Assignment Question
For centuries, people of color have been exploited by individuals within the medical field. Institutional racism, such as experimentation on slaves and court ordered sterilization, has led to poor health outcomes for people of color that continue to be prevalent in healthcare today. Please take a few minutes to review one or all the items below: (Video): Harriet Washington: Epidemics of Conspiracy https://www.youtube.com/watch?v=KbbWaIEmHnA (Video): History of Racism in Medicine https://www.youtube.com/watch?v=IfYRzxeMdGs (Article): The First Birth Control Pill Used Puerto Rican Women as Guinea Pigs https://www.history.com/news/birth-control-pill-history-puerto-rico-enovid (Listen): The Supreme Court Ruling That Led To 70,000 Forced Sterilizations https://www.npr.org/sections/health-shots/2016/03/07/469478098/the-supreme-court-ruling-that-led-to-70-000-forced-sterilizations (Article): It’s Time to Address the Role of Implicit Bias Within Healthcare https://www.healthaffairs.org/do/10.1377/hblog20200108.34515/full/ (Article): Recognizing and addressing gender bias in patient care https://physicians.dukehealth.org/articles/recognizing-addressing-unintended-gender-bias-patient-care (Article): How Implicit Bias Harms Patients https://www.medicaleconomics.com/view/how-implicit-bias-harms-patient-care In your essay: Discuss how poor people, especially poor people of color, are affected by inequalities in the medical system How does lack of privilege drastically affect people’s lives as a result of inequalities in the medical system? What can be done differently to achieve more equality in care? Do you think that things have gotten better or worse in terms of inequality after the Affordable Care Act was instituted?
Assignment Answer
Inequalities in Healthcare: A Historical Perspective on Race, Poverty, and Privilege
Introduction
Healthcare is a fundamental human right, yet for centuries, people of color have been subjected to systemic exploitation and discrimination within the medical field. The legacy of institutional racism, from experimentation on slaves to court-ordered sterilizations, has left a lasting impact on the health outcomes of people of color. This essay will delve into the ways in which poor people, especially those belonging to racial and ethnic minority groups, are affected by inequalities in the medical system. It will explore the profound consequences of a lack of privilege on individuals’ lives, driven by disparities in healthcare access and quality. Additionally, this essay will discuss strategies for achieving greater equality in healthcare and evaluate whether the Affordable Care Act (ACA) has improved or exacerbated healthcare inequalities.
Historical Injustices: Exploitation of People of Color in Medicine
- Exploitation of Slaves in Medical Experimentation
One of the most reprehensible aspects of the historical exploitation of people of color in medicine is the experimentation on enslaved individuals. From the 18th century onward, medical practitioners subjected enslaved people to cruel and often fatal experiments. Dr. J. Marion Sims, often hailed as the “father of modern gynecology,” conducted numerous surgeries on enslaved Black women without anesthesia, perpetuating the suffering of these individuals in the name of medical progress (Washington, 2020). These experiments not only caused immense physical harm but also served as a foundation for later medical practices, perpetuating disparities in healthcare access and outcomes.
- Court-Ordered Sterilizations
The 20th century witnessed another disturbing chapter in the exploitation of vulnerable populations—court-ordered sterilizations. The Supreme Court’s 1927 decision in Buck v. Bell upheld the legality of forced sterilizations, primarily targeting individuals deemed “unfit” to reproduce. This ruling resulted in approximately 70,000 forced sterilizations, disproportionately affecting people of color and those living in poverty (NPR, 2016). Such practices not only violated individuals’ bodily autonomy but also had long-lasting consequences on their reproductive health.
Inequalities in Modern Healthcare
- Socioeconomic Status and Access to Healthcare
The link between socioeconomic status (SES) and healthcare access is undeniable. Poor people, particularly those of color, often face significant barriers to accessing quality healthcare. Low-income individuals are more likely to lack health insurance, leading to delayed or foregone medical care (Health Affairs, 2020). Limited access to preventive care and early intervention contributes to worse health outcomes, perpetuating a cycle of poverty and ill health.
- Health Disparities in Diagnoses and Treatments
Health disparities are evident in the diagnoses and treatments received by individuals of different racial and ethnic backgrounds. Implicit bias among healthcare providers can lead to differential treatment based on race, with minority patients receiving less aggressive treatment and experiencing longer diagnostic delays (Medical Economics, 2020). These disparities result in poorer health outcomes for people of color, often culminating in higher mortality rates.
- Maternal Mortality Disparities
The racial disparities in maternal mortality rates in the United States are particularly stark. Black women are more than three times as likely to die from pregnancy-related causes as white women, highlighting systemic inequalities in maternal healthcare (CDC, 2020). These disparities persist even after controlling for socioeconomic factors, emphasizing the role of structural racism in maternal health outcomes.
The Intersection of Race and Poverty in Healthcare Inequalities
The intersectionality of race and poverty magnifies the inequalities within the healthcare system. People of color who are also economically disadvantaged face a double burden of discrimination, making them more susceptible to poor health outcomes. Several factors contribute to this intersectional disparity:
- Limited Educational Opportunities
People living in poverty often have limited access to quality education, which can hinder their health literacy and ability to navigate the healthcare system effectively. This lack of education can lead to a higher likelihood of misunderstanding medical advice, mismanaging chronic conditions, and experiencing adverse health outcomes.
