Abstract
The essay looks at the social problem of racism in society. Racial and ethnic minorities are seen a poorer quality of health care as compared to the White non-minorities. Although the sources of these disparities are complex, they are rooted in historic inequities. Racism in health care industry involves many participants and at different levels, such as the healthcare systems, healthcare professionals, and the patients. Stereotyping, biases and uncertainty contribute to disparities in the treatments provided. Minorities experience a range of barriers when accessing health care. The purpose of the essay is to study the social problem and what segment of society are affected by the problem and in what ways. It also looks at how the problem can be reduced and alleviated. Unfortunately, limited research has been done on how patient race or ethnicity influence decision-making in health care settings. Discussions about race and racism, in general, are potentially unnerving. And the topic becomes even more sensitive if it relates to medical care and racial discrimination in health care.
Introduction
The individual acts of interpersonal discrimination grow out of racism and manifest in different realms of society. People encounter these forms of racism in their lives, workplaces and even in healthcare settings. Racism and discrimination often take roots from gender, race, age, ethnicity, sexual orientation and religion (Cipriano, 2016). Discrimination and racism have been the tradition of American society, and it is sad to see that despite a heightened public awareness, non-white Americans continue to face racial and ethnic discrimination not only in their daily lives but in health care too. Blatant discrimination in health care industry is no secret. It would be a mistake to ignore those issue involving disparities in health care. After all, more than a third of the US population belongs to an ethnic minority. There are disturbing facts that reveal that it is the racial and ethnic populations that suffer lower life expectancy, higher rates of preventable diseases and higher infant mortality as compared to the non-minorities (Cipriano, 2016). Statistics show that Black Americans bear the most serious health burdens that rob them of a healthy life.
If one looks back in America’s history, sharp racial and ethnic streaks were drawn in all segments of society and healthcare. In fact, the roots of racism in health care systems can be drawn back to slavery. For example, the plantation health care services were meant to preserve the health and medical care of their employees, who were primarily the slaves. Scientific models about race emerged in America during the early and mid-1800s. As the country progressed towards the 20th century, certain social transformations further deepened the racial separations in healthcare services. The growth of surgical and medical advances led to the higher middle-class paying for their medical services, and Jim Crow laws further hardened racial divides. Several “Negro” medical schools and hospitals emerged during the post-Reconstruction period for African Americans. It was essential to train black health professionals for the African-American communities rising in numbers. However, the increase in training costs had deep effects, particularly in the African-American community. To add to those problems, minorities failed to gain equal footing in the profession (Smedley, Stith, and Alan, 2003). Research demonstrates that multidisciplinary team in the health care setting is made of nurses, dietitians, physicians, social workers and others. Multidisciplinary teams play an essential role in patient care through follow-up techniques and address the multiple risks faced by patients. However, stereotyping, biases, and uncertainty on the clinical encounter itself can result in unequal treatment. There is a higher probability that these can hamper the quality of medical care given to the patients. It has been observed that the minorities experience several barriers to accessing health care, even when they are insured at the same level as whites. Some factors that aggravate the issue are language barriers and cultural familiarity as asserted by Smedley, Stith, and Alan (2003).
Discrimination is not always easy to prove, but the consequences are quite evident. Prejudice involves thoughts and insensitivity, but may not get manifested in actual behaviors. And, it is the bias that leads to discrimination. It is no surprise to find racism manifesting in the attitudes of health care providers toward patients of different ethnic groups. Thus, discrimination is likely to occur along ethnic and racial lines. One can only imagine the adverse impacts on the health care environment for those receiving poorer quality of health care. Unequal distribution of health care resources and lower quality of services can lead to higher morbidity and mortality rates among racial and ethnic categories plus the lower economic classes (Discrimination and Racism in Health Care, 2016), Healthcare is a resource that needs to be distributed fairly. Nurses and other health care providers can be the perpetrators as well as the victims of racial discrimination. Selective mistreatment undermines the experiences of individuals giving and receiving health care. The successful outcomes and greater satisfaction in healthcare settings rely a lot on the interpersonal trust in physicians Findings suggest that the Whites were more trusting than Blacks and other racial minorities. Although trust is not a racial attribute, several situational factors and experiences can hamper its degree. African Americans reportedly experience some discrimination in health care setting, and this could corrode their levels of trust in the physicians.
(Adegbembo, Tomar and Logan, (2006). Finding suggest that elimination of racism can help build trust between Blacks and Whites and the healthcare professionals. According to Smedley, Stith and Alan, (2003), the ethnic minorities not only end up having a poor quality of health care but develop mistrust in the health care system. It is thus reasonable to speculate, that because of the mistrust, the patients may refuse treatment or comply poorly with treatment. These reactions among the minority patients are understandable as a response to the negative racial discrimination they face in health care settings. Thus, the behavior and attitudes of the patients’ and providers’ have a direct link to the health outcomes. However, it is seen that the healthcare provider is the most powerful actor in those settings as compared to the patient during clinical encounters.
