Racism is the Health Risk. Not Race
Let’s make the distinction between race and structural racism when discussing increased risk for certain diseases.
As an incoming medical student, I did not think my medical education would impact the quality of care I provide for my patients depending on their race. I don’t want to pick and choose who I get to help, and I definitely don’t want my medical school to subconsciously or unintentionally train me to treat one race better than others. The pandemic has revealed how our current medical institutions have actively participated in racist systems that benefit the health of white individuals while disproportionately burdening the lives of Black individuals.
African Americans have a higher prevalence of diabetes, high blood pressure, and chronic kidney disease — all risk factors for COVID-19. Black individuals in Chicago have a higher mortality rate (73 per 100,000) compared with white residents(22 per 100,000). While it evident that there are some genetic factors that may predispose African Americans to certain health conditions, it is important to recognize how systemic factors like discrimination ultimately affect the overall lifestyle and ultimately life of Black Americans. All of these statistics can be explained by racism. Not race.
We are often taught that race is a risk factor for health conditions but it is now clear more than ever that this risk is not biological. It is social.
The higher mortality rates African Americans face due to COVID can be attributed to various factors associated with racism: unequal distribution of testing sites, poor quality of healthcare, poor or lack of health insurance, unemployment or low-quality jobs, and food and housing insecurities. The implicit biases health care workers and medical students hold also have a dramatic effect on patient care. According to a study published in Proceedings of the National Academies of Science, half of the medical trainees surveyed held one or more of such false beliefs:
“Black people’s nerve endings are less sensitive than white people’s.”
“Black people’s skin is thicker than white people’s.”
“Black people’s blood coagulates more quickly than white people’s.”
NONE of these statements are true and have NO scientific backing. Inaccurate beliefs of Black individual's pain experience lead to systematic under treatment compared to white Americans. The fact that these blatantly racist beliefs dating back to slavery are still held, reveals how healthcare workers are by no means immune to stereotypes and biases. Nowadays, it is not the intention of medical institutions to perpetuate these beliefs, but it is important to recognize how they do, so we can fix it.
Black Skin Matters
If you flip through a medical textbook or resource, you’ll often find images and models of lighter, white skin individuals. A recent study showed a total absence of brown/black skin in publications related to COVID-19 Skin Manifestations. The “COVID toes” have all been pink and white. This is a problem considering people of color have been affected more by COVID.
Skin diseases often present differently in skin of color so how are we expected to recognize, diagnose, and treat conditions in people of color when we learn from a homogenous set of samples (similar to the visual representation above). We can see the effect of this lack of training as people of color are more likely to have common dermatological conditions like psoriasis and have worse skin cancer prognoses than white individuals. Sufficient exposure to patients with darker skin complexions during clinical training and education can prevent misdiagnoses of our future patients of color.
Structural racism is a 400-year long virus that has infiltrated all of our policies, practices, and institutions. It has perpetuated barriers to opportunities — higher poverty rates, greater infant deaths, lower high school graduation rates, and higher unemployment.
The COVID-19 pandemic has placed a spotlight on the unfair burden that African Americans face in our healthcare system. However, with this pandemic comes solid structural changes. I am happy to see medical training acknowledging these issues and actively changing their curricula in order to focus on the social and environmental factors that affect health.
Increasing diversity on campus, increasing representation in clinical education, providing diverse examples of clinical presentations are just some ways this is being done.
Race should not and cannot be a risk factor for health. Biological race is not to blame for the increased likelihood of disease, it is rather structural racism. According to the US Department of Health and Human Services, African American adults are 60 percent more likely than non-Hispanic white adults to have been diagnosed with diabetes and 2 times more likely to die from diabetes.
We must start asking why this is, and realize how redlining, undernutrition, housing insecurities, lack of access to quality education and work opportunities, lack of preventative care, police brutality, and exposure to toxic pollutants can contribute to such statistics.
Being Black should not mean an increased risk for lung cancer (African Americans smoke less cigarettes overall). Being Black should not mean an increased risk of COVID. By eliminating these one to one associations that blame race on the likelihood of illness, we can actually focus on the structural and systemic ways Black Americans are burdened.
