Doctors Call for Systemic Reform to Improve Black Health Experience

Plenty of medical research explores inequitable outcomes for Black Americans navigating the health system, but few probe the reasons why those disparities exist and persist.

According to a Verywell survey, one in three Black Americans have experienced racism while navigating the U.S. healthcare system. Racism damages the Black health experience by influencing the entire health journey.

The survey, consisting of 1,000 White respondents and 1,000 Black respondents, asked about how their healthcare experience drives their decisions to switch providers or make health decisions.

To get at the heart of why racism persists in health care and what can be done to alleviate its harms, Verywell gathered a panel of four members of its Medical Advisory Board representing different medical specialties. In a roundtable conversation led by Verywell’s Chief Medical Advisor Jessica Shepherd, MD, the panelists explained how health disparities play out in their work and their visions for a more equitable health system.

Here’s what they had to say.

Separate Fact from Fiction

A key step in reducing health inequities is to tailor patient communication appropriately.

Each health provider and staff member should undergo anti-bias and cultural humility training, said Latesha Elopre, MD, MSPH, assistant professor of infectious diseases at the University of Alabama at Birmingham.

Patients may experience racism at every step of a medical visit—more than a quarter of Black respondents to the Verywell survey reported experiencing racism while scheduling appointments and checking in.  

“Patients have a reason to not trust healthcare systems, because health care systems have historically been racist and are currently racist,” Elopre said.

When discussing racism broadly, the facts and figures used can skew one’s perception of the reality. For instance, contrary to popular belief, Black Americans go to the doctor as often as White Americans. Three-fourths of respondents said they have seen a health provider in the last year and most get a physical every year, according to the Verywell survey.

“The reason why some of these myths continue to persist is because on a systemic level, the physicians and the healthcare providers allow it,” said Shamard Charles, MD, MPH, executive director of public health at St. Francis College in New York. Providers should be mindful of their context—sharing statistics on emergency room admissions based on data collected in New York City is not applicable to patients in Birmingham, Alabama, for instance.

“What are the true facts regionally? Is this something that’s impacting the nation? Is this something that’s impacting the city? Your words, the facts that you use, the statements that you make—they matter,” Charles said. “If you don’t think it matters, it shows a complete lack of respect for your patient. The patient will go back home and spew the same facts to their family members. They are trusting you to be their encyclopedia. They are trusting you to be better than Google.”

Representation in Care Affects Health Outcomes

It’s not enough, Elopre said, to merely communicate about health disparities. It’s important, too, to explain root causes and dispel myths like those that suggest certain diseases are inherent to Black people.

“A lot of people, when they’re talking about disparities in general and educating patients about health disparities, still don’t explain the context of why those disparities exist,” Elopre said. “You have to actually say, ‘HIV and STI rates are not higher in Black communities because of behaviors within Black communities.’ [Higher rates] have happened over decades because of things like systematic racism.”

Due to experiences of racism, 36% of survey respondents said they changed healthcare providers, while 28% report not making a follow up appointment and 24% stopped getting treatment.  

“Being diagnosed with HIV is traumatic in and of itself for many people. Unfortunately, most physicians do not get that right. There’s a lot of stigma around it,” Elopre said. “I have people travel miles and miles away from their home cities to come and see me because they feel like they’ve been stigmatized and isolated.”

Only a quarter of Black Americans reported seeing a provider of the same race and only half said they felt their provider was familiar with Black patients.

“I get a lot of patients who come to me because I’m probably one of the only African American primary care physicians in the area. They’re seeking me out because they are feeling some racism—they don’t feel that they’re being paid attention to and that they’re being listened to,” Rochelle Collins, DO, family medicine physician and assistant clinical professor of family medicine at Quinnipiac University in Connecticut, said. “I guess they feel that with someone who looks like them or has the same experiences as them, they’re going to get more personal care or less racism.”

Heather Woolery-Lloyd, MD, director of the skin of color division at Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery in Miami, Floria, said dermatology is the least diverse medical field. A lack of representation among researchers and physicians means there are few providers competent at treating skin of color and there is less emphasis on studying skin diseases that affect this population.

