With recent attempts of the Trump administration to repeal the Affordable Care Act (ACA), millions of Americans are at risk of losing their healthcare and protections for pre-existing conditions. The ACA prohibits insurers from charging people higher rates for having pre-existing health conditions and “excluding coverage for services related to those conditions.” Especially with the strain of COVID-19 on families’ economic stability, these legal inhibitions are a savior for 135 million Americans with pre-existing conditions.
Due to the uncertain prolonged consequences of COVID-19, insurance companies are more likely to charge higher premiums or deny coverage completely for those who have been infected. The elimination of Medicaid would replenish racial and ethnic disparities regarding health coverage and access to care. As the mortality rates from COVID-19 are higher for Black, Latinx, and Indigenous people, these communities would be at higher risk of experiencing inadequate treatment for infection, or potentially developing a more severe case due to underlying conditions.
“It doesn’t matter to me whether you are legal or not, it doesn’t matter to me whether you have insurance or not, you should have the same rights as a white [person] with Blue Cross Blue Shield that comes to the hospital,” Dr. Natalie Mantilla, a colorectal surgeon said. “You should be treated with the same level of respect, you should be given the same quality care, and there should be no difference because of racial [identity] or economic status.”
BIPOC and marginalized communities are already distinct targets of health inequities, which are now being spotlighted by the pandemic. These inequities arise due to implicit biases, structural racism, and cultural barriers.
Implicit bias within healthcare results from the stereotyped associations made by healthcare professionals toward their patients based on characteristics such as race or gender. For example, a study done by the Journal of Clinical Oncology found that oncologists who were rated higher in a test for implicit bias spent less time with their patients and that their patients rated the physician interactions as less patient-centered and supportive. In this way, implicit bias is incredibly dangerous as it affects the degree of care a healthcare professional gives a patient on the basis of that patient’s identity.
In a study done by the emergency department at Emory University, Black patients with isolated long-bone fractures were found to be less likely than white patients to receive analgesics for their symptoms. Another study conducted, examining pain management in patients with metastatic or recurrent cancer, depicted that only 35% of patients from marginalized communities received proper medications, compared to 50% of white patients who received the appropriate prescriptions.
“I actually spoke to a Black woman who had been going to the same white doctor for three years for issues with her back. She complained about her pain [and] illnesses, [but] her doctor completely [dismissed her]. And three years later when she finally switched doctors she realized she had a [major] issue with her lower lumbar system,” Dante Morehead, an M.P.H, said.
Morehead is a community health educator at the Fred Hutch Office of Community Outreach and Engagement. He focuses on engaging African American and African descent populations in cancer prevention, health education, and population health research.
According to a study done by the Proceedings of the National Academies of Science, in 2016 half of 222 white medical students and residents at the University of Virginia believed that Black people had thicker skin or had less sensitive nerve endings than white people. Thus, these medical trainees reported less pain ratings for a Black patient compared to a white patient.
These beliefs have been apparent in medical professionals since the beginning of modern U.S. medicine. In the 19th century, physicians sought to medically distinguish physical differences between Black people and white people that would reinforce white supremacy. They stated that Black people had “thicker skulls, less sensitive nervous systems, and diseases inherent in dark skin.”
These widely accepted differences, established by individuals in favor of enslaving other human beings, comprised the historical origins of medical racism. Well into the 20th century, surgeons still exploited Black people for their experimental operations, as they maintained the belief that Black people had a higher pain tolerance. Black people were used as guinea pigs for mustard gas by the U.S. military and studied for the progression of untreated syphilis by the Tuskegee Institute from 1932 to 1972.
Medical knowledge resulting from racist beliefs functions as the foundation for racist implicit biases held by healthcare professionals today. Although these exploitations have long been prohibited, the idea that Black patients have a higher pain tolerance is exhibited by educated medical professionals today — explaining why the healthcare system is not trusted by BIPOC and why these issues can have potentially fatal consequences.
In addition to implicit biases ingrained within society, cultural barriers also hinder patients from receiving quality care. Non-English speaking individuals may not have access to a translator or English-speaking family member, preventing them from understanding their doctor’s plan or concerns. Interpreter services also increase the cost and length of a non-English speaking patient’s visit, making it less likely that a patient would come and see a physician.
A study by the Journal of General Internal Medicine showed that among patients that were not proficient in English, 49% had trouble understanding a medical situation, 34.7% were confused about how to use medication, 41.8% had trouble understanding a label on medication, 15.8% had a bad reaction to medication due to miscommunication, 66.7% faced a barrier when accessing healthcare, and 20% did not seek healthcare services due to fear of not being able to communicate with their provider.
Adequate patient-doctor communication is imperative for safe and consensual medical treatment. Doctors must explain their treatment plan to non-English speaking patients, as otherwise there is a gross lack of patient-doctor trust and comfortability, coupled by increased risk of patient safety.
“I have called to big hospitals here in [Chicago] and as soon as they capture [my] accent, as soon as they see [my] Latina name, I can feel how they treat [me] differently,” Dr. Mantilla said. “Unfortunately I have to pull out the surgeon card, and tell them up front that [I’m] a surgeon and [that they cannot treat me this way].”
“I have called to big hospitals here in [Chicago] and as soon as they capture [my] accent, as soon as they see [my] Latina name, I can feel how they treat [me] differently.”
— Dr. Natalie Mantilla
Structural racism within the healthcare system prevents delivery of equitable care. Despite the fact that Black people have been disproportionately affected by COVID-19, medical representation by physicians in COVID-19 studies does not reflect this. When physicians describe the dermatologic effects of the virus they do not include or display Black skin. For example, red, lesioned toes have appeared as an unusual symptom of COVID-19. The only toes, however, being displayed and analyzed by dermatologists are pink and white. The lack of representation of Black people by dermatologists in their study of the repercussions of COVID-19 spotlights continued racial disparities within the healthcare system.
If BIPOC patients are not receiving quality care because of a physician’s implicit and explicit biases, there is no guarantee that these patients are receiving adequate attention for their symptoms, which can have fatal consequences. With COVID-19 intensifying and exposing these implicit biases, grounded in systemic racism, these patients will naturally and continuously exude distrust with the healthcare system.
Last updated 10/22/20
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