Confronting racism in health care

Weeks after the acquittal of George Zimmerman in the shooting death of 17-year-old Trayvon Martin, local communities are still holding peaceful demonstrations to show solidarity with Martin’s family, and to underscore the message that we have not yet achieved the civil rights and justice envisioned by the Reverend Martin Luther King Jr in his historic speech, “I Have a Dream,” on August 28, 1963. Fifty years later, we are reminded of the lingering tensions and discrimination that characterize race relations in this nation.

President Obama, in a surprise unscripted speech on July 19, talked about his personal experiences as an African-American and our history of racial injustices that continue to affect black people. As the country’s first black President, his words were historic; they reopened the dialogue about race in America.

What, then, is the responsible conversation about race in health care? More than a third of the US population reported belonging to a racial or ethnic minority group in the 2010 US Census. Disturbingly, however, the Centers for Disease Control and Prevention (CDC) Office of Minority Health and Health Equity find that racial and ethnic populations suffer lower life expectancy, higher infant mortality, and higher rates of disability and preventable diseases than non-minorities. Black Americans bear the most serious burden, according to statistics in the CDC’s first Health Disparities and Inequalities Report (2011), which analyzes the factors creating higher disease burden for some populations that rob them of a healthy life. The report calls for immediate action to accelerate efforts at the federal, state, and local levels to shrink gaps in access to care, reduce preventable deaths, and impede the ever-increasing incidence of morbid conditions that threaten a dramatic reduction in quality of life and life expectancy.

Blatant discrimination is no longer rampant in health care, but it is no secret that subtle biases and stereotyping persist. For years, “separate but equal” conditions existed. As a nursing student in the mid-1970s I was deeply disturbed by the socioeconomic segregation that occurred on the obstetrical units of an inner city hospital. Mothers with insurance were placed on a unit with nicely appointed private rooms. The poor, almost all African-American women, were on another unit that had rooms with multiple beds. In the 1990s, I was on a team designing a new clinic building. To my shock and disbelief it was suggested there be two entrances—one for private patients and one for those who were indigent. Fortunately there was no indulgence of this ill-founded request.

Over time, we have implemented protections for patients’ rights and embraced the need for cultural diversity but we may have fallen short addressing the same concerns for workers. In February a neonatal ICU registered nurse sued a Michigan hospital for discrimination when it honored a request from a white father to bar African-American nurses from caring for his baby. The hospital honored the request for some period of time before correcting the discriminatory action. The nurse settled the case with payment for emotional stress and harm to her reputation; a second nurse has also sued over the same incident.

Most people prefer to have a caregiver who looks like them, and understands and appreciates their racial, ethnic, and religious beliefs and practices. There are benefits to accommodating race concordance; however, it is not to be misinterpreted as accommodating racial bias as pointed out by Paul-Emile (2012), who studied physicians’ rationale for acceding to patients’ racial preferences. She points out the complexity of such accommodation and posits there is no moral reason to allow decisions based on racial bias.

The nurse who commits subtle intentional or unintentional racism, reinforces prejudice that leads to disparities in care. Many would say nurses exhibit less racism than other groups. But any racism is still racism and strikes at the core of our professional obligation to protect and care for patients. Hall and Fields (2013) advocate for “positive profiling” to address and prevent racial health disparities and inequities. They suggest nurses can use evidence to remove barriers to care and implement strategies to avoid the potential for subtle racism that results in delays in care, reduced referrals, or suboptimal treatment. They boldly address the difficulty admitting racism exists in our workplaces and care settings, pointing out that the majority of nurses are white, and that racism perpetuated by whites is more prevalent than that of any other people of color.

Health care has no place for hate, anger, stereotypes, discrimination, or marginalization. As uncomfortable as it may seem, talking about how we treat one another, and how we avoid discrimination, is a crucial step toward eroding historic prejudice. It’s time to address the subtle racism affecting the health of the very people we have pledged to protect and serve. Let’s create a safe environment for the crucial conversation. Racism hurts all of us.

References

Centers for Disease Control and Prevention. CDC Health Disparities and Inequalities Report— United States, 2011. MMWR. 2011;60(Suppl):1-116.

