*Note affiliations are from 2022
Chiara Mosca1, Grace Wang2, Claire Yang3, Dr. Brooke Ellison4
1East Islip High School, Islip Terrace, NY 11752, 2Lexington High School, Lexington, MA 02421, 3Ward Melville High School, East Setauket, NY 11733 4Department of Behavioral and Community Health, Stony Brook University, Stony Brook, NY 11790
Despite significant technological developments in diagnosis and treatment procedures coupled with a deeper understanding of chronic and life-threatening ailments, medicine has not advanced enough to eliminate its most pernicious facet: ethnic and racial disparities. As defined by the Institute of Medicine (IOM), disparities are “racial or ethnic differences in the quality of healthcare that are not due to access-related factors or clinical needs, preferences, and appropriateness of intervention.”1 Even when the aforementioned factors are accounted for, racial and ethnic minorities tend to receive poorer quality care compared with nonminorities. National data has revealed that life expectancy has increased and infant and adult mortality has subsequently decreased over the past 50 years2; however, African Americans continue to have higher rates of mortality and morbidity than Caucasians for most indicators of physical health. Hispanics and American Indians also have elevated disease and death rates for multiple conditions.3 Such startling statistics necessitate instantaneous attention to remedy this dilemma including increased communication and education efforts, insurance for healthcare coverage, and community coalition-driven interventions to reduce and ultimately prevent healthcare disparities to the maximum extent.
Racial and ethnic mistreatment in the healthcare field has been a long-standing trend in the medical community. In the USPHS Syphilis Study at Tuskegee, 600 African American men, 400 of which had syphilis, were observed in an attempt to understand the effect of “untreated syphilis.” Despite the discovery of penicillin as a reliable remedy for syphilis, the majority of participants were not treated.4 Rooted in the idea that people of color are physically and genetically distinct and inferior to Caucasians, this pseudoscientific ideology pervaded the modern healthcare field. The belief of biological differences between African American patients and Caucasian patients led to the belief that African American patients feel less pain than white patients.5 The racial bias in pain tolerance has had severe effects on the treatment and health of patients of ethnic origin. Information released by the Centers for Disease Control and Prevention (CDC) indicates that Black, American Indian, and Alaska Native women are two to three times more likely to die from pregnancy-related causes than white women.6 This also may be attributed to the discrediting of ethnic women’s concern regarding their own health as less severe or critical.
Clear communication in clinical settings is quintessential to fostering a healthy physician-patient relationship. A report by the Office of Management and Budget estimates that 66 million patients encounter language barriers when accessing healthcare each year.7 Without sufficient interpreter services, patients with limited English proficiency have difficulty expressing their concerns and receive lower-quality care. To ameliorate this, interpreter services through volunteers should be obtained and health insurances should provide reimbursement given that these services are unavailable. Stricter guidelines should also be enforced to prevent young children from acting as interpreters to prevent them from encountering situations beyond their maturity level.8 Greater communication will facilitate more meaningful physician-patient interactions where minorities can transparently express their medical concerns, hopefully bridging the gap in an inequitable environment where they struggle to even be understood. The CDC wrote a 2016 supplement that includes interventions to address the inequality across various identities and conditions. Interventions ranged from evaluations of the Living Well with a Disability program, written reports which outlined HIV prevention interventions in the Hispanic or Latino community, descriptions of the Boston Children’s Hospital’s Community Asthma Initiative program, and more.9 It is imperative that the government partners with hospitals and organizations raise awareness for the disparities in the healthcare sector, as well as take steps to increase individuals’ access.
1 Stith AY, Nelson AR. Institute of Medicine. Committee on Understanding and Eliminating Racial and Ethnic Disparities in Health Care, Board on Health Policy, Institute of Medicine. Washington, DC: National Academy Press; 2002. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care.
2 National Center for Health Statistics. Health, United States and, Socioeconomic Status and Health Chartbook Hyattsville, MD. U.S. Department of Health and Human Services; Washington, DC.: 1998.
3 Williams, D. R., & Rucker, T. D. (2000). Understanding and addressing racial disparities in health care. Health care financing review, 21(4), 75–90.
4 40 years of human experimentation in America: The Tuskegee study. Office for Science and Society. (2020, December 30). https://www.mcgill.ca/oss/article/history/40-years-human-experimentation-america-tuskegee-study.
5 Hoffman, Kelly M et al. “Racial bias in pain assessment and treatment recommendations, and false beliefs about biological differences between blacks and whites.” Proceedings of the National Academy of Sciences of the United States of America vol. 113,16 (2016): 4296-301. doi:10.1073/pnas.1516047113
6 Racial and Ethnic Disparities Continue in Pregnancy-Related Deaths.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 6 Sept. 2019, www.cdc.gov/media/releases/2019/p0905-racial-ethnic-disparities-pregnancy-deaths.html.
7 Newman B. Doctors’ orders can get lost in translation for immigrants. The Wall Street Journal. 9 January 2003:1.
8 American College of Physicians. (2004). Racial and Ethnic Disparities in Health Care. Annals of Internal Medicine. https://doi.org/10.7326/0003-4819-141-3-200408030-0001.
9 “Strategies for Reducing Health Disparities.” Centers for Disease Control and Prevention. https://www.cdc.gov/minorityhealth/strategies2016/index.html