware of the injections.[1]

Depicted is war chief Pontiac holding a war hatchet. It was in Pontiac's War that Jeffery Amherst famously proposed gifting smallpox infected blankets to the indigenous peoples.

Starting in the 18th century, the United States has committed many acts of medical injustice against Indigenous Americans. In the 18th century, smallpox was used as a biological weapon to wipe out indigenous populations. In particular, in 1763 Sir Jeffery Amherst ordered soldiers to take the blankets and handkerchiefs of smallpox patients and gift them to indigenous people of Delaware at a peacemaking parley.[1] There is also the prevalence of involuntary sterilization of young indigenous girls and women. From the data yielded by multiple studies, it's suggested that the Indian Health Service sterilized between 25 and 50% of indigenous women from 1970 to 1976.[1]

Contemporarily, the health outcomes of indigenous populations in the US are still vastly worse than the greater population. In the state of Montana, the life expectancy for indigenous women is 62, while for men it is 56. These numbers are significantly lower than the national averages by around 20 years.[12] This is due to a number of factors such as the fact that unequal funding plagues the Indian Health Service that is in charge of ensuring the access the federal government must provide and that around 25% of indigenous people in the US report facing discrimination in medical settings.[12][13] An executive director at South Dakota Urban Indian Health, Donna Keeler, explains that while her clinic receives federal funding for indigenous people living in urban areas, federal prison inmates would have more federal funding allocated to their healthcare.[12]

The document shown is the results of a 2010 inquiry into the STD research that took place by the US in Guatemala. President Barack Obama enlisted the Presidential Commission for the Study of Bioethical Issues to oversee the project.

In the United States, 20% of Hispanic Americans report encountering discrimination in healthcare settings and 17% report avoiding seeking medical care due to expected discrimination.[14] Studies of Hispanic people living in the U.S. reveal that after experiencing an instance of discrimination in a healthcare setting they, afterward, delayed seeking medical treatment again.[5] The discrimination faced by Hispanic Americans can further contribute to the negative health outcomes that stem from the experience of racism and discrimination by minorities.[14] Cultural incompetency can hinder productive relationships between healthcare providers and patients because different cultural norms of communication can give the impression that a physician is not properly attending to the concerns of their patient as was found in studies on Latina experiences with the healthcare system. It was found in one study that in the role that communication plays in the dynamic between Latina patients and healthcare providers, the way women perceived their communication with their provider was greatly impactful to their perception of discrimination.[5]

The aforementioned U.S. Public Health Service Sexually Transmitted Disease (STD) Inoculation Study of 1946-1948 is just one historical example of the way in which Latin American populations have been victim to medical racism and medical injustices.[1]

From 2006 to 2012, California prisons performed illegal sterilizations on inmates and more than half of the women were black or Latina.[4] Also in 2012, both black and Hispanic patients have been found to be under-treated for pain.[3]

In 2020, a nurse whistleblower alleged the practice of forced hysterectomies at a US Immigration and Customs Enforcement facility.[15]

In addressing the issue of medical racism in the United States, there are different ways to mitigate unconscious bias that leads to the perpetuation of health disparities. Practices like better diversity training, introspection of biases, "cultural humility and curiosity", and a full commitment to changing the culture of healthcare and the impact of stereotypes can work to lessen the effects that unconscious bias can have on patients.[2] Academia should assist medical students in recognizing and addressing race-based inequities and microaggressions. Curriculums that address racial bias could improve patient interactions with incoming healthcare professionals. A 2020 study of resident-led programs dedicated to racism training effectively promoted awareness of racism in the workplace. By generating awareness of institutional racism early on, better practices may help to mitigate further effects of medical racism.[16]