The damaging effects of racism on the health of Americans of color have been demonstrated in multiple studies going back decades and in anecdotal evidence of generations. The roots of the causes may be found in historic patterns of disenfranchisement, exclusion and the persistent biases built into many of our institutions. We cannot allow unfair treatment to continue to be the norm. We all have roles to play in creating a more humane system of healthcare.
As healthcare professionals, where do we begin to chip away at systems that do not serve all patients fairly? Here are four targets for change.
- Professional growth: Medical caregivers, especially physicians, nurses and licensed mental health professionals need to reflect the demographics of the communities they serve. We need more physicians of color if we are to improve healthcare. For example, Black physicians make up a small percentage of doctors relative to the Black population. When Black doctors care for Black babies, mortality is cut in half. Yet, after 20 years of attention to this, Black physicians still only make up 5% of doctors. We have recently seen work at places like Rush Medical College in Chicago, where a determined senior associate dean has driven significant improvement in the diversity of medical students admitted and who complete their course of study.
- Practice: Quality and safety improvements need to be targeted at communities of color. When Black women, even those of means with higher education still die at three times the rate of white women in childbirth, improving your organization’s safety and quality ratings will yield top results if you focus on ensuring that people of color are given significantly improved attention. We are all affected by the biases built into medical education and the pervasive effects of cultural barriers. Studies have shown medical students who believe that Black people feel less pain or need less pain medication become doctors who inadequately medicate and who may tend to trivialize the symptoms reported by Black patients.
- Practice: Stratify healthcare data collection and analysis in your organization with attention to factors known to reflect marginalization. It has to start with race, but other factors like gender amplify the differences. Attempts to improve healthcare results with blanket practices or those based on the narrow assumptions associated with research based on nonrepresentative samples cannot be expected to make a difference. Many of our large healthcare systems cannot at present tell what the difference in outcomes on most procedures is for different racial groups. If we don’t know what is differentiating our results, we can’t address the practices that lead to poor quality care. For example, UChicago Medicine ensures all data in the warehouse is cut by race, gender and ZIP code so all users have access to that level of information.
- Personal: Mentor and (more importantly) sponsor leaders of color, whose access to advancement and experiences of prejudice and unresponsive systems have them out in the cold. Sponsorship has demonstrated benefits for those who are sponsored through creating visibility and opportunities, and it has large benefits for organizations who are trying keep their talent. And sponsorship is a team activity. Leaders from underrepresented communities benefit from multiple sponsors who work together or in parallel to ensure top talent is given room to blossom.
Health systems that neglect some populations or who allow distrust to grow because they haven’t focused enough attention on what patient diversity requires will lose their connections to those communities. Healthcare organizations are already under pressure from so many directions. It is important that the industry takes the lead on ensuring high quality, readily accessible healthcare to all of our people.
Doug Riddle, PhD, DMin, is curriculum director for The Carol Emmott Foundation, advancing intersectional gender equity in healthcare. Gayle Capozzalo, FACHE, is executive director of The Equity Collaborative, an initiative of The Carol Emmott Foundation.