Anti-black racism and disparities in health care
P.E.I. is on the cusp of opening its new medical school to address the shortage of doctors and to alleviate the issue of limited seats reserved for P.E.I. medical students in outof-province facilities. In order to serve P.E.I.’S growing Black and racialized populations, anti-racism training and programs like the newly launched Black Health Primer, which was launched on March 21, 2024, the International Day for the Elimination of Racial Discrimination should be a core component of doctors' training to alleviate disparities in treatment and outcomes.
MORTALITY RATES
Pervasive systemic inequities and racism, which manifest in anti-black stereotypes and biases, lead to negative health outcomes for members of the Black population accessing health care.
Data collected during the COVID-19 pandemic and statistics pointing to the higher global maternal mortality rates for Black mothers highlight this sobering reality. Research into racism in medicine has uncovered myths and false beliefs about biological differences, such as Black people having thicker skin and the misconception that Black patients have higher pain tolerance. Leading to inadequate treatment and the underprescription of pain medication, as evidenced by Hoffman et al.’s 2016 study.
Myths concerning higher pain tolerance and remiss pain management have an enduring history rooted in beliefs dating back to slavery and the dehumanization of a race. Beliefs which are perpetuated in society and the media today, such as the resurgence in the use of the N-word on social media platforms like Tiktok. Is it any surprise, then, that Black populations have a deep-seated mistrust of medical professionals and health care stemming from a history of violence, experimentation and deceit?
EARLY EXPERIMENTS
The legacy of systemic antiblack racism is embedded in a medical model whose foundations are grounded in the exploitation of Black men and women. Early medical practitioners like Marion Sims, lauded as the Father of Gynecology, perfected his craft through experiments on enslaved women like Betsy, Anarcha and Lucy, whom he leased from their enslavers for a period of five years. Over this time, these women were subjected to horrific surgeries without the benefit of anaesthesia, in part because it was commonly believed that Black women did not experience pain the same way white women did.
Other examples of exploitation include Henrietta Lacks, whose cells (Hela) were taken without her consent, which led to many scientific breakthroughs and was used to develop the COVID-19 vaccine. Additionally, the unethical Tuskegee Study, which ran for 40 years, gathered data on the progression of untreated syphilis in Black men.
Black children, who are one of society's most vulnerable populations, are also subjected to these same biases. Sabin and Greenwald’s 2012 study used the implicit association test to investigate the attitudes and beliefs that doctors held about Black pediatric patients.
The results demonstrated a link between physician bias and narcotics prescription to treat post-surgical pain. Doctors with pro-white implicit bias were found to be significantly more likely to prescribe pain medication to white patients, providing further evidence of how bias can lead to the abhorrent medical neglect of Black children.
DELAYED TREATMENT
Beyond the underprescription of pain relief, there are further far-reaching impacts of racial bias in health care.
Black patients with advanced kidney disease are being denied treatment and kidney transplants based on a highly contested "race correction factor" that is applied to extimared glomerular filtration rate (egfr) calculations when estimating kidney function in Black patients. This race correction factor has been applied for decades and is based on the belief that Black people have naturally higher levels of creatinine in their blood due to their higher muscle mass. However, this belief has yet to be supported by reputable research.
Subsequently, this results in Black people being referred for care too late despite being affected with disproportionately higher levels of kidney disease that advances more quickly. A health equity lens would ensure health practitioners are not only aware of these differences but would expedite referral and treatment accordingly.
The current lack of understanding about racial bias and education for medical staff is failing Black and racialized patients.
Neglecting to provide medical students with information, awareness, and the skills to advocate against racism and offer equitable care to patients undermines the social determinants of health for vulnerable populations, allowing them to, once again, fall through the cracks. Providing training to students leads to better patient satisfaction and outcomes and a change in opinion regarding race-based medical practice.
ELIMINATING BIAS
To ameliorate this harm, researchers have been testing the effectiveness of programs to decrease racial bias in medical practice. Lynn et al.’s recent study found that a student-led program successfully increased the participants’ knowledge of racism and bolstered their confidence to stand up to racial discrimination.
This and other programs are leading the way to establishing a more equitable health system. The newly launched Black Health Primer is designed to fill gaps in education and training, offering a series of eight modules on Black health to create responsive health care and improve the health of Black people and communities across Canada. By engaging medical practitioners in this or similar educational opportunities, health-care providers can ensure optimal care that benefits all community members through better health, productivity and longevity.
Confronting the brutal legacy of racism and historical injustice that proliferates as systemic inequality today will take an intentional and concerted effort. However, I believe achieving the desired outcome of an equitable and just society is worthy of the investment. P.E.I.’S new medical school is an opportunity for the Island to lead the way.