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Posted: October 16th, 2023
Racial Discrimination in Healthcare Delivery in the US
Racial discrimination is the unfair or unequal treatment of people based on their race or ethnicity. It can occur in various settings, including education, employment, housing, and criminal justice. However, one of the most critical and pervasive areas where racial discrimination occurs is in healthcare delivery.
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Healthcare delivery refers to the provision of health services to individuals or communities by health professionals or organizations. It includes preventive, curative, rehabilitative, and palliative care. Healthcare delivery is influenced by many factors, such as availability, accessibility, affordability, quality, and equity.
Racial discrimination in healthcare delivery can affect all these factors and have negative consequences for both patients and providers. It can lead to lower life expectancy, higher morbidity and mortality, lower quality of care, lower patient satisfaction, lower provider performance, and higher healthcare costs.
In this blog post, we will explore how racial discrimination manifests in healthcare delivery in the US, what are its causes and consequences, and what can be done to prevent and address it.
How does racial discrimination occur in healthcare delivery?
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Racial discrimination in healthcare delivery can occur at different levels: individual, interpersonal, institutional, and structural.
Individual level: This refers to the beliefs, attitudes, and behaviors of individual patients or providers that are influenced by racial stereotypes or prejudices. For example, a patient may avoid seeking care from a provider of a different race due to mistrust or fear. A provider may consciously or unconsciously treat a patient differently based on their race or ethnicity. This can result in underdiagnosis, undertreatment, overdiagnosis, overtreatment, miscommunication, or disrespect.
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Interpersonal level: This refers to the interactions between patients and providers that are influenced by the social and cultural norms of their respective groups. For example, a patient may face language barriers or cultural differences that hinder their communication or understanding with a provider. A provider may lack cultural competence or sensitivity to address the needs and preferences of a patient from a different background. This can result in poor rapport, low adherence, low satisfaction, or conflict.
Institutional level: This refers to the policies, practices, and procedures of healthcare organizations that create or maintain disparities among racial or ethnic groups. For example, a healthcare organization may have inadequate diversity or representation among its staff or leadership. A healthcare organization may have unequal allocation or distribution of resources or services among different populations. A healthcare organization may have implicit or explicit biases in its hiring, training, evaluation, or promotion processes. This can result in limited access, lower quality, lower efficiency, or lower accountability.
Structural level: This refers to the broader social, economic, and political factors that shape the opportunities and outcomes of different racial or ethnic groups. For example, a racial or ethnic group may face historical oppression or discrimination that affects their socioeconomic status or living conditions. A racial or ethnic group may face environmental hazards or exposures that affect their health status or risks. A racial or ethnic group may face legal barriers or restrictions that affect their rights or entitlements. This can result in systemic inequities, injustices, or disadvantages.
What are the causes and consequences of racial discrimination in healthcare delivery?
Racial discrimination in healthcare delivery is not a new phenomenon. It has deep historical roots and complex contemporary causes. Some of the main causes are:
- Racism: Racism is the ideology that one race is superior to another and that this superiority justifies domination or exploitation. Racism can be explicit or implicit,
overt or covert,
intentional or unintentional.
Racism can be manifested through individual acts of hatred or violence,
interpersonal acts of exclusion or discrimination,
institutional acts of segregation or oppression,
structural acts of exploitation or marginalization.
Racism can affect how people perceive themselves and others,
how they relate to each other,
how they access resources and opportunities,
how they experience health and illness.
- Bias: Bias is the tendency to favor or disfavor a person or group based on preconceived notions or stereotypes. Bias can be conscious or unconscious,
cognitive or affective,
personal or social.
Bias can be influenced by factors such as education,
media,
culture,
religion,
politics.
Bias can affect how people process information and make decisions,
how they communicate and collaborate,
how they evaluate and reward performance,
how they deliver and receive care.
- Power: Power is the ability to influence or control others' actions or outcomes. Power can be formal or informal,
legitimate or illegitimate,
positive or negative.
Power can be derived from factors such as wealth,
status,
authority,
knowledge,
skills.
Power can be exercised through means such as coercion,
persuasion,
manipulation,
collaboration.
Power can affect who has access to what resources and opportunities,
who sets the agenda and makes the rules,
who benefits and who suffers,
who is accountable and who is not.