- Employment and Income Disparities
Racial and ethnic minorities are more likely to be employed in low-wage jobs without health insurance benefits. As a result, they may delay seeking medical care due to cost concerns or lose income if they take time off work for medical appointments. This delay in care can exacerbate health conditions and lead to poorer outcomes.
- Neighborhood Environment
Residents of low-income neighborhoods often lack access to healthy food options, safe recreational spaces, and quality housing. These environmental factors can contribute to the development of chronic health conditions, such as obesity and asthma, disproportionately affecting communities of color.
- Discrimination and Stress
Experiences of discrimination and the stress associated with poverty can have profound effects on physical and mental health. Chronic stress is linked to a range of health problems, including cardiovascular disease, depression, and anxiety (APA, 2020). Discrimination, both explicit and implicit, further compounds these stressors.
Strategies for Achieving Healthcare Equality
- Culturally Competent Care
To address healthcare disparities, healthcare providers must receive training in cultural competency. This includes understanding the unique cultural, social, and historical factors that influence patients’ health beliefs and behaviors. Culturally competent care can improve communication and trust between providers and patients of diverse backgrounds.
- Implicit Bias Training
Addressing implicit bias within healthcare is crucial for reducing disparities in diagnoses and treatments. Medical professionals should undergo training to recognize and counteract their biases. Implementing standardized guidelines for diagnosis and treatment can also help mitigate disparities based on race or ethnicity.
- Community-Based Interventions
Community-based interventions can help bridge gaps in healthcare access and promote preventive care. These initiatives may include mobile clinics, community health workers, and outreach programs that bring healthcare services directly to underserved communities.
- Health Education and Literacy
Improving health education and literacy, especially in underserved communities, can empower individuals to make informed decisions about their health. Schools, community centers, and healthcare organizations should collaborate to provide accessible health education resources.
- Medicaid Expansion
Expanding Medicaid in states that have not yet done so can extend healthcare coverage to millions of low-income individuals and families. This step would significantly reduce disparities in access to care, particularly among people of color.
The Impact of the Affordable Care Act (ACA)
The Affordable Care Act (ACA), signed into law in 2010, aimed to increase access to healthcare and reduce disparities. While the ACA made significant strides in expanding coverage, its impact on healthcare inequality remains a subject of debate.
- Expanding Medicaid
One of the ACA’s key provisions was the expansion of Medicaid to cover more low-income individuals and families. However, this expansion was made optional for states, and several chose not to participate. As a result, millions of low-income individuals in non-expansion states continue to lack access to affordable healthcare (Kaiser Family Foundation, 2021).
- Coverage Gains
The ACA led to a substantial reduction in the uninsured rate, benefiting many people of color who were previously disproportionately uninsured. This coverage expansion helped individuals access essential healthcare services and preventive care.
- Continued Disparities
Despite the ACA’s achievements, healthcare disparities persist. Racial and ethnic minorities still face barriers to care, including implicit bias and unequal access to high-quality providers. While the ACA addressed some aspects of healthcare inequality, it did not eliminate systemic issues rooted in racial and economic disparities.
Conclusion
Inequalities in the medical system, particularly those affecting poor people of color, have deep historical roots and persist to this day. Exploitation, discrimination, and disparities in healthcare access and quality have contributed to poor health outcomes for marginalized communities. The intersection of race and poverty exacerbates these inequalities, leaving vulnerable individuals with limited options for improving their health.
To achieve greater equality in care, it is essential to address implicit bias, provide culturally competent care, and implement community-based interventions. Additionally, expanding Medicaid in all states would help bridge the coverage gap for low-income individuals and reduce disparities in access to care.
While the Affordable Care Act made significant strides in expanding healthcare coverage, it has not entirely eliminated healthcare inequalities. Progress in achieving healthcare equality requires ongoing efforts to dismantle systemic racism, reduce poverty, and ensure that all individuals have access to high-quality healthcare regardless of their race or socioeconomic status.
References
American Psychological Association (APA). (2020). Stress and health disparities: Contexts, mechanisms, and interventions among racial/ethnic minority and low-socioeconomic status populations.
Centers for Disease Control and Prevention (CDC). (2020). Racial and ethnic disparities continue in pregnancy-related deaths.
Health Affairs. (2020). It’s time to address the role of implicit bias within healthcare.
Kaiser Family Foundation. (2021). Status of Medicaid Expansion and Work Requirement Waivers.
Medical Economics. (2020). How Implicit Bias Harms Patients.
National Public Radio (NPR). (2016). The Supreme Court Ruling That Led To 70,000 Forced Sterilizations.
Washington, H. A. (2020). Epidemics of Conspiracy.
Washington, H. A. (2020). History of Racism in Medicine.
History. (2020). The First Birth Control Pill Used Puerto Rican Women as Guinea Pigs.
Duke Health. (2020). Recognizing and addressing gender bias in patient care.
