Black Americans are disproportionately killed by police officers — a fact that became a focal point following the death of George Floyd and other Black people in recent months.
But they’re also more likely than the rest of the population to die in other ways, such as during childbirth, from diabetes and cancer, or while on the operating table. That's also extended to the coronavirus, where Black Californians are overrepresented in the percentage of COVID-19 deaths.
Experts say these trends are tied to a history of medical abuse against patients of color, unequal access to care and a lack of Black and brown physicians.
Now, as Black Lives Matter demonstrators push for reform in law enforcement, education and other sectors, some medical professionals say it’s time to build a more equitable health system.
A Critical Moment
Earlier this month, a group of doctors published a paper suggesting five ways to dismantle racism in medicine, including establishing single-payer health care, diversifying the workforce and creating medical licensing and accreditation based on their ability to address racism in health care.
“This moment is really critical,” said Dr. Rhea Boyd, director of strategy and equity for California Children’s Trust and one of the paper’s authors. “Before now, it would be more difficult to say the things we had to say … We are trying to highlight the ways that structural racism profoundly shapes health.”
That includes factors such as where hospitals and clinics are located, which neighborhoods have access to parks and healthy foods and who can afford insurance. Most recently, criticism has centered on the lack of COVID-19 testing in communities of color.
Osagie Obasogie, a professor of bioethics at UC Berkeley, said these problems go back decades. He pointed to the Jim Crow era, when segregation forced Black patients to get care at understaffed, under-resourced Black hospitals. He also brought up the involuntary gynecological experiments that were performed on female slaves.
“Medicine has as many institutional problems as the police, in regard to understanding how the institutional dynamic can lead to horrific outcomes,” he said. “Where they often come together is both fields can initiate premature death in the Black community.”
Since the protests began following Floyd's death, doctors have been calling on medical institutions to support Black lives and urging health officials to allow public demonstrations despite the COVID-19 pandemic. But they’ve also been asking deeper, more difficult questions about their own field.
In California, the latest state data show Black people make up more than 9% of COVID-19 deaths, despite making up only 6% of the population. Many doctors say the fact that coronavirus is disproportionately killing Black Californians is a symptom of long standing health inequity.
That’s opened up conversations about other disparities in care. In 2017, African Americans had the shortest life expectancy of all Californians, and they were the most likely to be diagnosed with prostate, colorectal, and lung cancer cases in 2016, according to a 2019 report from the California Health Care Foundation. They also had the highest death rates for breast, colorectal, lung, and prostate cancer in 2016, according to the foundation.
These disparities are perhaps most visible in pregnancy and childbirth, which are disproportionately dangerous for Black mothers and babies. In California, Black infants died at about twice the rate of white babies in 2016.
It’s something that was weighing on Sophia Fox-Sowell, 28, while she was out at the racial justice protests in Sacramento.
“My sister is Black and she refuses to have her baby in a hospital [because of the rates],” she said. “That system of distrust, it needs to change. That’s what makes it systemic racism, and it feels like a trauma that might never heal.”
Research is still emerging on why Black moms and infants fare so much worse, but many experts point to the daily racial hostility that Black mothers face, regardless of economic class. Those experiences can lead to high stress, which can cause early delivery and low birth weight.
Dr. Zea Malawa, a pediatrician who advocates for better outcomes for children of color in San Francisco, says there needs to be more support for Black mothers from start to finish. That goes from ensuring they have access to prenatal care to helping them feel comfortable at the hospital.
“People kind of have approached this issue as trying to help Black women tolerate stress better,” she said. “And I hate that approach because it relies on Black women having to survive a harmful environment, and ignores the very real problematic environment Black women live in.”
There’s also a growing body of academic and journalistic research showing that laboring Black women receive sub-par treatment in the hospital setting compared to white mothers. This can mean more infections, blood clots and other preventable but often-fatal complications.
