In the post I wrote a few weeks ago on racial inequity in COVID-19 vaccinations, I alluded to the history of the abuse of people of color by the medical field as a reason that some people of color may feel hesitant about the vaccine.
While I think it was important to talk about medical racism in my post from a few weeks ago, I think it is also important to dedicate a post all by itself to this topic, especially given the amount of attention this term has gotten in the past couple of weeks. Additionally, since it is Black History Month, it seems particularly timely to talk about this term now. As such, while medical racism was not among the terms I had initially planned to cover in my “what is” blog posts, I think it is important to cover this term.
But what is medical racism, and how has it manifested itself over the years?
In short, medical racism is “the systematic and wide-spread racism against people of color within the medical system.”[1] Racism against people of color within the medical system has taken a variety of forms over the past several hundred years in the United States, including, but not limited, to: policies that affect health outcomes disproportionately in communities of color, the disparity in health care coverage by race, biases held by healthcare workers against people of color, the use of the medical field as a means of harming people of color, and disproportionate use of people of color for experimental purposes in medicine.
The form of medical racism that involves policies affecting health outcomes disproportionately in communities of color is wide-ranging. It involves everything from the fact that unsafe water is much more common in communities of color than in white communities[2] to the building of highways through Black communities[3] (highways that would have an impact of pollution on said communities that got these highways[4]). Some of these policies might not always have in mind the intentional harming of health outcomes for people of color (though the building of highways in Black communities was in many cases intentional), but the result of such policies is harming people in communities of color.
Speaking of things that can negatively affect health outcomes for communities of color, one thing that can cause this is the disparity in health care coverage by race. I talked about this issue in my “Obamacare and Race” post a number of weeks ago, as there are particularly high uninsured rates among American Indians, Hispanics, and Blacks in particular. To Former President Obama’s credit, Obamacare has made that disparity somewhat less stark than it used to be, but it’s a disparity that still exists.
Even when people of color have health insurance, though, sometimes the doctors and healthcare workers that insurance covers can have biases against people of color. Sometimes that bias is explicit, but sometimes it can be implicit too, such as implicit preferences for white patients over Black ones,[5] false beliefs about the nature of how Black bodies are,[6] and the fact that many doctors don’t believe their patients of color when they say they are in pain (an issue particularly prominent with Black women).[7] This form of medical racism comes up every now and again, but especially in light of the painful COVID-19 pandemic, it’s a form of medical racism that really needs to be talked about thoroughly.
Sometimes, the medical field is used as a means of harming people of color, whether it be denying medical treatment available to others, or using medical treatment as a means of harming others. Both things happened with the way the American government in the 1830s handled smallpox in Native American populations. Initially, Native Americans were denied the access to smallpox treatments that whites got. However, many Native American populations later got this access when smallpox threatened removal of said populations to other lands.[8] In other words, denial of the smallpox treatments was initially used to harm Native Americans through suffering without medication, and then distribution of them was used to help accelerate the infamous Indian removals of the 1830s. I am sure there are other examples of this form of medical racism, but the example talked about in this paragraph is one that needs to be talked about more, in my humble opinion.
The final form of medical racism that I think is worth talking about is one that involves the disproportionate use of people of color for experimental purposes in medicine. This is when experimental medicines that are, these days, typically tested with a cross-section of people or with other animals get tested disproportionately on people of color. It was this form of medical racism that led to the exploitation of Black slaves in the medical field for the purposes of experimenting.[9] This form of medical racism was also involved in the “Tuskegee Study of Untreated Syphilis in the Negro Male,” a study where researchers told the people involved that they were being treated for “bad blood,” but in reality did not get treatment during what was a highly unethical and ultimately lethal study.[10] Some in the medical field suspect that many people of color are hesitant to participate in medical studies these days because of the legacy of how such experimental studies did so much harm to many people of color.[11]
The form of medical racism that seems to be talked about the most these days is the disproportionate use of people of color for experimental purposes in medicine. However, the reality is that medical racism can take so many other forms, as well—forms that ultimately can contribute to negative health outcomes.
[1] https://www.ywcaworks.org/blogs/firesteel/tue-07212020-0947/what-medical-racism
[2] https://www.nrdc.org/stories/unsafe-water-more-common-communities-color
[3] https://www.theguardian.com/cities/2018/feb/21/roads-nowhere-infrastructure-american-inequality
[4] https://www.lung.org/clean-air/outdoors/who-is-at-risk/highways
[5] https://www.businessinsider.com/biases-you-didnt-know-existed-in-the-medical-industry-2020-4#black-people-are-24-times-more-likely-to-die-from-the-coronavirus-4
[6] A study in 2016 found that half of white medical trainees held false race-based beliefs such as Blacks having thicker skin than whites: https://www.pnas.org/content/113/16/4296
[7] https://www.today.com/health/implicit-bias-medicine-how-it-hurts-black-women-t187866
[8] https://ais.arizona.edu/thesis/politics-disease-indian-vaccination-act-1832
[9] https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)32032-8/fulltext
[10] You can read about the long version of this story on the website of the Centers for Disease Control and Prevention: https://www.cdc.gov/tuskegee/timeline.htm
[11] https://www.npr.org/sections/health-shots/2017/10/25/556673640/scientists-work-to-overcome-legacy-of-tuskegee-study-henrietta-lacks
Blind Injustice 
Yes people of color do not fare as well in a lot of health markers as you have written about. Doing a fine job of it.
