Structural Racism in US Healthcare: Disparities and Solutions

Abstract

“Since the Jim Crow era (1875–1968), racism has become an integral part of the United States government structure and financing of the health care system. Federal programs, such as the Medical Assistance for the Aged program (also known as Kerr-Mills), that are committed to serving the poor are underfunded, especially in states that have a large black population (Yearby et al., 2022).” “As of November 2021, American Indian and Alaska Native, Black, and Latino people all had suffered from higher rates of hospitalizations and deaths related to COVID-19 compared with White people.” Yearby, R., Clark, B., & Figueroa, J. F. (2022). Structural racism in historical and modern US health care policy. Health Affairs, 41(2), 187–194. https://doi.org/10.1377/hlthaff.2021.01466 “For several decades, research has shown that while blacks (or African Americans) often have higher rates of psychological distress than whites, some studies also find that whites have elevated levels of depressive and anxiety symptoms compared to blacks” (Williams, 2018). “A recent study of Latino adolescents found that both individual online discrimination (derogatory text, images, and symbols directly targeted at individuals because of their race and ethnicity) and vicarious online discrimination (derogatory incidents targeted to people of one’s own racial or ethnic group) were adversely related to adolescent mental health.” “A recent nationally representative, quasi-experimental study found that police killings of unarmed black Americans worsened mental health among blacks in the general population but had no effect on whites.” Williams, D. R. (2018). Stress and the mental health of populations of color: Advancing our understanding of race-related stressors. Journal of Health and Social Behavior, 59(4), 466–485. https://doi.org/10.1177/[phone]814251 “Preterm birth and other poor birth outcomes disproportionately affect women of color. Black women, in particular, have a two-fold higher risk of preterm birth as compared to White women. The use of stereotypes by health care providers and patient perceptions of these stereotypes affect the experience of care quality for those in marginalized groups” (Altman et al., 2019). “Socially-driven issues such as disrespect, abuse, and discrimination within the health care system play a significant role in how women of color access and experience care during pregnancy, birth, and postpartum, which contributes to adverse outcomes for mother and baby.” Altman, M. R., Oseguera, T., McLemore, M. R., Kantrowitz-Gordon, I., Franck, L. S., & Lyndon, A. (2019). Information and power: Women of color’s experiences interacting with health care providers in pregnancy and birth. Social Science & Medicine, 238, 112491. https://doi.org/10.1016/j.socscimed.2019.112491 “Black Americans have a higher overall incidence of cancer and a higher rate of death from cancer than any other racial or ethnic group. The findings of Morrison et al. lead us to believe that in addition to these burdens, blacks are also inadequately treated for pain from cancer.” Cancer facts and figures, 1999. New York:American Cancer Society, 1999:24-5. https://www.proquest.com/docview/70977517?accountid=39901&forcedol=true&pq-origsite=primo “Beyond nursing home care, members of racial and ethnic minority groups are more likely to reside in areas that suffer from physician shortages, including shortages of primary care doctors, surgeons, and mental health providers, which is also a product of structural racism.” “Numerous lawsuits have challenged low rates as violations of federal Medicaid requirements. In 2017 Medicaid beneficiaries and providers in California also challenged rates on anti-discrimination grounds, alleging that the low Medicaid rates were...