How Systemic Racism Impacts Health Care — And What You Can Do

People of color face a disproportionate level of health risk compared to white people in the US. And when it comes to Black maternal health, in particular, there are serious concerns. Think: the fact that Black women are three times more likely to die from a pregnancy-related cause than white women. 

That’s a reason why the Biden-Harris admin has called April 11-17 Black Maternal Health Week. And why Vice President Kamala Harris has met with government leaders and journalists (including theSkimm) to present proposed changes to health care policy that would help US parents and infants. Read: extending postpartum Medicaid coverage, giving “birthing-friendly” designations to hospitals that incorporate best practices (that she plans to roll out next year), and implementing implicit bias training to providers. That last one is aimed at improving Black women’s experiences with their doctors.

“The reality is that when that Black woman walks into a clinic or a hospital or an emergency room, she is just not taken as seriously,” Harris said. And studies have backed up that claim. 

Why can Black patients — women in particular — face so many health care challenges? 

Because systemic racism. This answer can be applied to so many inequities people of color face—education, housing, incarceration, and more—so it shouldn’t come as a shock that health care is also biased.

How did this happen? 

The US health care system was segregated well into the 20th century — as in, many hospitals and clinics were completely separated by race, or required Black people to use different wings of medical facilities with subpar care. Also, people of color’s understandable mistrust in the medical system dates back decades. See: the Tuskegee study and Henrietta Lacks. Fast forward to today, and while segregation isn't as explicit, there is still implicit bias that permeates the health care industry. A study found that on average, white Americans spent 80 minutes waiting for or receiving care, while Black Americans spent 99 minutes and Hispanics 105 minutes waiting for that same care. In 2017, 75.4% of white Americans had private health insurance, compared to 55.5% of Black Americans. Lower quality of care combined with a higher rate of health issues creates a system that fails many people of color. 

Let’s talk specifics. 

Racial disparities affect many health issues — not just pregnancy and childbirth. So we’ve broken down some of the numbers and reasons why there’s such a gap.

Childbirth:

• Black, Native American, and Alaska Native women are about three times more likely to die from pregnancy-related causes than white women. 

• Part of the reason why: People of color are less likely to have access to quality prenatal care. And they’re more susceptible to conditions like obesity and heart disease, which can complicate pregnancy and childbirth. 

• But some encouraging news on this front: VP Harris has announced that Michigan is the first state to extend Medicaid coverage to one full year after birth (as opposed to just two months). Other ways Harris hopes to help maternal health outcomes: by recognizing the important services that midwives and doulas can provide. And implementing on-the-ground training that can work to limit problems with implicit bias (like the misconception that Black patients have a different pain tolerance than white patients).

Chronic disease:

• Minorities are up to twice as likely to have most major chronic diseases (think: asthma, diabetes, hypertension, obesity, and more).

• Part of the reason why: Because it's harder for people of color to get the recommended seven to nine hours of sleep. That’s due to things like economic stress and living in neighborhoods with more noise and violence. And the issues start long before hitting the sheets. Studies have shown that perceived discrimination—everything from workplace to housing—can impact mental and physical health, and cause chronic disease at higher rates.

Cancer:

• The cancer mortality rate is 25% higher for Black Americans than white Americans. And Hispanics are more likely than white Americans to be diagnosed with cancer at an advanced (and more life-threatening) stage. In one study, Black children were between 38% and 95% more likely to die of cancer, and Hispanic children were between 31% and 65% more likely to die.

• Part of the reason why: In many cases, socioeconomic status. Studies have shown that this can play out in a lot of different ways: more frequent exposure to cancer-causing carcinogens, inability to afford transportation and take off work for screenings or treatments, and less access to insurance, to name a few.

Infertility:

• In a review, 12% of Black women, 10% of Asian women, and 9% of Hispanic women experienced infertility, compared to only 7% of white women. Though people of color experience infertility more, they receive less treatment—11% of Black women and 12% of Hispanic women receive treatment, compared to 16% of white women. 

• Part of the reason why: Cost. Infertility treatments are often pricey. IVF, for example, costs an average of $20,000—and people of color are less likely to be insured and able to afford treatments. That’s in part because of wage disparities between white people and people of color in the US. In 2016 — the most recent year

  data is available — you’d have to combine the net worth of 11.5 Black US households to get to the net worth of one average US white household. A lack of communication and stigmatization around the issue of infertility also plays a role. For instance, Black women wait twice as long on average as white women before getting help with infertility.

COVID-19:

• Black and Latino Americans are three times as likely to get COVID-19 and twice as likely to die from the virus. 

• Part of the reason why: Most of the serious and life-threatening COVID-19 cases involve underlying conditions, like chronic diseases, which are more common in people of color. People of color are also more likely to hold at-risk jobs—about 43% of Black and Latino workers have service jobs that cannot be done remotely, while only about 25% of white American workers hold these kinds of jobs (and are more likely to be able to stay socially distant while making a living). In addition, housing disparities play a part: people of color are more likely to live in crowded urban communities that make physical distancing harder. 

Mental health: 

• Only one in three Black Americans who need mental health treatment actually receive it. And Native Americans and Alaskan Natives report higher rates of post-traumatic stress disorder and alcohol dependence than any other racial group. 

• Part of the reason why: Health insurance doesn’t always cover therapy and people of color are less likely to have insurance that covers it and less likely to be able to pay out-of-pocket. In terms of substance abuse, Native Americans and Alaskan Natives have high rates in part due to their history of trauma in this country—such as being forced off their land and separated from their families. The toll that takes on mental health can trickle down and span generations. 

As we wait for progress in health care and policy, how can someone advocate for their health?

“Know your power. Own that power,” Harris told theSkimm.

She said that when a health care provider doesn’t take you seriously “it is not you, it is them that has to listen and respect and understand. And [you] certainly must not silently suffer, because there is a whole system that has been designed to help [you]. And so let’s hold the system accountable to do it.”

Harris added: “I am convinced that bringing this issue to this level — using the bully pulpit that, frankly, I'm fully aware that we have — we'll have generational impacts. We want to ensure that women are heard.”

theSkimm

The past few years have shown, with painful clarity, that systemic racism is alive and well in the US — everywhere from the boardroom to the waiting room. Health care is just one issue that can stand to gain from the nation’s racial reckoning. But fixing a centuries-old system that fails many people of color starts with policy.

Updated on April 14 to include VP Kamala Harris' policy proposals and quotes.