Two things came to mind.
1. The act you referred to a “Obamacare” was a conservative slur. It’s real title is: The Affordable Care Act. Yes Obama signed it in to law and lobbied for it. But, without congressional approval laws don’t go anywhere. (This last statement may not be as true as it should be. The executive order has become a common tool for a president. Trump used it extensively, which has led President Biden to us it as well, plus some for his own agenda.) Then, the courts have their say, and if the Supreme Court says it’s not constitutional it can have the effect of law, or just annul or change it as it did with The Affordable Care Act, and might do again with a pending case which seeks to make a part of it unconstitutional with the possibility of annulling it in total.
2. A lot of what you say can be said about the trans* population, and as always worse for transgender women of color.
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Yes, people of color do not fare as well in a lot of health markers. And medical racism probably has a fair bit to do with it.
With regards to Obamacare, I’m aware that the real name is the Affordable Care Act. I think it started as a conservative slur, but at this point it’s a term used by both conservatives and liberals. I even discovered this speech from September 2013 when Obama himself used the term “Obamacare” a dozen times (and used it interchangeably with the term “Affordable Care Act”). It could be compromised by the Supreme Court though, as you said. The Supreme Court could very well render my point about the legislation (as well as my post on Obamacare/ACA) moot.
And you’re correct about the fact that many of these issues affect the trans population, and particularly transgender women of color. With transgender women of color in particular, there are intersecting forms of medical discrimination (medical sexism and medical transphobia play a role as well as medical racism).
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Thank you, Brendan. When I was growing up, I heard about the Tuskegee experiment from relatives, but I had to go look it up and prove that it really happened, when telling some white friends about it, years later, because they just did not want to believe me. These things happen, and then get buried. I think that is one of the many reasons that it is important to bear witness to the fact that this discrimination, and racism, especially systemic racism, is real, and still alive and well in the US.
Peace
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These things do get buried. I was not even aware of the Tuskegee experiment until a few weeks ago. Things like the Tuskegee experiment show just how much systemic racism there’s been (and how much of it is buried).
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Yup.
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I hadn’t heard of the term medical racism, although I’m familiar with institutional racism in healthcare. I wonder if the term medical racism is broad enough to capture a phenomenon that is far more pervasive than just the medical profession.
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In certain ways, I think the term medical racism (or at least certain aspects of medical racism) could go in the institutional racism umbrella. But that’s a good question. All that being said, medical racism is a term being brought a lot more in the United States, so I think it’s good to know what that means, even if certain aspects of medical racism fall under the institutional racism umbrella.
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This is sad. I don’t have much to add other than I want things to be different, and the mere fact that they’re not, is so very terrible.
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First of all, I must apologize for the fact that your comment landed in spam. I also see you have at least one other previous comment that landed in spam.
But yeah, I too want things to be different in this arena. However, it’s going to take some work to get it to be different, and take some building of broken trust.
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Agreed. The system was never designed for non-white people and that must’ve change.
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I remember watching something just a few months ago, where black women who present with heart attack symptoms, are more likely to be turned away than any other group. Wish I could remember where I watched that.
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That honestly wouldn’t surprise me. With Black women you get, I think, intersecting prejudices (ones related to being Black and being a woman), prejudices that combined could conceivably result in the statistic you heard.
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There was a story in the news recently about a black female doctor who died from COVID-19 because she wasn’t taken seriously.
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That is the ultimate head-shaker for me–dying because she was a doctor who wasn’t taken seriously by doctors.
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It needs to stop.
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Absolutely.
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Reblogged this on Project ENGAGE.
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Thanks for sharing!
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Racism has it’s tentacles in every part of the human condition and the medical field is no different. I can understand why people of color are hesitant to get a vaccine or depend on the medical field which has not shown any concern for them. We will all be affected negatively by even a small group of people not trusting the science and people of color are not a small group. Native Americans are also a group, as you pointed out, that has a healthy distrust of the medical field. It is hard to say that the Medical establishment has to fix this, but really there is no one else.
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You’re right that there is that significant mistrust. Mistrust that is definitely understandable. The question, of course, is how can we address that lack of trust.
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I think it is going to take leaders of the particular communities working with both sides of the issue. Any change has to start at the top.
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