Racial discrimination in healthcare delivery has serious consequences for both patients and providers. Some of the main consequences are:
- Health disparities: Health disparities are differences in health status or outcomes among different groups of people. Health disparities can be measured by indicators such as life expectancy,
mortality,
morbidity,
quality of life,
health behaviors,
health risks.
Health disparities can be influenced by factors such as genetics,
biology,
behavior,
environment,
social determinants.
Health disparities can result from factors such as lack of access to care,
lack of quality of care,
lack of patient-centered care,
lack of culturally competent care.
- Health inequities: Health inequities are differences in health status or outcomes among different groups of people that are avoidable, unfair, or unjust. Health inequities are a subset of health disparities that are caused by social injustice or discrimination. Health inequities can be measured by indicators such as health gaps,
health gradients,
health ratios,
health proportions.
Health inequities can be influenced by factors such as racism,
bias,
power,
privilege.
Health inequities can result from factors such as unequal distribution of resources or opportunities,
unequal exposure to hazards or risks,
unequal treatment or protection by laws or policies,
unequal participation or representation in decision-making or governance.
- Health injustice: Health injustice is the violation of human rights or dignity in relation to health. Health injustice can occur at individual, interpersonal, institutional, or structural levels. Health injustice can be manifested through acts such as violence,
abuse,
neglect,
exploitation,
coercion.
Health injustice can be experienced through feelings such as pain,
suffering,
fear,
anger,
shame.
Health injustice can be challenged through actions such as resistance,
advocacy,
solidarity,
empowerment.
What can be done to prevent and address racial discrimination in healthcare delivery?
Racial discrimination in healthcare delivery is a complex and multifaceted problem that requires comprehensive and coordinated solutions. Some of the main solutions are:
- Education: Education is the process of acquiring and applying knowledge, skills, and values. Education can be formal or informal, individual or collective, academic or professional. Education can be used to raise awareness, challenge stereotypes, promote diversity, foster empathy, enhance competence, improve performance, increase accountability.
- Research: Research is the process of generating and disseminating evidence, insights, and innovations. Research can be quantitative or qualitative, descriptive or explanatory, basic or applied. Research can be used to identify problems, measure disparities, analyze causes, evaluate interventions, inform policies, inspire actions.
- Policy: Policy is the process of making and implementing decisions, rules, and plans. Policy can be public or private, local or global, formal or informal. Policy can be used to set goals, allocate resources, regulate behaviors, monitor outcomes, enforce compliance, ensure justice.
- Practice: Practice is the process of delivering and receiving health services. Practice can be clinical or non-clinical, individual or organizational, preventive or curative. Practice can be used to provide access, ensure quality, enhance satisfaction, improve health, reduce costs.
- Advocacy: Advocacy is the process of influencing or supporting others' actions or outcomes. Advocacy can be personal or social, direct or indirect, confrontational or collaborative. Advocacy can be used to voice concerns, demand rights, seek remedies, mobilize allies, create change.
- Action: Action is the process of taking steps to achieve a desired result. Action can be individual or collective, planned or spontaneous, proactive or reactive. Action can be used to prevent discrimination, address disparities, eliminate inequities, combat injustice.
Conclusion
Racial discrimination in healthcare delivery is a serious and urgent issue that affects millions of people in the US and around the world. It has negative impacts on health status and outcomes for patients and providers alike. It is caused by multiple factors at different levels of society and requires multiple solutions at different levels of intervention.
We all have a role and responsibility to prevent and address racial discrimination in healthcare delivery. We all have a stake and interest in ensuring that everyone has equal access to quality healthcare that respects their human rights and dignity.
We hope that this blog post has provided you with some useful information and insights on this topic. We invite you to share your thoughts and experiences with us in the comments section below.
Works Cited
- Racism in healthcare: Statistics and examples - Medical News Today
https://www.medicalnewstoday.com/articles/racism-in-healthcare
- The 2022 National Healthcare Quality and Disparities Report: We Still Have Much Work to Do | Agency for Healthcare Research and Quality
https://www.ahrq.gov/news/blog/ahrqviews/2022-national-healthcare-disparities-report.html
- AMA guidelines offer path to prevent discrimination in medicine
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