“Of all the forms of inequality, injustice in health is the most shocking and most inhuman.”
These words which Rev. Dr. Martin Luther King, Jr. spoke in 1966 were accurate of the centuries prior and have sadly echoed in the decades since because of a persistent history of racism and bias in medicine.
In History
In 1851, Dr. Samuel Cartwright contributed to the New Orleans Medical and Surgical Journal with a report on diseases Black Slaves face, including “drapetomania” – “the mental disease causing slaves to run away.” The implication was that seeking freedom was pathological. To justify slavery, scientific racism wrongly tried to prove that Black people were inferior to white people and there are examples of researchers comparing Black skulls and white skulls filled with buckshot in an effort to prove that Black people’s brains were smaller and less developed than those of White people inferring that they needed to be enslaved. These instances of discrimination in health and science, along with other erroneous facts published in medical journals, have contributed to a lack of equity in health care.
Then there is the story of Fannie Lou Hamer, a champion of justice in health care during the early 1960’s Civil Rights Movement. In 1961, Hamer went into surgery to have a uterine tumor removed, but while there she also received a “Mississippi appendectomy,” an involuntary hysterectomy that was not uncommon for Black women in the state at that time. This atrocity spurred her political action, which led to her helping found the Mississippi Freedom Democratic Party and getting Black Americans registered to vote for the first time. Her unfair and inhumane treatment from the medical field drove her to take action toward improving health care equity across the nation with her cry of “sick and tired of being sick and tired.”
Today
Unfortunately, COVID-19 has highlighted racism in health care and disparities in health care outcomes for people of color. We still feel the effects of a long history of inequality in health care. This history has a lasting impact on Black Americans’ perceptions of themselves within the doctor-patient relationship, as well as a physiological toll of racism on physical health and mental health.
• Black children are more likely to get suspended than non-Black children for the same behavior and are thus more likely to not finish school. Level of education is a leading indicator of health.
• Racial trauma increases the likelihood of anxiety and PTSD occurring in Black individuals.
• 42% of Black adults report workplace systemic racism and discrimination.
• Trauma experienced by pregnant Black women can affect the brain of the fetus, priming a child for an earlier onset of depression and anxiety.
Eradicating systemic racism can truly improve the economic and healthcare outcomes of everyone.
In Practice
Everyone, healthcare professional or not, can help by exercising cultural humility — a pursuit of self-reflection in which an individual examines their own experiences to better understand the experiences of others. An important aspect of cultural humility is being aware of and mitigating your own biases. Extend yourself by learning the personal experiences of people who are different than you.
• Take time to reflect on your own biases and how they affect your worldview.
• Ask about someone’s experience with racial trauma and educate yourself on the history of racism and healthcare inequality.
• Be consistently willing to evaluate and change.
• If you see someone in need of assistance or treated unfairly, advocate for them.
• For healthcare providers, when delivering care, ask questions that will empower clients and patients to feel like they’ve engaged in their outcomes.
On this MLK Day of Service, I am grateful for the strides in healthcare justice illuminated by Dr. King, Fannie Lou Hamer and countless others, and look forward to eliminating health care disparities and an increase in cultural humility that will lead to better care for Black Americans.
Janet Taylor, MD, MPH, is a Community Psychiatrist at Centerstone, a not-for-profit health system providing mental health and substance use disorder treatments to people of all ages.