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Manifest Destiny

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Racial minorities in the United States and even Canada have continuously suffered when

seeking medical attention. Health and medicine are supposed to be the main freedoms that all

people can enjoy. However, the fact that an individual comes from the minority makes it harder

for them to get the right attention compared to the person from a racial majority. The racism

evident in other spheres of life, including housing, education, and even securing employment,

tends to pervade into the medical field, an area that is supposed to be devoid of the

characterizations of people based on skin colour suppose medical ethics were to be followed.

Research shows an impact between racism, social injustice, and violence and the health

outcomes among minorities. Negative health outcomes from the racialized medical care system

include substandard healthcare, apathy towards seeking medical attention that could degenerate

into poor community health outcomes. The state of mistrust that the historically marginalized

and discriminated members of the society have towards the healthcare system defines medical

decisions by the victims of the healthcare system (National Academies of Sciences, Engineering,

and Medicine, 2017). Systemic racism is a significant social determinant of health whereby the

institutionalized covert and overt racism and implicit personal biases affect the quality of

healthcare outcomes and the minorities' willingness to engage with the medical community.

Apathy towards the medical system has a lasting impact on the public health outcomes witnessed

in the long run.

A minority child must deal with various forms of racism from the moment that he or she

takes the first breath. Davis (2019) explores the issue of racism in the medical community by

analysing birth stories of black women living in the United States. Davis (2019) notes that her

subject's encounters are equivalent to obstetric violence in any part of the world. However, they

may not be presented in the United States, whereby racism has been so normalized that the overt
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manifestations are expected or even accommodated. Strategies of overt and covert racism often

demean the diversity of the minority (Erlank, 2004). They also tend to offer the perception that

the proposed way is better as it was the case in residential schools (Wilk, Maltby and Cooke,

2017). The author refers to one of her subject's experiences with the medical community when

assisting two women, one white and one black. The event recounted in the article occurred at the

same hospital; hence, no institutional variances explain the differential treatment. The two

women are different. The black woman was on Medicaid while the white woman had private

insurance. The fact that black women were a minority and poor made it harder for her to gain the

high quality of care accorded to her counterpart. The differences in treatment were evident in the

pain medication prescription, induced labor approach, and the allowance for familial support

while giving birth. The white woman was treated better based on her race and her socioeconomic

standing. The incident indicates that social injustice and inequality extend to the treatment of

expecting and delivering mothers and their unborn children. The author aptly terms this incident

as obstetric racism. The article further notes that the adverse birth outcomes were 49% higher

among black women than women of any other race. In essence, the nature of care extended to

expectant mothers and their unborn children before and during birth is directly linked to these

adverse outcomes.

According to Davis (2019), obstetric racism falls between obstetric violence and medical

racism. Obstetric violence refers to gender-based violence directed towards women giving birth

that are subjected to violent acts, including aggressive post-delivery procedures due to their

status as obstetric patients. Obstetric violence is only witnessed by women meaning that it is

gendered in its incidence. Obstetric violence can be witnessed at any stage of pregnancy and

extends to the postpartum period. For instance, women may be guilted into thinking that they are
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responsible for some of the complications witnessed during childbirth. Dehumanizing women is

common during childbirth, and it may even extend to birth rape and any other violation that may

be experienced after that. Medical professionals often take advantage of women during childbirth

simply because they have the power to do so. Medical professionals increase the risk of adverse

events, including postpartum depression. Obstetric racism leans to the extreme, whereby

obstetric violence is repeatedly targeted towards minority women.

The incident recounted earlier is only a manifestation of the societal treatment of

minorities vis a vis the majority population when it comes to healthcare. The relationship

between race and health outcomes is more complex and diverse, with the impacts often

confounding one another and later magnifying to increase the negative health outcomes such as

the one mentioned before (Cogburn, 2019). Race is a pervasive feature in the treatment of an

individual. For example, the woman who had an adverse obstetric outcome suffered due to

historical racial injustices that compounded one another over several generations. Her race may

have exposed her to overt and covert racism, which affected the occupation and socioeconomic

standing that would put her in the position of experiencing obstetric violence and racism. She

may have had fewer opportunities to secure employment and afford private insurance due to

deliberate actions by the government. She may have also suffered from the treatment by the

nurses due to the belief that black people do not feel pain or that they exaggerate their pain.

Therefore, even when she was being treated, the medical professionals' implicit biases about

racism played into the decision-making, contributing to her child's negative experience and

adverse events.

