For Black folks, health care isn’t just about insurance

By Guest Columnist Aug 13, 2007

Originally posted at Too Sense. dnA writes: An article in the WaPo outlines some pretty disturbing findings about who receives what quality of care, an issue, quite literally, of life or death.

Black babies, according to the federal government’s Centers for Disease Control and Prevention, have higher death rates than white babies. Black women are more than twice as likely as white women to die of cervical cancer. And in 2000, the death rate from heart disease was 29 percent higher among African Americans than among white adults, and the death rate from stroke was 40 percent higher.

The problem isn’t just reflected in opaque statistics, doctors literally treat black people differently than they treat others. While in the past I’ve argued that colorblind medicine is bad medicine because people of different races face different health issues, from blacks and Sickle Cell Anemia to Tay-Sachs disease among Jews. This is not what I had in mind.

No conscious bias was apparently present — there was no connection between the explicit racial views of physicians and disparities in their diagnoses. It was only when researchers studied physicians’ implicit attitudes — by measuring how quickly they made positive or negative mental associations with blacks and whites — that they found a mechanism to explain differences in medical judgment. "Physicians who had higher biases against blacks were less likely to recommend thrombolysis for blacks," said Alexander R. Green, the study’s chief investigator and a faculty member at the Disparities Solutions Center at Massachusetts General Hospital. […] The patient was described to some physicians as white and to others as black. Physicians were asked to decide whether the pain was the result of coronary artery disease and whether to prescribe clot-busting drugs. Doctors were more likely to think "Mr. Thompson" was having a heart attack when he was black than when he was white. But they did not prescribe treatment to reflect this — physicians who thought a black Mr. Thompson was having a heart attack prescribed thrombolysis less often than when they thought a white Mr. Thompson was having one.

Racism’s power in this day and age is not in the direct expression of racism, but the internalizing of racial stereotypes that guide our actions subconsciously. Such internalized biases occur in people of all races, which is what makes them so dangerous.

Mahzarin Banaji, a co-author and Harvard psychologist who helped develop the Implicit Association Test used in this study, said the racial bias unearthed by the study is at odds with conventional views of bigotry — and perhaps more insidious. Rather than harboring deliberate ill will, she said, the physicians had apparently internalized racial stereotypes, and these attitudes subtly influenced their medical judgment without their even realizing it.

Part of dealing with internalized bigotry is confronting it sincerely. Few people are willing to do that, least of all the politicians and judges who make the decisions about how our country is run. The effects are devastating, from medical care to education to criminal justice.