Racial discrimination is a serious social problem with its ill effects that can cast long and lasting shadows on the society. According to Smedley, Stith and Alan, (2003), both perpetrators and victims of the social injustice need to get aware of the issue. Survey research suggests prejudicial attitudes toward minorities among white Americans and particularly towards African Americans. Thus, it is reasonable to assume that majority of healthcare providers, like other members of society may not be aware of their prejudiced behavior towards the African American patients. A large body of published research shows that racial and ethnic minorities are deprived of even routine medical procedures as cornered to their white counterparts. They are less likely to receive appropriate cardiac medication, peritoneal dialysis, and kidney transplantation and get a lower quality of basic clinical services. The discrimination often occurs at the patient-provider level and hampers the quality of trust and the services provided. There are racial differences for the appropriate cancer diagnostic tests and antiretroviral therapy for HIV infections as stated by Smedley, Stith, and Alan, (2003). Other health service categories suffering racial discrimination include diabetes care, kidney transplantation, pediatric care, and mental health and nursing home services. Also, differences in the quality of care lead to poorer survival rates among minorities.
The bias against minorities, clinical uncertainty, and individual belief system impact the quality of health care provided. The health care provider may feel clinical uncertainty when he interacts with the minority patients and the stereotypes held by the provider influence his behavior towards the patients. Patients might also react to providers in a certain way, and those may only contribute to disparities. Thus, the race or ethnicity of the patient is likely to influence physician decision-making. For example, any kind of uncertainty on behalf of the physician may be about the condition of a patient and this add to the disparities in treatment. Doctors can
be viewed to be working with prior beliefs about the patients’ conditions and his socioeconomic status and ethnicity. There is psychology research body that shows how stereotypes evolve and purist and may affect interpersonal interactions. Individual beliefs and general orientations make people respond and behave in a particular manner. Prejudice is a negative attitude and surveys have shown that white Americans carry a prejudicial attitude toward minorities and particularly African Americans, who are thought to be less intelligent and more prone to violence. Thus, it is reasonable to assume that the vast majority of white healthcare providers may get prejudiced against their fellow black doctors and nurses and when providing service to the black patients. It is quite likely that the healthcare providers are not aware of the prejudice in their own behavior
like other members of society.
The relationship between treatment decisions by the doctors and race or ethnicity can be complex. The final decisions are likely to get influenced by perceptions of the health care provider toward patient’s race or ethnicity, even after his income, education, and personality is at apt with the white patients. Those stereotypes, prejudices, or uncertainties can influence
the quality of care for minorities, leading to poorer health outcomes. If the health professionals make decisions about treatment without complete information, it can impact the final outcomes negatively. Sometimes resource and time constraints lead to hurried decisions and thus are likely to produce negative outcomes (Smedley, Stith, and Alan, 2003). There has been progress made in this direction and improvements made in health care delivery, but problems continue for the minority populations. There are substantial differences in the health of Americans, and the minorities are seen to suffer from certain diseases several times as canopied to white Americans. For instance, the case of cancer, Hepatitis B cases, and diabetes are sent to be significantly higher in Native American population as well as Chinese, Korean and Vietnamese. The life expectancy among African Americans is six years lesser than the life expectancy for white Americans (Discrimination and Racism in Health Care, 2016). The racial disparities among Americans are seen in both need and access. Even when those ethnic minorities gain access to the health care system and carry the ability to pay for services, they are less likely to get quality medical, surgical or other therapies as compared to the whites. Whatever the reason behind the disparities in health care, they are unjustifiable and need to be eliminated.
Studies and investigations on the consequences of racism show negative health outcomes. Encounters with racism can certainly increase anxiety and cause one to worry or rehearse defensive and aggressive actions. Racism shapes other significant social determinants such as nature of health care, determinants of health outcomes and economic resources (Harrell, Hal, and Taliaferro (2003).
These studies illustrate that African Americans and Hispanics remain disadvantaged about whites. Their experiences in the healthcare office impact their perceptions and responses towards the medical care settings and outcomes. The health care systems and how they are organized and function, too play a role in the quality of patient care given. For example, language barriers pose a problem for many patients if the health care provider lacks resources and translation services. The physicals are unable to assess symptoms of minority patients because of cultural or linguistic barriers. Globalization means being swept beneath a standard umbrella of cultural homogenization. However, immigration and globalization can make nations and cultures more protective of their cultures and intensify local identities. The effect of globalization on racism 's hard to study. The global media can stereotype certain cultures and promote prejudices among local peoples. Still, it promotes cross-cultural exchange and encourages tolerance towards other cultures. The United States has been experiencing racial change throughout its history, but never at that pace is it undergoing now. The total population of whites is expected to decline in the next fifty years while the African-American population will increase in size. Thus, it is essential to understand the negative outcomes of discrimination and racism in the society and move closer to ideal of equality and justice.
