Running head: RACISM IN HEALTHCARE
Racism in Healthcare
Ashley Gillam
Western Washington University
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Racism in Healthcare
Introduction
In a social justice class I got the opportunity to experience a ride along with a sheriff.
This experience peaked my interest in racism and how it effects the healthcare system and
patients. The sheriff had pulled into a gas station to see why a black person was hanging in the
parking lot. When the Sheriff got out to talk to him, he angrily grabbed his name tag and pointed
to the gas station indicating he worked there. With the stories in mainstream media and the
horrible history black people have, I do not blame him. I can also see how it can cause problems.
What if the Sheriff had tried to pry information out of him? Would it have turned into a fight or
another mainstream story on the local news? Talking to someone who holds your life in your
hands, like a doctor, can be just as frightening.
As a nurse, this experience sparked interest in the prevalence of racism in healthcare and
what can be done to stop it. Law enforcement and healthcare both work closely with patients,
and I have seen patients fear in their eyes when being cared for. I want to look at the current
research about racism in healthcare and evaluate what is being done and what still can be done to
put a stop to it. When I started researching I was trying to prove that racism was present in
healthcare, but found this to already be proven. I chose my articles related to the content. I had
three main articles and used others to supplement the research. I used key words and sifted
through the results to find the articles that were most relevant to my topic. My interest then went
to how it affects healthcare and how to stop it. Racism negatively impacts healthcare delivery in
the United States evidenced by poor patient experience, decreased quality of care, and increased
economic burden.
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Poor Patient Experience
The United States becomes more diverse every day. Statistics estimate that white people
will only hold under 50% of the total population within the next 50 years. That is a drastic
change and a good reason to evaluate racism in healthcare. Minorities are quickly becoming the
majority (Department of Strategic Planning, 1998). As a country with racism so embedded in our
roots, this is a scary thought. In school I was taught to look at a person holistically and always
treat the underlying cause. It is important to know what damage racism does before I address the
issue of how to fight it.
First it is important to address mental health as this is a major issue in the United States.
It explains reluctance to speak to health care professionals related to trauma and post-traumatic
stress disorder. It has been found that black peoples mental health is effected by racism. The
depth of effect depends on the duration and amount of racism the person encounters. Even if the
person experiencing racism has a fulfilling life, the effects of racism on the person overbears that
(Pieterse, Todd, Neville, & Carter 2012). If we look at our patients holistically, it would show
that their mental health and physical health are connected, and we need to care for both. Mental
health issues severely effect healthcare and will make the patient not trust white people, decrease
their health, and cause more need for healthcare visits due to stress induced medical issues.
Decreased Quality of Care
In numerous articles there is the same common ground. Black people are more likely
than white people to reside in facilities with higher percentages of Medicaid recipients, poorer
staffing ratios, and more serious inspection violations (Cassie & Cassie, 2013 p207). This
makes me question rehospitalization rates, because if the data above is true then rehospitalization
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rates would be high. Li, Glance, Yin, & Mukamel (2011) performed a study and found that black
patients had a 40% higher risk of being re-hospitalized within 30 days of admission and a 50%
increased risk of being rehospitalized within 90 days of admission. These statistics are shocking
and evaluation of why they are so high is essential.
The nursing homes with higher percentages of Medicaid patients, poor staffing ratios, and
inspection violations play a huge part in increased racism. Li, Glance, Yin, & Mukamel (2011)
found that these facilities are resource poor and are more likely to send the patients to the
hospital because they cannot provide emergency care. Black patients have distrust for the
medical system related to how people in healthcare treated them in the past. This mistrust makes
them ask for more treatments at times because they do not believe the doctor is doing all he can
do. The mistrust also goes the other way and the patient will not speak to the doctor. This lack of
communication will lead to misdiagnosis and increase risk for readmission. This negatively
effects the delivery of healthcare because the patient does not trust the workers and the workers
do not have the tools to effectively care for the patient.
We need to close the gap present in todays research. We need to look at not only people
who are racist, but the health care system and government policies that empower racism to
continue to exist. Let me use physical restraints as an example. Cassie and Cassie (2013) found
that in the United States, tremendous gains have been made in the reduction of physical
restraints. Only 3.2 percent of nursing home residents are restrained. The question is how many
of those 3.2% are from a minority race and why? Cassie and Cassie (2013) also found that
almost half the black residents were restrained compared to the 38% of white patients. Even with
the United States having a dramatic decline in restraint use, there is a racial disparity present in
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the restraint use that is left. The disparity of restraint use negatively effects healthcare delivery
because these patients will continue to distrust the system.
Economic Burden
There are incentives available to facilities for having low rates of rehospitalization.
Medicare offers incentives for facilities from all care settings if they can decrease
rehospitalization rates. Insufficient use of resources is also a problem in healthcare, and there is
an incentive for facilities who use only what they need (Li, Glance, Yin, & Mukamel, 2011).
There is a huge economic burden related to racism and its power to alter peoples health. $1.24
trillion dollars was taken from the economy related to health inequalities (Li, Glance, Yin, &
Mukamel, 2011). There is a disparity between minorities and white people regarding health. This
is due to stress of racism, policies and procedures, poor housing, and less opportunities. The
disparity causes heart disease, higher incidence of cancer, and poor living situations that expose
this population to environmental degradation, unhealthy foods, tobacco, and alcohol (Smedley,
2012). We need to learn how to stop the racism to benefit the US population as a whole. If we do
this, we can decrease the negative effects racism has on health and healthcare delivery.