Hall JM, Fields B. Continuing the conversation in nursing on race and racism. Nurs Outlook. 2013;61(3):164-73.

Paul-Emile K. (2012). Patients’ racial preferences and the medical culture of accommodation. UCLA Law Review. 2012;60(4):462-504.

17 COMMENTS

  1. I find it absolutely astonishing when Caucasian nurses, such as the ones above state that they do not see disparities in healthcare and that the Nurses of Color do not experience racism. First, if you your self have never been discriminated against because of your race, you are blind to what the Nurses of Color and Patients of Color are going through. You are probably one of those Caucasian nurses that under the section on skin, check the box pink for People of Color. You also do not have a clear definition of bias, it is real and clearly affects both Patients and Nurses of Color adversely. I have more problems with Caucasian Nurses than any group I have ever worked with; I am a veteran of the United States Army and I have never had the issues like the issues racism and bias that I have with Caucasian Nurses. Educated Women of Color are viewed as aggressive, opposed to assertive – you choose not to deal with bias and prejudice. However, I will continue to be a strong, Women of Color, Nurse, Veteran making my mark and being a role model to my children and fellow Nurses of Color.

  2. Something to note is that in talking to people about their experiences in health care further emphasize that subtle bias is harmful, no matter how minor it seems. Deflecting these incidents as such allows us to dismiss our inherent biases, which in turn build a health care system that negatively affects minorities, and sometimes endangers them. Sometimes these biases are unconscious. This is why people who say it is not a race problem miss the point: by saying that racism in health care does not exist, they undermine the numerous stories for minority patients who do not receive the help they need because doctors do not believe them. Just because it is something that they do not experience, does not mean it does not exist. This is a real problem that the medical community must be responsible for and recognize.

    In this article (https://www.cbc.ca/news/canada/north/yellowknife-woman-raises-concerns-of-cultural-bias-in-health-care-system-1.4703688), for example, Yellowknife citizen Jennifer Lafferty describes a humiliating hospital visit where she was in extreme pain, and doctors and nurses dismissed her, noting that she was “hyperventilating” in her emergency record. Lafferty would later be diagnosed with strep throat and an 8.3mm kidney stone, and still has not been contacted for an apology.

    Lafferty is an Indigenous woman, who notes that not being taken seriously by medical professionals is not an uncommon experience for Indigenous people. It is one of many stories that CBC reports where Indigenous people report that they are not being treated with respect, and that their symptoms are not treated as they should.

    I make this point to urge for more empathy in the medical community, and for them to make a conscious effort to listen to minorities. It is uncomfortable to acknowledge that racial biases exist in the health care system, but a necessary step to take.

  3. The racism in health in the Virginia Beach area is VERY obvious. So much so that there are even Black and other doctors taking stabs at black patients. My husband and I both happen to deal with chronic pain due to Arthritis and my husband has major spine problems. Neither one of us has EVER been a junkie in all our lives. Yet we’re demonised and treated like crap every time we had to go to pain management or urgent care. Then when I’ve gotten assertive with a nurse at the Hospital concerning the medicine (it wasn’t strong enough for the pain that I was having). She flagged my prescription record out of spite. Truthfully speaking, I’m literally a ticking time bomb that’s about to explode. Because I’m not going to keep sitting here rotting away in agony, while I see white patients who are younger and have less ailments. With pain patches, medication with enough strength and dosage for breakthrough pain. That’s how I know that this “Opioid Epidemic” is BS. Because it’s white people who are overdosing off this illegal use crap. Far more than blacks ever can, much less have. Yet they use us blacks as the damn whipping boy for this ish, by using this FARCE as a way to withhold needed medications from us out of nothing more than hatred, spite and racism. In order to take away our livelyhoods and our dignity. Then try to play with our intelligence by lying, being rude and disrespectful, when we shoot down any of their stupid attempts to mind phuck us. These evil ase holes and SOBs, deserve to burn in the hottest part of hell, with lighter fluid in tow…And YES I meant it, EXACTLY how I said it…

  4. Where I work, employees are promoted based on their skin color, not based on competence. A black nurse with an advanced degree and more experience has less chances to be a unit coordinator compare to white nurses with associate (AS) degree. The pay gap between white and black is tremendous. Patients disrespect black nurses however they’re pleased, and management would fire or suspend the nurse, and they won’t do that for the white nurses.