American Medical Associate (AMA) reflects the barriers to professional medicine and the organization reveals a white character. It is observed that only 2% of American physicians are Blacks. Thus, those disparities in medical field are not only at the front gate but at the admission door enters too. There is a need to reinforce solidarity of health and hospital workers with patients and assume superior control over those institutions. The health workers should end the oppressive hierarchy which pervades the health system without regard to race or socio-economic class. Equal access to health care facilities should be based on the need and not on race. The exclusive standards of admission to professional training for the “white” stereotyped should dissolve, thus giving way to equal opportunities for all (End Racism in The Health Care System, 2016)
American Nurse Association (ANA) believes that nurses along with other health care providers carry responsibility for ensuring a work environment that is free of discrimination. ANA "Code For Nurses", demands the nurses to show respect for human dignity and provide services with respect based on the nature of health problems, and not the calls, ethnicity, race or personal attributes of the patient (Discrimination and Racism in Health Care, 2016). Quality at health care practices should be encouraged, and the health care providers should see to it that all patients enjoy equal and quality health care. Health care should never be made sensitive to differences in race, needs of different groups or specific health practices. Inequality in health care practices can lead to life-threatening consequences and can corrode the very society one lives in. ANA believes it is critical for Americans to understand the negative impact of discrimination in healthcare which takes its roots from the racism that still pervades the society. The minorities have rights to equality and justice and the health practices should meet the specific needs of each person. Nurses must deliver the holistic care needed and work to include diversity within their health professions. Strategic plans need to be developed to addresses the issues of discrimination in the health care profession and eradicate racism, in order to provide equal health care for all.
The Davis and Moore theory outline the functional view of social stratification and how it meets the complex social systems. Certain jobs, skills, and economic status are given more merits. Because of their race and social positions, certain people get less opportunity than others. Thus, we find that the functionalist approach explains the issue of racism in the society the best. As certain groups of people and skills are given more importance. According to the theory, the differential access to the primary society rewards influence the esteem and value of different strata in the society and can further institutionalize social inequality and enforce stratification. Davis and Moore theory of stratification provides a very straightforward and clear logic to the social stratification and inequalities (Modern Theories Of Social Stratification. 1953). It is successful in explaining as to how the ethnic minorities in the US get deprived of equal health care opportunities and the reasons behind.Conclusion It is sad to see that the subject of discrimination and racism continues to be talked about even after so many years. Discrimination can permeate in the different social structure of the society and impact different populations in a different way. There is a high level of apparent lower quality of health care and misdiagnosis in minority populations. The prejudices and bias against those populations are the chief cause behind the particular attitude and behavior among health care professional towards black workers and patients. It is essential to raise awareness on the social problem and educate nurses, health care professionals and the masses on the issue and their adverse outcomes. It would need concerted efforts and education to work towards the promotion of justice in access and delivery of health care to all, irrespective of the gender, ethnicity and race. There is a need for immediate action at the federal, state, and local levels to strike at the roots of the problem and fill the gaps.
References
Adegbembo, A. O., Tomar, S. L., & Logan, H. L. (2006). Perception of racism explains the difference between blacks' and whites' level of healthcare trust.
Cipriano, Pamela F. (2016). Confronting racism in health care, americannursetoday Retrieved from http://americannursetoday.com/confronting-racism-in-health-care/
Discrimination and Racism in Health Care (2016), nursingworld, Retrieved from http://www.nursingworld.org/MainMenuCategories/Policy-Advocacy/Positions-and- Resolutions/ANAPositionStatements/Position-Statements-Alphabetically/Copy-of- prtetdisrac14448.html
End Racism in the Health Care System (2016), uic.edu, Retrieved from https://www.uic.edu/orgs/cwluherstory/CWLUArchive/healthracism.html
Harrell, J. P., Hall, S., & Taliaferro, J. (2003). Physiological Responses to Racism and Discrimination: An Assessment of the Evidence. American Journal of Public Health, 93(2), 243–248.
Modern Theories of Social Stratification. (1953). ntu.edu. 1(1), 114–153.
Smedley, Brian D., Stith, Adrienne Y and Alan R. (2003). Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care (with CD). National Academies Press (US), 1(1), 1–740.
