Committing to diversity and inclusion in integrative care

Understand structural systemic racism in healthcare

The natural bridge between structural racism and healthcare are the social determinants of health, which are heavily influenced by systemic racial policies. Social determinants of health are the economic and social conditions that influence individual and group differences in health status, which include five key areas: economic stability, education, social and community context, neighborhood and built environment, and health and healthcare.

National data reveal that, over the past 50 years, the health of both Black and white people has improved, with increases in life expectancy and declines in mortality, according to a study published in the journal Health Care Financing Review. However, Black individuals continue to have higher rates of morbidity and mortality, and Hispanics and Native Americans have elevated disease and death rates.

Although the study authors said the role of medical care as a determinant of health is somewhat limited, medical care, especially preventive care, early intervention, and appropriate management of chronic disease, can play a role in health. Therefore, racial and ethnic differences in the quantity and quality of care are likely a contributor to racial disparities in health status.

For example, patients of color often have less access to medical care due to higher rates of unemployment and under-representation in jobs that include health insurance. Additionally, an increasing number of studies point to racial discrepancies in the receipt of major therapeutic procedures. Research suggests that some providers are less likely to offer treatment or perform a procedure on a patient of color versus a white patient, even if the diagnosis is the same.   

Racial disparities exist in healthcare and are not the result of individual behaviors, but rather a widespread societal problem. Policy and research points to improving equal access to quality medical care, improved data and monitoring, regulatory vigilance, and education and training initiatives, along with recruiting providers from disadvantaged minority backgrounds. Individuals providers can do their part to recognize this deeply rooted systemic racism and discrimination in healthcare, and both educate themselves and take action in their practices and communities.

Some helpful books and online resources related to systemic racism in healthcare include:

• Death Gap: How Inequality Kills by David A. Ansell
• Black and Blue by John Hoberman
• Black Man in a White Coat by Damon Tweedy
• Breathing Race into the Machine: The Surprising Career of the Spirometer from Plantation to Genetics by Lundy Braun
• In the Wake by Christina Sharpe
• Precarious Prescriptions by James W. Moore
• Troublesome Science by Rob DeSalle
• Body and Soul: The Black Panther Party and the Fight against Medical Discrimination
• Medical Bondage: Race, Gender, and the Origins of American Gynecology