Evidence based practice (EBP) is something that guides me in my nursing career. So why
doesnt evidence based practice stop racism? There is little baseline data to work with related to
minorities and their health. This makes comparison research hard to do and nearly impossible to
figure out how to close the gap we have racially in health care. The National Institute of Health
allowed women and minorities to be included in research in 1998. There is still an issue finding
minorities to participate because of language barriers and no insurance. Evidenced based practice
does not include specifics for minorities. Research states we have to be careful changing EBP
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because it could threaten the relevance of the current ones (Lee, Fitzpatrick, & Baik 2013). We
need to change policies and EBP to stop the negative effects of racism on healthcare.
Future Recommendations
Lee, Fitzpatrick, & Baik (2013) gives some suggestions for health care professionals to
give better care to minority patients. When nurses act on evidence based practice, they need to
think of their patient and how relevant it is to their case. It is also important for nurses to do
some self-evaluation and identify their own stereotypes associated with ethnic groups. Nurses
also need to educate themselves on the culture of the patient they are caring for. Some diets will
not work for some cultures. I had a Mexican patient who barely spoke English and he hated the
food served to him. Everyone was concerned that he was losing weight because all he wanted
was rice and beans and a tortilla. Technically it wasnt in his diet, but this patient will not eat
anything else. We have to adapt care to patients and the lifestyle they had before they came to us.
We can do our best to educate, but we cannot force anybody to change.
The United States has an increasing population of minorities and healthcare needs to
effectively reflect that. Nurses, doctors, therapists, and people at all levels need to be educated to
effectively care for minorities (Lee, Fitzpatrick, & Baik 2013). Research is essential for nurses to
further their education. They need to stay up on current evidence based practice and be able to
adapt to the many cultures that they come into contact with. Continuing education is key. What
does the current research recommend to fix the gap, and is it realistic?
Education and research seems to be the common ground in the recommendations. It is
difficult to make policies for populations that are so diverse. It is important to take into account
sociocultural factors, health behaviors, and difference in illness between different cultures (Lee
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Fitzpatrick, & Baik, 2013). Self-reflection is important throughout all processes especially
dealing with race. The health care worker needs to address their own views on race, and the
stigma attached to it. I may not try and be racist, but I may have racist tendencies. I need to
evaluate my thoughts and my feelings about race before I can care for a diverse population
effectively.
Cassie & Cassie (2013) recommends future research for use of physical restraints. They
state that health care workers and policy makers need to work together to make racial disparities
disappear. That is why it is important to go to conferences especially as a working nurse to be
able to give first hand data. Li, Glance, Yin, & Mukamel (2011) suggest finding what causes the
racial disparities and planning interventions towards those to prevent rehospitalization. That
would include further research and education. It would also take collaboration with policy
makers to ensure that the research took effect everywhere.
Conclusion
So the big question here is where is the research to help us fight the racism still present in
health care? When my grandma was sick and dying in the hospital, I saw her programmed racism
come out. She didnt want anyone of color to care for her. She was raised that way. I tried to talk
to her about it but she could not budge because she had a deep seeded hatred and mistrust of
these people she had never met. It wasnt too long ago when minorities couldnt purchase a
house, or when citizenship was taken away from people for having a certain percentage of
minority in them. How do we as a country change these peoples minds? I know for my grandma
I couldnt and a law wouldnt have either. My mom exhibits racism as well as many other
members of my family. This is an inevitable product of growing up in that kind of atmosphere. I
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can educate these family members and change their minds. These next generations are how we
change the racial disparities by researching, educating, and advocating for our patients.
According to available sources and after taking a closer look at the issue of racism in
healthcare, it is clear that racism negatively impacts healthcare delivery in the United States. This
is evidenced by poor patient experience, decreased quality of care, and increased economic
burden. There is a disparity in healthcare between minorities and white people. This has to
change. How do we change it? The research suggests collaboration with policy makers and
multidisciplinary. Holistic care is important for minorities as they have a lot of mental health
issues going on from prolonged exposure to racism and shortcomings related to it. Selfevaluation to better care for minorities is essential to give culturally competent care. Education is
key because to better care for our patients, we need to make sure we are equipped with the right
tools. To effectively ensure racism stops negatively effecting healthcare, these steps need to be
taken into action.
During the process of writing this paper, I learned a lot about not only racism but
academic writing. I lacked confidence in writing before and this paper helped me realize my
potential. Source analysis is hard to wrap my head around because I did not feel I was up to the
level of the people writing the papers. I did not feel like I could join their conversation. Again, I
underestimated myself. Having opinions on topics and joining academic conversations is a part
of nursing and although hard, very rewarding.
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References
Cassie, K. M., & Cassie, W. (2013). Racial disparities in the use of physical restraints in U.S. nursing
homes. Health & Social Work, 38(4), 207213.
Department of Strategic Planning. (1998). Discrimination and racism in health care. Retrieved from
[Link]
Lee, H., Fitzpatrick, J. J., & Baik, S.-Y. (2013). Why isnt evidence based practice improving health
care for minorities in the United States? Applied Nursing Research, 26(4), 263268.
[Link]
Li, Y., Glance, L. G., Yin, J., & Mukamel, D. B. (2011). Racial disparities in rehospitalization among
medicare patients in skilled nursing facilities. American Journal of Public Health, 101(5), 875
882. [Link]
Pieterse, A. L., Todd, N. R., Neville, H. A., & Carter, R. T. (2012). Perceived racism and mental health
among black American adults: A meta-analytic review. Journal of Counseling Psychology, 59(1),
19. [Link]
Smedley, B. D. (2012). The lived experience of race and its health consequences. American Journal
of Public Health, 102(5), 933935. [Link]