More States Are Formally Recognizing Racism in Health Care

The existence of racial disparities in health care treatment has been widely recognized for decades. The COVID-19 pandemic, however, has reinforced how deadly this unequal medical treatment can be. According to the Centers for Disease Control and Prevention, non-Hispanic Blacks experienced a slightly higher rate of infection of COVID-19 (1.1 times more) than whites, but were hospitalized 2.8 times more and had fatality rates of 1.9 times higher than those of whites.

A major component of treatment disparities lies in the implicit racial bias of many health care professionals. According to a 2016 study by the National Academy of Sciences, “a substantial number of white laypeople and medical students and residents hold false beliefs about biological differences between Blacks and whites,” which negatively impact pain management and treatment recommendations administered by health care practitioners.

In that study of non-medically trained white individuals, 73% of participants agreed with at least one inaccurate statement of several presented regarding perceived biological differences between Blacks and whites. Respondents were asked for their perceptions (if any) on differences in bone density, brain size, fertility, pain tolerance due to thicker skin, fewer or less sensitive nerve endings, and other misperceptions. Alarmingly, when the same questions were posed to 220 medical students and medical residents, 50% of respondents believed at least one of the false items was “possibly, probably, or definitely true.” Given that the second group of respondents are medically trained, the study’s researchers determined that racial bias and misperceptions were “surprisingly high.”

The devastating impact of this type of implicit bias is that Black patients frequently receive lower standards of treatment from the health care community, leading to extensive instances of health disparities. Take the differences in breast cancer mortality, for example. Although there is a similar prevalence of breast cancer among Black women and white women (Black women actually have a slightly lower prevalence of breast cancer), the American Cancer Society reports that the breast cancer mortality rate for Black women is 40% higher than it is for white women.

Another example: infant mortality. According to the CDC, non-Hispanic whites experience 4.6 infant deaths per 1,000 live births, whereas non-Hispanic Blacks experience 10.8 infant deaths per 1,000 live births, more than twice that of their white counterparts.

Again, this has been a long-standing reality, but in response to the COVID-19 pandemic, lawmakers in several states are seeking to advance legislation that recognizes the existence of racial bias in health care and determine ways to address this long-standing inequality.

In February 2021 the New York Senate advanced legislation to reduce racial disparities within health care. The legislation included initiatives to pursue cultural education training for medical professionals and to establish programs for recognizing health care disparities. Bill S1352, Cultural Education for Medical Professionals, will require health care professionals to complete continuing medical education courses for cultural awareness and competence training. The bill’s sponsor, Senator José Serrano, said in a press release that “even before the COVID-19 crisis highlighted the deep inequalities in our society, there was ample evidence that minority groups face glaring disparities in access to quality healthcare.”

On May 18, 2021, the Connecticut state Senate passed a bill declaring racism a public health crisis. The bill, among other measures, calls for better racial and ethnic data collection in health care, and requires that hospitals conduct implicit bias training with employees providing direct care to pregnant or postpartum women.

“This past year illuminated the inequities within our health systems, and I intentionally use the word ‘illuminate’ because they’ve always been there. But perhaps they existed because they were acceptable practices,” Connecticut Senator Marilyn Moore said. “When we address these inequities, we make the systems better for all. … People say you can’t undo racism, but you can create legislation that takes us in the right direction.”

California Senator and chair of the Asian Pacific Islander Legislative Caucus, Richard Pan, is sponsoring Senate Bill 17, encouraging California to recognize racism as a public health crisis, as well as establish an Office of Racial Equity and a Racial Equity Advisory and Accountability Council to ensure accountability on racial inequities in California. The office would aggregate and analyze outcome data to identify racial and ethnic disparities, and the council would then make recommendations for legislation to address structural racism in state policies.

The legislation passed by various states have been encouraging first steps after a history of overlooking disparities in access to health care and equitable treatment. However, there is more work to be done. While it is vital to combat racial bias from within the health care community, it is also vital to increase visibility of inequitable treatment of patients to attempt to reduce personal manifestations of bias. Physicians may not be aware of their own personal biases or how they individually contribute to disparities, as implicit bias most often has subtle, nonverbal manifestations. And even should physicians recognize their personal biases, efforts to reduce individual bias may have only limited success.

Rather, it is critical to approach racial disparities within health care by identifying and addressing inequities broadly within health care systems. A study published by the National Institute of Health recommended that within medical systems, information should be aggregated to make racial disparities apparent within medical establishments. Although subtle bias is difficult to discern within individual cases, the extensive data collected regarding patients, treatments, and outcomes can be organized and analyzed by patients’ race and other variables related to racial disparities. This practice would allow institutions to better recognize racial bias as a pressing administrative concern within their organizations to ensure accountability and hopefully lead to systemic change within the organization.