“A [dermatologist] who’s not familiar with the hairstyling practices in women with textured hair might make recommendations or prescribe a product that’s not compatible with that hair type,” Woolery-Lloyd said. “I do a lot of lecturing to dermatologists, talking about skin of color and why you don’t recommend shampoos every day or alcohol-based solutions, or why melasma has a tremendous impact on quality of life and we really need to treat it.”

Schooling and training send messages to providers that can influence how they respond to patients. In dermatology, where providers may treat STIs, there’s a lack of representation in textbooks and board exams for people of color, Woolery-Lloyd said.

“Textbooks don’t have pictures of common skin things like atopic dermatitis or psoriasis in skin of color. But what makes it even worse is the only places where there is representation of skin of color is in the STD [STI] section,” she said, indicating it exaggerates the proportion of non-White people who have STIs. “That’s a huge issue.”

Building a Foundation of Trust Improves Care

Fewer than 60% of Black Americans who have experienced racism in the health system said they had positive perceptions of healthcare providers and institutions. Less than half of the same group said they have confidence in nurses and physicians assistants, doctors, physical therapists, and other providers.

A key component of providing quality care is establishing a trusting relationship with patients through open and empathetic communication, Charles said. This includes trusting patients to advocate for their needs.

The first step to doing that, the panel agreed, is making time for patients to ask difficult questions, and answering them with understanding of their cultural background.

“We need to trust our patients,” Charles said. “Part of building that trust is meeting them exactly where they are, but not doing that in a nominal way. We need to ask them questions. We need to have them repeat back what we said to them. We need to make sure that people understand that infectious diseases doesn’t care who you are—it doesn’t care if you’re black, brown, white, green—you can do everything right and it can still impact your life.”

“Even though there’s an amazing amount of research being done, unpacking all different types of health disparities, we’re still experiencing this very big ideological chasm,” he added. “It’s really hard to meet in the middle and to especially have Black people trust the federal government, trust health care providers, even trust us—the liaisons for good health.”

Reducing Disparities Requires Structural Change

When it comes to chipping away at disparate health outcomes, collaborations between family medicine and primary care physicians can bolster preventative health, said Collins.

“My job as a physician and a primary care provider is education—teaching people how to learn a lot about their bodies, how to pay attention to certain things and having an open conversation with their primary care provider,” Collins said.

Nearly 70% of Black Americans said the system as a whole is to blame for inequities in health care, according to the Verywell survey.

“We don’t want our hospital boards to be made up of eight White men and the one Black woman who is the executive heading [diversity and inclusion], Charles said. “If we really want the change, then we need to have the change through and through, and that’s going to be hard. That means some people are going to have to give up a little so someone else can get a little bit more.”

Improving representation in the healthcare workforce depends on bolstering diversity in medical education.

One positive step, Woolery-Lloyd noted, was a report showing the lack of diversity in dermatology spurred institutional leaders to improve access to medical school for students of color and invest resources in researching skin of color.

Woolery-Lloyd added that financial resources are crucial for medical education access. “Offering mentorships, fellowships, and observerships really makes some candidates who were excellent candidates even better,” she said, because these paid opportunities that for growth without financial burden.

Robust support includes forgiving medical student debt and supporting frontline workers, who are disproportionately people of color, with education and professional development, Charles said.

Improvement Is on the Horizon

“The time for having these conversations without actionable items at the end is over. Those days are long gone. We are at the place of policy,” Charles said. “We’re at the place of wiping out debt and making sure that Black people in this country are starting out at first base like everyone else and able to hit the home run, not just trapped on second.”

Younger respondents were more optimistic about the future—three-quarters of those identifying as Gen Z said they believe there will be a solution to healthcare inequality in their lifetimes. When asked about his optimism for the future, Charles said he’s “with Gen Z.”

The COVID-19 pandemic and racial reckoning in the summer of 2020 brought about opportunities to change harmful norms in health and society. The panelists say movements to tackle racism in both spaces go hand in hand. And while such broad change will be challenging to realize, it’s a key and urgent goal.

“I think as society moves forward, healthcare inequities and disparities will improve,” Elopre said. “We’re kind of at a reckoning as a society. We can choose to truly transform and go into a greater place—we just have to be brave enough to do it.”