In California, a bill that took effect this January creates implicit bias training for perinatal inpatient providers, improves the way maternal deaths are documented and requires hospitals to teach maternity patients how to file a complaint when they feel they’ve face discrimination while receiving care.
Also at the top of the list in discussions about racism in medicine: the lack of doctors that look like the patients they serve.
Experts say white doctors caring for Black and brown patients may not understand the patient’s lived experience, and sometimes prescribe lifestyle changes that the patient is unable to make.
If there are cultural or language barriers, the patient may be less likely to trust the physician and adhere to treatment. One 2018 study found Black men in Oakland who saw a Black male doctor were more likely to undergo diabetes and cholesterol screenings than those who saw a white physician.
White doctors may also hold unconscious biases or false beliefs about Black patients. A 2016 survey of white medical students found more than half of participants thought Black people were not as sensitive to pain as other groups. This belief has historically led doctors to provide fewer opioid prescriptions to Black patients with legitimate pain needs.
Dr. Lucy Ogbu-Nwobodo, who received her medical degree from UC Davis in 2018 and is now a resident at Massachusetts General Hospital, said having more Black and brown doctors is a major step toward solving the problem.
Her desire to diversify the workforce and bring attention to racism as a public health crisis led her to become active with “White Coats For Black Lives,” a nationwide medical student organization.
“We know that diversity in any setting elevates and enriches the experience for doctors and patients,” she said. “A homogenous health care system does not lead to better health care.”
California is a majority-minority state, but in 2015 both Black and Latinx doctors were under-represented compared to the population.
Dr. Stephen Lockhart, Chief Medical Officer of Sutter Health, remembers being one of the only Black students while attending medical school at Cornell University in the late 1970s.
“I got involved with really trying to mentor students, particularly African American or Latinx students … to try to enhance and increase those numbers, but the numbers were very small,” he said.
There’s been a statewide push in recent years to reduce barriers that keep some people of color out of the industry, such as medical school tuition and high-cost certifications. Kaiser Permanente offers paid medical office internships for students of color, and UC Davis runs a summer program for college students interested in working with the Latinx community.
Lockhart says California has made progress on this front, but not enough.
“We have a ways to go, and I think this whole idea of equity in education and economics, the digital divide, it’s just so pervasive,” he said. “That’s what we’re really seeing when we talk about George Floyd and the BLM movement that’s becoming prominent … hopefully we’re getting to the point where there’s a little bit of an awakening, or an inability to turn away.”
Ogbu-Nwobodo said change has to start early on, with better funding and less police presence in Black school districts. She said growing up in Oakland, she had fewer resources with which to climb up the ladder of the medical profession.
“We had limited access to textbooks,” she said. “What I’m seeing now as a physician, I’m working next to colleagues who were in science camp when they were 12.”
Humanizing The Field
Black health experts say the medical institution often fails to acknowledge the problem head-on, and instead points to the vague language of “health disparities.”
“That framing itself normalizes this idea that there’s something different about Black bodies and they have worse outcomes than other groups,” said Obasogie, the Berkeley bioethicist. “It mystifies the cause rather than making connections to what we know to be the true cause — this country’s long history of racism.”
In May, a group of Berkeley physicians voiced support for abolishing the clinical practice of classifying patients by race. They argue this allows doctors to blame Black patients’ ailments on biological differences and individual behaviors, rather than socioeconomic factors that they say perpetuate most health issues.
Boyd, who published the recent paper on solutions, said a lot of this comes down to seeing Black patients as more than just numbers.
“We think more should be offered to all of our patient populations than simply equity,” she said. “Than simply saying ‘right now we are going to give you resources based on what your need is’. Actually, if we are a care system, we should be endeavoring to actually love the patients that we care for.”
Ogbu-Nwobodo echoed this sentiment.
“They’re not just a diagnosis, they’re not just symptoms, they’re people who deserve the same level of compassion as everybody else,” she said. “We need to make sure we prioritize all patients. That’s what health care is about, and we are falling short.”
Editor’s Note: Sutter Health is a major donor to CapRadio.