  5. Racism in nursing is just as common in nursing as it is in law enforcement. Its just that nurses do not carry guns. However, prejudice and racial bias by a nurse is just as dangerous as a fearful racist with a badge and gun.

  6. Don’t bring black and white issues into play ? When I saw Anonymous. …I understand why you say that.

  7. I appreciate and applaud Pam’s editorial. Unfortunately, there is still a long way to go…in fact, it is almost harder to fight the covert racism than the more overt. For those who state there was and is no racism, you are sadly mistaken. It existed then and it does today. Each of us need to recognize that fact and try to do our part to dispel any and all forms of racism, sexism or any other -ism. Thanks for taking the time to write such a wonderful and honest article!

  8. This editorial pulled no punches. I agree with everything that was said. In fact, I believe a few points may have been missed.
    What about the misinformation re health care issues given to minorities by physicians and other healthcare personnel. This leads to their making poorly infomed decisions about their health and well being

  9. I believe we need to look into all disparity; I see more and more RN’s and LPN’s offered only part time and salary much lower than other similarly educated positions – which is sexism due to the female dominated career. This disparity is even more marked for my non-white colleagues.

  10. The commentary is uncalled for and is stated in the wrong arena. In the 1950’s & 60’s. the cultures were to place patients in areas of care according to financial AND color status NOT COLOR ONLY – please get your information correct. #2. As a nursing student and then a RN, I never witnessed disparity in care due to color BUT there was definitely disparity in placement due to financial status, to culture and MOST definitely to your sex. WOMEN of ALL color was discriminated against.

  11. I don’t see racism towards patients as much as I see it between personnel in the hospital. I started my career in a level one trauma center, and our objective was to save a life. We had patients with and with out insurance, black and white. We never did any less for any of them regarding their abiltiy to pay or the color of their skin. If you are in health care and you are unable to care for humans, irregardless of their economic status and skin color, then you need to leave.

  12. My experience with racial inequities in healthcare was similar to Editor Pam in the 60s. We’ve come a long way since then, but I agree that there are still remnants of underlying covert expressions of racism in a very small subset of nurses and other health professionals of both white and black races. We must all be honest and introspective, and cleanse our own attitudes to work harmoniously in providing excellent, unbiased patient care.

  13. Apparently the author believes that Mr. Zimmerman was wrongly acquitted – even though the FBI could find no incident of racism in his entire life – plus the fact that the young man he shot was holding him down and banging his head on the sidewalk. Are we not supposed to protect ourselves anymore if the perpetrator is black? Let’s don’t bring this black-white issue into play in nursing. We have enough real issues to worry about as it is.

  14. Believe at times it’s easy to call it racism but really, it is a behavior(s) that are provoking. Sometimes it is racism, no question. Think it’s important and effective that whites address racism when witnessed by another white and same goes for blacks & other races. I’m black, been a RN for 38 years and at times am outraged with some of everybody due to behaviors NOT race.

  15. I really don’t know where these “experts” have been living or if they have actually practiced the art of nursing. From the article I don’t believe they have any clue about the truth in direct care nursing. I have NEVER seen any incidences of racism in pt care by nurses or physicians. All patients have been treated equally and a patients color or race has nothing to do with the quality of care. I am so tired of the “race baiting”. Does my profession have to promote this??

  16. Thank you for this article because racism is still in our work environments. Leaders often take a do nothing approach to the problem because there are so many non functioning initiatives to prevent such actions.

  17. In addressing the topic, “Confronting Racism in Health Care,” the author provides only one strategy (Hall and Fields,’ 2013) to address and prevent racial health disparities and inequities. It would have been more helpful to offer readers other strategies to confront racism. For example, many nurse scholars in the field of transcultural health care have provided healthcare professionals with models and other strategies to effectively confront racism.
    Josepha Campinha-Bacote, PhD, MAR, PMHCNS-

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