Racism in Healthcare

Racism in Healthcare

Since the brutal killing of George Floyd and the Black Lives Matter protests being aired worldwide, I have had a lot of revolutionary awakenings. I, along with many other white people,  have come to face my white privilege and realise that these protests not only stem from the anger of police brutality, but the covert ways that society is designed for white people and so have kept people of colour oppressed in a time most people think we are the least racist we’ve been in history. 

I have been reading Me and White Supremacy by Layla Saad to question my internalised attitude to race, watched the 13TH on Netflix (a documentary on America’s mass incarceration problem), and have been having many uncomfortable but necessary conversations with friends and family about racism and white supremacy. With the knowledge I’ve gained from these resources, and finally truly listening to experiences and stories of black people on social media, I wholeheartedly intend to be an anti-racist and not just sit by evidence of oppression, despite knowing that the system is ultimately benefiting me. 

Some posts I’ve found extremely eye-opening on social media are statistics on how BIPOC (Black, indigenous, people of colour) are disadvantaged in healthcare. An action as overlooked as going to the GP can result in a white person getting the treatment they need, and a black person being ignored. From the difficulty of being treated seriously, their pain empathised, their symptoms recognised… white supremacy is weaved into our healthcare system. As a future white healthcare worker, it is a must that I recognise these injustices so that I can call it out, stand against it, and most importantly do not perpetuate it. 

I’ve compiled information I’ve found, and referenced with links (hover over the statement*), on the main areas of medicine that racism/white supremacy is present.

*I am still trying to work out how to get links within paragraphs a different colour so I apologise for links not being distinct from normal text. I may start doing Harvard referencing when doing informative posts like this instead.

As a patient

Diagnosis

Many conditions present differently in people of colour than in white people. Recognising these differences is crucial for a disease to be recognised in a black person as well as a white person so that both patients can receive the correct treatment. If doctors are not trained to spot the signs in skin colours other than white, then white people are benefiting from a system that is designed to only treat them.

Skin conditions, such as psoriasis, are commonly misdiagnosed in people of colour. In people with white skin, psoriasis appears as red or pink patches with silvery-white scales. In people with darker skin tones, psoriasis appears as purple or brown patches with grey scales.   

https://www.nhs.uk/conditions/psoriasis/symptoms/ – only a white skin photo on the NHS website!

The differences in presentation of symptoms between different races should be emphasised in medical school curricula, and more pictures of these symptoms on black people should be in textbooks. Similarly to the problem of the under-representation of female bodies in text books (even when it comes to medical imagery around reproduction, men outnumbered women in textbooks 2.5 to 1), amongst the images of females in textbooks that are present, 86% of them are white.

How are doctors expected to accurately diagnose serious health conditions if they are only ever taught how to spot them in a white person? 

Related post>> The Gender Data Gap in Medicine & Healthcare

Pain 

Studies have shown that false beliefs about biological differences between white and black people have led to a racial bias in how pain is assessed and managed. False beliefs such as ‘black skin is thicker than white skin’, lead black people (Americans, in this particular study) to be under-treated for pain relative to white people. This study also found that half of a sample of white medical students and residents endorsed these false beliefs, with these participants rating the black (vs. white) patient’s pain as lower and thus made less accurate treatment recommendations.

A big part of mistreatment of pain is also believed to be a lack of empathy for patients who do not speak English, and so their screams of pain or request for help is misunderstood. Quick and effective provision of translators is important so that patients receive the correct information that they can understand, to enable coherent communication which is a vital part of effective patient care. But also, doctors and healthcare professionals are being encouraged to take their time with patients who do not speak English, and try to correctly interpret their pain signals and explain what they need to know.

Many argue that these patients, especially if they have lived in the UK for a long time, should try to learn English to lessen this expectation on the NHS. But a research paper called Lost in Translation pointed out that the direct oppression of minority women in their families often leads to language isolation, where they are forbidden to learn English in fear of ‘integrating’ into society and gaining confidence. I admit I was quick to judge that long-term residents should try to learn the language, but (likely as a result of my white privilege) I overlooked the cultural implications of expecting people to do this.

Black women are 5 times more likely to die in childbirth than white women

https://www.bbc.co.uk/news/uk-england-47115305

A figure that should spark urgent investigation still isn’t fully understood. Black pregnant women are more likely to have complications during childbirth such as preeclampsia and while social factors could be a contribution to these figures, a report found that black middle-class women were more likely to die in childbirth than white working-class women in America.

But many believe the main reason behind the statistic is how black women are taken less seriously than white women, and are so mistreated for their pain which could be signals for complications. This leads us back to the pain assessment problem, and so perhaps if this root issue improves then less women will unnecessarily die from childbirth.

Many black women say their fears were ignored, and staff did not treat them in the same empathetic way as white women presenting the same worries. 

As a mental-health patient

Eating disorders are commonly seen as a ‘white woman’s’ problem, and many believe that black women are less susceptible because African culture celebrates larger bodies. Some research supports this, but others show that recurrent binge eating disorders occur at higher rates in black women than in white women. Many people link this to research that shows that binge eating or emotional overeating is often used as a way to cope with difficult emotions triggered by past trauma, such as racial discrimination. And no doubt, not exclusively to eating disorders but to all mental health conditions, continuous stress plays a huge factor. And irrefutably, black people go through a lot of stress to navigate a world built against them.

I found this article valuable when researching this.

Black women experience depression at higher rates than do white women and anxiety in black women is more chronic and the symptoms more intense than white women, both likely due to these daily stresses and past trauma of discrimination and fear. Obsessions and compulsions in black people with OCD often revolve around themes of cleanliness and order, thought to stem from stigmas of their dark skin being ‘dirty’. Click here for more on OCD. An upsetting realisation that despite people of colour being more likely to have a mental health condition, they find it difficult to seek treatment due to fear of not being understood, shame, and lack of money to afford treatment too, due to socioeconomic inequalities.

