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The last few years have underlined the inequity in the U.S. healthcare system, as Black Americans had the highest mortality rate in the face of COVID. And while some employers are working to design more inclusive, accessible benefits, it may not be enough to rewrite centuries of racial bias in healthcare.
According to The COVID Tracking Project, Black Americans died at a 1.4 times higher rate from COVID in the first half of the pandemic than their white counterparts. While affordability and accessibility certainly play a role, this inequity goes deeper than the herculean task of finding the right doctor at the right price — racial bias is built into the way healthcare providers assess patients when treating COVID, as well as other ailments.
“The truth is [healthcare] ‘research’ done a century ago was never done for the betterment of African Americans,” says Dr. Jayne Morgan, cardiologist and clinical director of the COVID task force at Piedmont Hospital in Atlanta, Georgia. “It was built on a false premise that gets written down in medical textbooks, and 100 years later, it’s what everybody has learned.”
Read more: Black History Month is the time to reevaluate your DEI efforts
Dr. Morgan is asking healthcare providers to begin questioning how they assess and treat Black patients, and advises employers to be aware of how the status quo is costing lives. She points to three algorithms within healthcare as prime examples of how racism denies Black patients care.
Lung health
A current formula for assessing lung health uses 19th-century documentation that suggests Black people have a 20% lower lung capacity than white people. This assumption has led to less diagnosis of respiratory complications, and hence, less treatment.
“Black people are less likely to be referred for specialty care or care that they may need because it’s assumed that a lower number is normal for them,” she says. “There is a race factor built into the software or instrument physicians are using, and they may not even be aware of it.”
Read more: How a ‘Black tax’ impacts the employee experience
Notably, Thomas Jefferson may have started this fallacy when he claimed to have noticed deficiencies in Black people’s respiratory systems in his “Notes on the State of Virginia” in 1832. Plantation physicians would go on to use Jeffersons’ “findings” to support their argument for slavery, saying forced labor helped strengthen their weak systems.
In other words, when testing how much volume of air a patient has in their lungs, today’s devices and software use claims that can harm the health of millions of people. As a result, Black people are less likely to receive proper treatment for respiratory complications — an issue that has only intensified since the arrival of COVID.
Kidney function
The calculation for measuring kidney function developed in 1999 assumed that Black individuals have more muscle mass than white people because they have higher levels of serum creatinine, a substance naturally found in muscle cells. Yet, an increased level of creatinine could be a sign of poor kidney function.
Despite the medical community noting this inconsistency, when calculating Black Americans’ estimated glomerular filtration rate, which tells physicians the patient’s level of kidney function, it is multiplied by a factor of 1.2, making their kidney function appear better than it is. Dr. Morgan notes that, like the algorithm used to determine lung health, many physicians are unaware this multiplication factor is built into the software they use to assess kidney function. Again, this assumption delays care.
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“Your referral to a nephrologist is delayed while waiting for your kidney function to reach a certain threshold,” explains Dr. Morgan. “You are delayed in being placed on the kidney transplant list. If we continue to use this multiplication factor, then African Americans are automatically triaged to a lower level of care.”
Vaginal birth
The Vaginal Birth After Cesarean (VBAC) calculator, the scoring index used to determine whether a person can have a vaginal birth after having a cesarean section for their previous baby, leads to a disproportionate amount of Black and Hispanic patients being pushed to have a c-section. But vaginal births tend to have lower infection rates, quicker recoveries and shorter hospital stays.
Essentially, the VBAC calculator assumes vaginal births are less safe for Black and Hispanic patients because they have a higher maternal mortality rate than white patients — but c-sections are sometimes even more dangerous to the health of the mother and baby. That isn’t to say that c-sections should never be an option, but it is being over-prescribed to Black and brown women, explains Dr. Morgan.
Read more: Doulas boost maternal health outcomes, according to an analysis of Medicaid data
“More white women can move forward with normal vaginal deliveries, while women of color are subjected to subsequent cesarean sections,” she says. “We have to say enough. We cannot continue to use these types of assessments.”
Even how we measure oxygen levels and check body temperatures are impacted by racism, given that the tools used, such as forehead thermometers and pulse oximeters, become more inaccurate the more melanin a person has, Dr. Morgan explains. She also points out that even Apple watches give less accurate readings on people with darker skin tones. A lawsuit has even been filed against the company, alleging the inaccuracy of its blood oxygen reader on people of color.
Dr. Morgan is hopeful that increased awareness will lead to more inclusive clinical trials as well as more informed doctors who know to account for racial bias in their results. As for employers, they may want to consider whether their workers have the resources to get help for persisting health conditions.
“We need to change the way physicians and hospitals practice medicine,” says Dr. Morgan. “And all of us need to try to understand what health equity would actually look like.”
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