The Uneven Playing Field in Healthcare
Racism is often at the root of healthcare inequity. Bringing awareness to this problem is the first step in knowing how to fight it.
Only in the last few years have I learned how different the healthcare experience of Black and brown patients is compared to white patients. Growing up white, I used to assume that any healthcare differences were due to things like income and education, not to racism. After all, my white family didn’t think of ourselves as superior; we figured that people of any background who worked hard, like our immigrant ancestors had, could improve their lives. There’s a level playing field, and people are generally decent to one another…right?
Well, many healthcare workers are decent to people. But we’ve all had times when we couldn’t get an appointment, had to wrestle with the insurance company, spent too long in the waiting room, or had a doctor brush aside our concerns. I started hearing stories of these things happening rather more often to people of color. And these stories were from patients with similar socioeconomic status to mine—I realized this was about more than income and education. It turns out these are well-documented trends.
- Emergency room waiting times for Black patients are 30% longer than for white patients (average 69 minutes vs. 53 minutes).
- Black children with appendicitis are half as likely to receive adequate pain medication as white children.
- While a quarter of white mothers change insurance coverage during the course of their pregnancy and postpartum care, nearly half of all Black, Hispanic, and Indigenous women have discontinuous insurance coverage.
- Black women are more likely to die in childbirth than white women, partly due to economic inequities.
I was shocked to learn some of these—are emergency room waiting times really that much different?! It turns out skin color does affect how patients are treated. I recently heard a lecture by Robert Chao Romero, author of Brown Church, who defined prejudice as interpersonal and cultural attitudes; prejudice says “my culture is better than yours, yours is inferior.” Although my family didn’t talk about others as inferior, we spent virtually no time outside of white circles and had no language to counter prejudiced thinking.
While prejudice happens on an individual level, there is more going on. Romero defines racism in terms of systems; racism says, “I will create laws and structures to privilege my people, and because you are inferior, you won’t have the same privileges.” Prejudiced people have set up the systems in our society for income and education, as well as access to clean water, nearby hospitals, and insurance coverage. I have benefited all my life from slanted systems: my immigrant ancestors farmed land taken from the Sioux tribes, my parents easily got a mortgage to move us to a suburb with great schools, and now I’m discovering I get automatic respect in the doctor’s office because of the color of my skin. Romero said “because of sinful nature, sin is ordinary, so racism is ordinary.” Conquering racism will require more than overcoming our personal prejudice—it will require changing longstanding systems to make the playing field level.
As Christians, we know racism is wrong and that healthcare shouldn’t depend on race. Scripture teaches that all people are created in God’s image (Genesis 1:27). Every human life is sacred in God’s eyes, whether healthy or sick, unborn or aged, Black or white (Psalm 139). Christ calls us to be one (John 17:20-23), and in him we have one faith, one baptism, and one God and Father (Galatians 4:3-6). Yet the biblical story doesn’t seek to eliminate cultural differences. Rather, from the blessing of Abraham (Genesis 22:18) to the gathering of the great multitude in heaven (Revelation 22:9), scripture speaks of God blessing many nations, tribes, languages, and ethnic groups (see our podcast interview with theologian Esau McCaulley). Our current system is far from what God desires for us.
I am motivated by the Micah 6:8 call to “Do justice,” and by the Matthew 25:31-36 call to care for the sick and the hurting as if they were Jesus himself.
The COVID-19 pandemic has been a wakeup call regarding racial disparities in healthcare. The virus itself is colorblind, but the healthcare system is not. People of color have less access to quality healthcare, which leads to more COVID deaths. The healthcare and government systems have not treated them fairly, leading to more hesitancy on vaccines. KFF reported as of mid-March that Black residents of the District of Columbia had received only 36% of vaccinations, while they make up 46% of the total population, 49% of cases, and 69% of deaths.
Last June I listened to a sermon by Bishop Claude Alexander. Bishop Alexander was preaching after the killing of George Floyd and addressed several examples of prejudice and racism, including healthcare. Although I have been shocked by many of these examples, Black communities are not surprised. Bishop Alexander preached from Jeremiah 8:20-22 in The Message:
“The crops are in, the summer is over,
but for us nothing’s changed.
We’re still waiting to be rescued.
For my dear broken people, I’m heartbroken.
I weep, seized by grief.
Are there no healing ointments in Gilead?
Isn’t there a doctor in the house?
So why can’t something be done
to heal and save my dear, dear people?”
Alexander repeated, “For us nothing’s changed, we’re still waiting.” This cry of lament is so apt for those experiencing repeated injustice. He pointed to the hope in the word “still”—that God’s people even in their sorrow do not turn away from the Lord, but keep waiting on him.
My takeaway from the sermon was different. The cry of lament is coming from people suffering under the very systems that have repeatedly benefited me. Thus, I need to do what I can to change things. I could be motivated by the U.S. Declaration of Independence (which promises life and liberty to all), or I could be motivated by critical race theory (which has some useful insights when framed from a Christian perspective, as discussed here). But I’m actually motivated by God’s command to care for those who are suffering. I am motivated by the Micah 6:8 call to “Do justice,” and by the Matthew 25:31-36 call to care for the sick and the hurting as if they were Jesus himself.
What Can Be Done?
A recent article in the New England Journal of Medicine highlighted some known ways to reduce healthcare disparities (you can hear more from one of the authors, physician Fatima Cody Stanford, on our podcast). One key factor is having patients cared for by a doctor of the same race. One of the most sad examples in the article is the death of infants:
“Infant mortality is halved when Black newborns are cared for by Black rather than White physicians. Physician–patient racial concordance makes the difference between life and death for these infants.”
Another is bringing healthcare through community groups:
“64% of Black men brought their blood pressure to normal levels after a barbershop-based health intervention, as compared with only 12% of the control group. As safe, trusted fixtures within their communities, barbershops represent forums of culture and camaraderie for Black men, where they can be heard by someone who can relate to their experiences.”
That’s something we all want—to be heard by a doctor who can relate to our experiences. It turns out to be critical to our health.
Thus, a major need today is for more physicians of color, to give more patients access to doctors who can relate to them, and to change the system from the inside out. All of us can work to level the playing field in science education, helping children of color fall in love with science, showing young people of color role models of doctors and scientists, and supporting those who pursue careers in science and medicine.
Another need is for people to hear accurate information from voices they trust. In the storm of misinformation on COVID and vaccines, it is hard for all of us to discern the truth, and all the harder for people of color who have been lied to by authorities in the not so recent past. All of us can amplify the voices of the many Black doctors and scientists who are speaking out on vaccination, such as immunologist Kizzmekia Corbett who helped develop the Moderna vaccine.
Our society is far from God’s ideal of compassion and healing for people of all races and ethnicities. But we can follow Jesus’ call to treat the sick as we would treat him. How? Jemar Tisby gives a simple outline in his new book How to Fight Racism: A.R.C. A for Awareness—learn the racism playbook so you can counteract it. R for relationships—build real friendships across race, the foundation for reconciliation. And C for Commitment—don’t stop with A and R, but commit to making real change to systems. Let’s learn about the disparities in our current healthcare systems and do our part to change them. May God guide us.
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