I have come across some experiences on social media that this mental difficulty doesn’t even stop when they do access help. Many therapists overlook the racial causes of a black person’s trauma, and one denied the black patient’s request to see a black therapist who is more likely to relate. There should be more diversity in the workforce of therapists and mental health workers who can relate with the trauma many black patients have from struggles with their race and identity, as this is crucial to treating their mental health conditions from the root cause.

As a medical student

Racial Discrimination in Medical School

A joint BMJ and BMA investigation found that medical schools are poor at recording students’ complaints of racial harassment (of 40 medical schools in the UK, 32 responded to The BMJ’s request, of which 16 said they collected the data.) Only half of medical schools collect data on students’ complaints about racism and racial harassment. And since 2010 they’ve recorded just 11 complaints. Meaning many students do not bother reporting incidences knowing nothing will be done about it. ‘Instead, they internalise the humiliation and prepare for a career where discrimination is commonplace, no doubt affecting their self esteem and their ability to perform.’

As an NHS worker

Racial Discrimination in NHS trusts

In every London trust, a higher percentage of BME staff reported personally experiencing discrimination at work in the last 12 months compared to white staff. But, not surprisingly to POC, the discrimination is not just coming from racist public, it’s coming from colleagues. Black NHS staff report the highest incidence of bullying and harassment from their colleagues and leaders. POC cannot even feel safe and accepted in their workplaces. (Source)

Black and brown doctors are reported to the GMC (General Medical Council) more than twice the rate as white doctors

This view of black colleagues being seen as the ‘outsiders’ is believed to be an important reason behind why black and brown doctors are reported to the GMC more than twice the rate as white doctors. Doctors in minority groups do not always receive ‘effective, honest or timely’ feedback about their practice because ‘some managers avoid difficult conversations, particularly where that manager is from a different ethnic group to the doctor’. This means that concerns that arise about the practice of a BME staff member are often not discussed at the informal colleague-colleague level, but immediately referred to the GMC.

‘This is particularly important as complaints from employers are more likely to result in an investigation being opened and, ultimately, more likely to result in a sanction being applied, than complaints from other sources’ the GMC says.

Staff of colour are yet again having to deal with a higher risk of losing their jobs, because of feeling like an ‘outsider’ resulting in their fellow colleagues finding it difficult to have conversations with them.

92% of board members are white

We need stricter policies in place to tackle racism in healthcare, yet with only 8.4% of NHS Trust board members from a BME background in 2019, diversity in senior management just isn’t good enough. This is an improvement from 7.4% in 2018, but is still significantly lower than the 19.9% proportion of BME across the general workforce across all NHS trusts in England.

The fact that BME staff are still significantly underrepresented in senior pay bands (6.5% of staff at very senior manager pay band are BME, compared to a 19.7% representation in the workforce) raises yet another issue: it is easier for white healthcare professionals to move up in their career than black staff. The same NHS report cited earlier found that white staff were more likely to access non–mandatory training and continuous professional development (CPD) compared to BME staff. This is making it difficult for BME staff to access the higher paid roles, but also the senior roles which hold the power of policy- and decision-making. 

Finally, white privilege means that most white doctors do not even realise there is a problem, simply because they are not the ones being oppressed. When NHS staff were asked if they believe that their trust provides equal opportunities for career progression or promotion, white people agreed they did at a much higher rate than BME staff, see graph below. This stresses the importance of achieving racial diversity within the management systems that identify racism and can manage policies against it.

Imagine how much better the healthcare system would accommodate for minorities, if people of minorities actually made up a suitable proportion of management teams?

https://www.england.nhs.uk/wp-content/uploads/2020/01/wres-2019-data-report.pdf – annoyingly it keeps uncropping my photo – click the link to the NHS Workforce Race Equality Standard Report 2019 and scroll to Fig 12!

Our healthcare system was built upon the exploitation of black people

As I thought I was rounding up this blog post, I discovered the huge amount of medical history of exploiting people under the name of science. One example being the case of Henrietta Lacks, an African-American women born in 1920. Her cervical cancer tumour biopsy became the source of the Hela cell line, the first immortalised cell line which reproduces indefinitely, and continues to be a source of medical data today. As was normal then, no consent was obtained to culture her cells, nor were she or her family compensated for their extraction or use.

There is a book on this case: The Immortal Life of Henrietta Lacks by Rebecca Skloot and Sarah Moss

Another example: The Tuskegee Syphilis Experiment

The Tuskegee Study of Untreated Syphilis in the African American Male ran by the US Public Health Service (PHS) was a clinical study conducted between 1932 and 1972 to observe the natural history of untreated syphilis. 600 (399 of which had latent syphilis) African-American men in the study were promised free medical care, but were deceived by the PHS who disguised placebos, ineffective methods, and diagnostic procedures as treatment. The men who had syphilis were never informed of their diagnosis, despite the risk of infecting others or their disease leading to serious complications such as blindness or death.

There are many many other cases like these, which you can look into. An important thing about these stories is that they are a perfect example of how white people had (and still do, but more covertly) dehumanised people of colour, and treated them like test subjects to improve the healthcare which was made for treating white people.

I hope this has summarised some of the racial injustices present in healthcare, and how as future medics we need to make change. Please remember I have conducted this as a white person through the lens of my privilege. I am certain there are many more examples of racial injustice in healthcare that go unreported therefore listening to the stories of BIPOC people is essential to understanding what they have, and continue to, go through in a white supremacist society to get the basic human right of healthcare. 

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