Social determinants of health: Race and gender

The U.S. has a long history of racial bias and profiling in medicine, which continue to plague the healthcare system today. This phenomenon perpetuates the idea of inherent biological disparities among races within the medical profession. 

Looking back in history, many people of color, especially Black women, have been subjected to unethical medical experiments due to racial profiling. For instance, experiments conducted on enslaved women concerning cesarean sections and obstetric fistula repair took place without consent or any pain medication as a result of the misconception in the medical field that Black women had a higher pain tolerance than white individuals; this notion  still continues in contemporary medicine. 

As a result of experimentations related to C-sections and obstetric fistula, the obstetrics field advanced dramatically. Therefore, America must be cognizant of the racial and gender bias that allowed for medical advancement. There are countless ways that this racial and gender bias impacts medicine today, thus demonstrating that the medical field continues to use and abuse people of color. 

More modern examples of racial profiling include the vaginal birth after cesarean race-based filters, the Tuskegee Syphilis experiment and the prescription of BiDil to primarily Black patients. All of the examples and experiments listed above were created based on an individual’s race rather than on biological facts. 

In a 2014 study concerning structural racism 26.2% of all Black, non-Hispanic individuals were found to be living in poverty and 38% of Black, non-Hispanic children younger than 18 were living in poverty. When this epidemiologic data is combined with racial profiling in contemporary medicine, the idea of health improving as one’s social position rises — otherwise known as the social gradient of health — emerges, supporting the idea that health is impacted by social factors. By examining health outcomes and inequalities through the lens of interactions between race and gender, the concept of the social gradient of health and the theoretical framework of the social determinants of health become evident on a broader scale. This view can be carried out by looking at modern examples of case studies that exemplify the social gradient of health and support the social determinants of health. Through the analysis of case studies, viable solutions and policy reforms emerge as potential avenues to address and mitigate health inequalities. 

The theoretical framework of the social determinants of health posits that social factors play a significant role in individuals health outcomes. Lack of access to healthcare, whether due to monetary issues or accessibility challenges getting to a doctor, can heavily impact an individual’s health — not to mention what type of healthcare individuals have access to. There are socioeconomic differences in the type of healthcare available to areas with different incomes. 

Typically, access to quality healthcare is correlated with disposable income. Lower-income areas, if they have access to healthcare, can only access healthcare services such as free clinics and teaching hospitals. The social gradient of health implies that race and gender have a substantial impact on this idea in the form of social currency. The social gradient of health lends itself to be used as a measurement tool for the social determinants of health. Specifically, as it concerns race and class, the combined effect of social factors and improving social position underscores race and gender as pivotal determinants of health outcomes. 

As discussed above, gender and race intersect, causing health inequalities. One example is the use of race-based modifiers in VBAC tests. VBAC is a series of questions that decides the likelihood of a prospective parent delivering a baby vaginally after previously delivering baby via C-section. As a part of the battery of questions asked, race is taken into consideration, and if the prospective parent is either Black or Hispanic, according to the results of the VBAC test, their likelihood of successfully delivering a baby vaginally after a C-section decreases significantly.

In one instance there was a 15% increase in the likelihood of vaginal birth after a C-section solely based on whether the patient identified themselves a white rather than as black or Hispanic. The reasoning behind such a large VBAC difference is racial profiling, specifically, judgements made about the shape of biological female’s pelvises based on race and what shape pelvis is better suited to delivering vaginally. The use of a race-based correction factor in VBAC scores, when examined through the theory of social determinants of health, shows that one’s gender and race can be used as social capital, which directly affects health care inequalities and outcomes.  

Furthermore, disparities in women’s cardiovascular outcomes compared to men’s is another indicator of the way that gender affects healthcare treatment. The symptoms of CVD in women are under researched, which contributes to the disparities in outcomes. Not only does the lack of research and diagnosis of CVD in women contribute to some of the health disparities in women’s CVD, but it also exposes a failure in the medical system that can be applied to a wide range of women’s health care outcomes beyond treatment of CVD. 

Many women consistently avoid seeking medical treatment until absolutely necessary, because there are many cases in which male doctors give women biased care and do not listen to women’s concerns. This leads to worse health outcomes. However, when women are treated by female doctors and given less biased, patient-centered care their health outcome improves. 

Due to lack of research and the fact that CVD symptoms in women often look different than in men, doctors often misdiagnose women who have CVD, which ultimately leads to more drastic and often fatal health outcomes. 

Another example of the intersection of gender and race in the healthcare field is the heart failure drug, BiDil. BiDil was approved in 2005 by the FDA despite significant problems with its scientific evidence. BiDil is prescribed predominantly to Black patients as it is thought to work effectively for Black patients over white patients. However, in the original study examining the effectiveness of BiDil for heart failure, only Black men and women were used as test subjects, thus skewing the data. 

Since the original study, more studies have been conducted disproving this notion, but many doctors still prescribe BiDil to Black patients for heart failure, even when it might not be the most effective drug to treat their condition. With the disparities in healthcare outcomes for women with CVD and the racial bias in prescribing BiDil to Black patients, it becomes clear that Black women are most at risk to experience drastic and possibly fatal health outcomes due to gendered and racialized healthcare in America.  

Access to health care needs to be increased in order to reduce health inequalities. Patients would greatly benefit from the medical profession providing more patient centered care, rather than generalizing symptoms and diagnoses, which shows bias against Black women, thus adversely affecting their health outcomes. To improve the care for women in particular, more research needs to be done to update how conditions and diseases affect females and not just men. These policy solutions will help to fix the issues in the case studies described above, help to narrow the healthcare inequalities and supply more resources to focus on other areas described in the social determinants of health.