Today’s medical and health care disparities are rooted in a long history of U.S. policies and events and reflect the ongoing effects of racism at many levels: institutional, structural, policy, and interpersonal. Masu. Understanding this past and how it shapes current disparities can help inform and guide efforts to address them. We also recognize the resilience of marginalized populations in the face of these challenges and disparities, and prioritize community engagement and leadership to reduce disparities and improve overall health and well-being. It’s also important to consider ways to develop their strengths. This overview examines how past policies and events relate to current disparities among Black people in medical care and health outcomes. This is based on KFF’s interactive timeline, “How History Has Shaped Racial and Ethnic Health Disparities,” and KFF’s 2023 Racism, Discrimination, and Health Survey.
Today, black people face persistent problems disparity in health care and health outcomes. These include higher uninsured rates, higher likelihood of going without care due to cost, and poorer reported health status (Figure 1). Their life expectancy is nearly five years less than whites (72.8 years vs. 77.5 years). Infant mortality rates for Black infants are more than twice as high as for white infants (10.6 per 1,000 versus 4.4 per 1,000 as of 2021), and Black infants are more likely to die from pregnancy-related reasons than white infants. almost three times higher (39.9 vs. 14.1 per 100,000 live births between 2017 and 2019).
The health and health care disparities that Black people face today are fundamental to and reflect that. historic Racist and discriminatory practices and beliefs. Race is a social construct and there are no biological differences between races. However, many historical policies and events have persisted since the biological differences between races and white supremacy were debunked. These inaccurate beliefs contributed to misconceptions such as that black people feel less pain than white people, and to the historical mistreatment and mistreatment of black people by the medical system. For example, in the 1800s, doctors experimented on enslaved black women to develop new surgical techniques, and in the early 1900s, low-income women of color were subjected to forced sterilization. The federal government withheld treatment for syphilis from poor black men in order to study the progression of the disease. It was conducted under the infamous 40-year U.S. Public Health Service study of untreated syphilis at Tuskegee that began in 1932.
Science has since disproved these theories, but these beliefs continue to permeate the U.S. health care system today. As recently as 2016, researchers found that white medical students, residents, and the general public continue to hold widespread beliefs about the biological differences between blacks and whites. These include beliefs that black people have thicker skin and that their blood clots faster than white people. Race also continues to play a role in medical education and clinical decision-making, through the attitudes and biases of healthcare providers, disease stereotypes and nomenclature, and as part of clinical algorithms, tools, and treatment guidelines. Masu.
This history continues to be reflected in the experiences of people seeking health care. According to a 2023 KFF study, black adults are more likely than white adults to say they have been treated unfairly or disrespectfully by a health care provider because of their race or ethnicity. They were also found to be more likely to report negative experiences, such as being refused pain medication. Requests and questions are needed or ignored (Figure 2). More than half of Black adults feel they need to pay close attention to their appearance in order to be treated fairly during medical visits, and about 3 in 10 feel that they are at risk of being disrespected by health care providers and staff. Most respondents answered that they are preparing for sex. Reflecting these experiences, black adults are more likely than white adults to view racism as a major problem in health care and to trust health care providers to do what is right for them and their community. Providers, who are less likely to say they trust them but the majority still trust doctors and health care, should do the right thing, at least most of the time.
Research shows that having a more diverse healthcare workforce may help address some of these challenges. According to KFF 2023 survey data, Black adults who have more visits with health care providers who share their racial or ethnic background report more positive interactions with health care providers (Figure 3). They are also more likely to trust their doctors and other health care providers to do what’s right for them and their communities all or most of the time. Other studies have shown that racial concordance between patients and providers has been shown to be associated with reduced emergency department utilization, reduced racial disparities in mortality rates for black infants, and increased visits for preventive care and treatment. Our findings suggest that it may contribute to improved healthcare utilization and health outcomes. However, compared to white adults, Black adults are underrepresented in the health care workforce and are less likely to be seen by health care providers with similar backgrounds.
The lack of diversity in today’s healthcare workforce is rooted in historical practices. Prior to the desegregation of public education, colleges and universities were established to educate black students, and by the late 19th century there were seven medical schools focused on training black physicians. In 1910, the Flexner Report, a study funded by the American Medical Association and the Carnegie Foundation, assessed the current state of medical education in the United States and Canada. The report recommended closing most historically black medical schools, leaving only two to survive: Meharry Medical College and Howard University. The number of Black doctors has declined in the wake of these closures, and despite recent efforts to increase the diversity of medical students, Black doctors remain underrepresented as a proportion of the population. A 2023 Supreme Court ruling against the use of affirmative action policies in higher education could exacerbate this problem, with experts concerned that it could undermine progress in diversifying the health workforce. There is.
In addition to these experiences within the health care system, Black people face a variety of underlying structural inequalities. social and economic factors It is the main driver of health. One of the most important factors is the ongoing residential segregation. The majority of the Black population lives in urban areas, where they have less access to health-supportive resources and are more likely to be exposed to health risks. Today’s residential segregation reflects past policies, especially redlining. Under a law passed in the 1930s, residential neighborhoods are rated based on mortgage risk, with high-risk neighborhoods marked in red. This is where the term “redlining” comes from. One of the factors that determines this grading is the racial composition of the community, with Black neighborhoods more likely to be redlined. This made it difficult for people living in or near black neighborhoods to obtain mortgages, while also preventing black families from purchasing homes in emerging suburbs. The Fair Housing Act, passed in the 1960s, eventually outlawed housing discrimination, but by then many black families had been forced out of their suburban homes by soaring housing prices.
Today’s housing patterns continue to reflect these past discriminatory policies, and Black people face even more situations. health risks. Continued residential segregation and disinvestment in areas where Black people are more likely to live results in Black people having more limited educational and employment opportunities, less access to healthy food, and less access to green space. They are more likely to live in areas with less access. , transportation options are more limited, making it more difficult to access health insurance, care, and pursue healthy activities. Additionally, many of these regions pose increased environmental and climate-related health risks, such as increased exposure to extreme heat, lead, pollution, and toxic or hazardous substances.
In the future, given their higher prevalence of many health conditions, Black people may disproportionately benefit from new medical advances but face increased barriers to accessing them. doing. One factor contributing to this disparity is underrepresentation in clinical trials. This underrepresentation reflects structural access barriers such as limited access to trial sites, reduced access to transportation and technology, and limited eligibility for trial participation if uninsured or with underlying medical conditions. Masu. Additionally, doctors are less likely to discuss clinical trials with patients of color, and patients of color may be concerned or reluctant to participate due to historical mistreatment and mistreatment of Black people by the health care system. It is also possible that there is little knowledge of Black people also face disparities in access to new drugs and treatments when they come to market. New drugs often come with high out-of-pocket costs, and fundamental inequalities in coverage and income can further increase economic barriers for Black people. Access can also be inhibited by bias in the clinical decision-making process and limited access to providers.
as clinical algorithm As artificial intelligence is increasingly used to guide clinical care and treatment decisions in healthcare, it will be important to assess how they impact disparities. Algorithms can introduce bias in treatment. For example, some have historically included race as a contributing factor to treatment disparities. One of the most well-known examples of this practice is the use of different scales to test kidney function in black patients. This practice is beginning to be phased out in many educational institutions. Algorithms can also lead to biased treatments if they are built on biased data or underlying data that is not representative of a diverse population. However, carefully designed algorithms have the potential to reduce bias in treatment and care.