Historical mistreatment of minority women when seeking obstetric care has been well

documented. Some of the instances of the overreach of the government and medical practitioners
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when dealing with minority women include the forced sterilization of Native American women

and sterilization of black women in America during emergency cesarean sections. The impact of

these histories has been a rightful mistrust of the medical practice. It has also led to women's

conditioning to never seek medical attention from government hospitals out of fear of recurrence

of the illegal sterilizations and the eventual disrespect of the women. The culminating impact of

this event is conditioning among all women born into these minority groups that the system will

not support them in time of need. Therefore, the women are less likely to approach modern

medical practitioners with the same level of trust that they would traditional midwives. The act

of the government or the medical professionals in mistreating the women creates the perception

of blank mistrust of the government even when there are justified reasons for seeking modern

medicine. For instance, the mistrust of modern medicine may force native American women to

deliver in the reservations with little help when there are obvious risks to the mother and child.

Further, the mistrust means that there are no modern tools for scanning the pregnancy to identify

potential issues from the onset. In the end, the racist and socially unjust actions taken by the

government affect present decisions.

Racial discrimination and differences in the healthcare sector are also affected by the

interpersonal interactions between medical professionals and patients. Medical professionals may

hold implicit biases that are handed down from the growing environment. If a person was

exposed to a single story about a given group, there is a risk that the person will always have the

implicit association of the said person with a given set of behaviors. These implicit biases are

imprinted on the minds of the children by the older generations, often parents. The inculcation of

these beliefs informs the decision-making on a subconscious level. Therefore, if a person was

exposed to images of drug-addicted black patients, there is a risk that this will be the association
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when a patient asks for pain medications. Cultural racism may eventually affect the level of

empathy extended to the patients resulting in negative health outcomes such as the one

mentioned before.

Inequities in health, especially among double minorities (those who qualify as minorities

based on more than one categorization), are also affected by social determinants of health. Social

determinants of health as defined by healthy people 2020 include economic stability, level of

education, the community and social context, the level of healthcare, and the built environment.

These social determinants are often present in some communities and absent in others. For

instance, economic stability may result in disparities in treatment at a healthcare facility. If one is

more stable, they have higher access to medical attention, especially in the United States, where

universal healthcare is still in its fledgling stages. When patients have more money, they are

likely to afford more specialists who can help improve health outcomes witnessed at the end of

the treatment.

Additionally, the level of care and the quality of care is often expensive, even in

neighborhood clinics. If one lives in the wealthy part of a town or even the country, there is a

high likelihood that the public health infrastructure in the area will be of good quality. The

reasoning behind this assertion is that the wealthy cities or neighborhoods often have higher

property taxes meaning that the government has adequate resources to develop the infrastructure.

If the region is poor, as with the first nation reservations, the infrastructure will be

underdeveloped. The clinics are also less likely to be well-staffed, leading to the need for the

patients to travel to the facilities outside the reservations where they are likely to experience

racism in one form or another.

Social and community context is an important social determinant of health. Historical

treatment of the community may determine how eager its members are when seeking assistance

from the government. One example of this approach is the historical interaction of the first

nations with the successive governments from colonial times. The very government has

mistreated the communities they are supposed to entrust for their care over the years. The

mistreatment that took place over the years means that the government's memory and aversion

are intergenerational. Oral tradition and the campfire tales may caution the people against the

government and the evil agenda of the government. Most of these sentiments would be correct

given that the colonial government was involved in the culture of tubal ligation, hysterectomies,

and residential schools. The actions of the governments may be interpreted as a direct affront to

future generations (Wilk, Maltby and Cooke, 2017). This was the case, especially in the case of

residential schools. The history of marginalization that has been directed at women and first

nations' children may increase the apprehension to use government facilities when seeking

medical attention. In the end, the views of the government and its service vary from one

community to the other. The health outcomes witnessed between the communities differ between

the marginalized minority communities and well-equipped communities.

Finally, marginalization and social injustice in the medical field tend to affect minority

communities. The example of the woman being denied proper care and later being exposed to

obstetric violence is indicative of how marginalization is operationalized within the medical

facilities. On the one hand, the marginalized women, or the women most likely to suffer from

marginalization are incapable of fighting or advocating for themselves. Additionally, they do not

have proxies who can advocate for them. The situation would have been different if the black

woman had private insurance and a support system. Social injustice does not extend to the
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minorities within the society alone. On the contrary, it also extends to the minorities within the

minority groups. Prevalence of historical and systemic discrimination can be a defeating factor of

better health outcomes.

Reference list

Cogburn, C.D., 2019. Culture, race, and health: implications for racial inequities and population

health. The Milbank Quarterly, 97(3), pp.736-761.

Davis, D.A., 2019. Obstetric racism: The racial politics of pregnancy, labor, and

birthing. Medical Anthropology, 38(7), pp.560-573.

Erlank, N., 2004. ‘Plain Clean Facts’ and initiation schools: Christianity, Africans and ‘sex

education’in South Africa, c. 1910–1940. Agenda, 18(62), pp.76-83.

National Academies of Sciences, Engineering, and Medicine, 2017. Communities in action:

Pathways to health equity.

Wilk, P., Maltby, A. and Cooke, M., 2017. Residential schools and the effects on Indigenous

health and well-being in Canada—a scoping review. Public health reviews, 38(1), pp.1-

23.