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Racism and Discrimination in Health Care

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Healthcare systems are microcosms of the larger society in which they exist

Where there is structural violence or cultural violence in the larger society, so will there be evidence of systematic inequities in the institutions of these societies. The healthcare system in Australia is one example—from a plethora of similarly situated healthcare systems—in which the color of a patient’s skin or the race of his parents may determine the quality of medical received. Life expectancy and infant mortality rates are vastly different for non-Aboriginal, Aboriginal, and Torres Strait Islanders residing in Australia. The life expectancy of Aboriginal men is 21 years shorter than for non-Aboriginal men in Australia.

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“Above all, do no harm” is what is expected from every healthcare professional, but what if the harm is unintentional and covert? The impact can be just as destructive. In American society, we like to think of ourselves as progressive and free of biases when it comes to treating people similar or different from us. We pride ourselves on being an open society that treats everyone equally; unfortunately, we know that is not the case in reality. With the rise of controversial figures on both sides of the political spectrum, there is clearly still mending to be done for race relations. The United States institutionalized discrimination, and those negative prejudices still carry over into our society today as Barbara Fields explains in her article Ideology and Race in American History. Due to these negative stereotypes and prejudices forming in this nation’s inception, people were sectioned off into different categories now known as race. This construct decided if people were treated either respectfully or poorly. Those of European descent were treated with respect and those of African American descent were treated poorly. The literature reviewed explores the impact and prevalence of healthcare discrimination that helped shape the current study. This chapter will provide context for racism and discrimination in this country (US); it will define and explore healthcare discrimination; discuss the impact of discrimination in healthcare for this AfricanAmericans, and examine the mechanisms of such discrimination and provide factors that can reduce its prevalence for healthcare professionals.

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A colleague of mine, Dr. Altaf Saadi, recently wrote about her experiences treating patients at our own hospital. She has been questioned, insulted, and even attacked by patients, because she is a Muslim woman who wears a headscarf. She is not alone. Recent published reports include overt bigotry expressed towards doctors of black, Indian and Jewish heritage. Several medical journals have just published guidelines for doctors with titles like “Dealing with Racist Patients” and “The Discriminatory Patient and Family: Strategies to Address Discrimination Towards Trainees.” It’s sad that we need these guides. And can we fix this? Articles addressing racism in medicine suggest many of the same things (King CJ, Redwood Y., 2016). To fight racism and discrimination, we all need to recognize, name, and understand these attitudes and actions

We need to be open to identifying and controlling our own implicit biases. We need to be able to manage overt bigotry safely, learn from it, and educate others. These themes need to be a part of medical education, as well as institutional policy. We need to practice and model tolerance, respect, open-mindedness, and peace for each other. It is important to link all of these goals and actions together, as they are layers of the same huge problem. The insidious structural racism, subconscious implicit bias, and overt, external discrimination come from the same place. Dr. Saadi’s words hold very true: “We — as physicians and society more generally — must realize that the struggles of one marginalized community are struggles of all of us. My fight as a Muslim-American doctor to serve my patients without fear of racism, and the fight of an African-American patient to be treated with dignity and respect, should also be your fights.” To that end, the call to action to address racism and discrimination in medicine is for all of us, providers and patients (Rachel R. Hardeman, 2016).

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To summarize, racism and discrimination in healthcare is an extension of racism experienced and expended to the society. The way racism and discrimination are experienced in education, military, and social places is also replicated in healthcare facilities

Over 15% of the medical practitioners have experienced racism and discrimination. Their suggestions to reduce racism includes setting task forces to recommend institutional strategies and policies that can reduce racism. Other recommendations include taking patients to courts for subjecting healthcare practitioners to disciplinary measures.

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National Center for Health Statistics (US). Health, United States, 2015: With Special Feature on Racial and Ethnic Health Disparities. Hyattsville, MD:
National Center for Health Statistics (US); 2016 May. Report No.: 2016-1232.

The Department of Health and Human Services, United States (HHS). National partnership for action to end health disparities: Offices of Minority Health. Washington, DC, 2011.

Rachel R. Hardeman, Ph.D., M.P.H., Eduardo M. Medina, M.D., M.P.H., and Katy B. Kozhimannil, Ph.D., M.P.A. Structural Racism and Supporting Black Lives — The Role of Health Professionals. New England Journal of Medicine, October 12, 2016.

King CJ, Redwood Y. The Health Care Institution, Population Health and Black Lives. Journal of the National Medical Association, May 2016.
Sreshta, Nina, et al. The Social Justice Coalition of the Cambridge Health Alliance: An open letter to our patients in the Trump era.

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