Disparities in health care disproportionately impact Black Oklahomans | Crimson Quarterly

Sitting at a Mexican restaurant in Dallas, Jermaine Thibodeaux watched as the people around him drank tequila and marched in a conga line around the room. 

He enjoyed eating chips and dip while talking with his godfather, whom he was staying with for the summer before leaving for the Junior Statesmen summer program at Princeton University. 

Suddenly, Thibodeaux slumped over in his chair. 

His godfather brought him to a local doctor to ensure he was OK. There, he was asked typical questions about his medical history, until his godfather said he was going to Princeton. The doctor replied, “Oh, he plays basketball.”

These uncomfortable moments when a health care provider stereotypes a patient is one reason why Black people are hesitant to go to the doctor, said Thibodeaux, who is now an OU professor in the department of African and African American studies.

The U.S. has a history of medically abusing and systemically under-serving racial and ethnic minorities, establishing lasting barriers to health care access and fostering distrust in the medical industry, Thibodeux said.

According to the Commonwealth Fund, trust in health care among Americans has declined in recent decades, and it’s the worst among Black Americans. A 2020 nationwide poll by The Undefeated and the Kaiser Family Foundation found that seven out of 10 Black Americans believe that people are treated unfairly based on race or ethnicity when they seek medical care, and 55 percent said they distrust the health care system.

Jabraan Pasha, vice president of health equity for Juno Medical and an international speaker on implicit bias, said many of the issues in health care today stem from past logic and ideologies, which were often used to justify slavery. 

According to the Centers for Disease Control, racial and ethnic minority groups in the U.S. experience higher rates of illness and death across a range of health conditions, including diabetes, hypertension, obesity, asthma and heart disease, when compared to white people. Additionally, the life expectancy of non-Hispanic Black Americans is four years lower than  white Americans.

According to The Commonwealth Fund’s 2021 Health System Performance Scores, Oklahoma ranks the worst in the country for inequities in health and health care for Black individuals with a score of six, with one being the worst and 100 being the best. For Latinx and Hispanic and American Indian and Alaska Native people, the score is just slightly higher at 10 and 12, respectively. Comparatively, Oklahoma has a score of 46 for white people.

“Health inequities were created, and that’s really hard for people to come to terms with,” Pasha said. “It didn’t happen organically, and that’s what people need to understand. (It’s) a direct result of policies, government action and individual actions over the course of hundreds of years.”

Implicit bias in health care

Racial and ethnic minorities face unique barriers to health care access and affordability and disparities in the care they receive, Pasha said.

According to the National Academy of Medicine, racial and ethnic minorities often receive lower quality care and are less likely than white people to be given appropriate cardiac care, to receive kidney dialysis or transplants or to receive the best treatments for stroke, cancer, HIV and AIDs. 

Pasha said much of this has to do with implicit bias in health care, which is the subconscious and unrecognized attitudes, stereotypes and associations about people or groups of people, according to the National Library of Medicine. Pasha said this bias can impact a person’s actions and decisions.

“Bias impacts really every walk of life, every sector, especially health care, and we’re going into a pretty high-stakes arena,” Pasha said. 

Many of the biases seen in health care today echo the pervasive — and typically inaccurate — narratives of the past, Pasha said. 

One common bias is the idea that Black people have thicker skin and fewer nerve endings and therefore have a higher pain tolerance. Thibodeaux said this idea originates from medical experiments performed on Black people in the 19th and 20th centuries.  

James Marion Sims, for example, conducted research on enslaved women in the 1840s without anesthesia or numbing agents to perfect surgical techniques related to women’s reproductive health. Credited as the “father of modern gynecology,” several of Sims’ methods and tools are commonly used in gynecology today, according to the African American Intellectual History Society. 

This is just one example of how Black people were used as a means to an end for research, Thibodeaux said. 

A study conducted by the Proceedings of the National Academies of Science in 2016 revealed that many medical students and residents still hold false beliefs about biological differences between Black and white people and these beliefs impact the accuracy of their treatment recommendations. 

According to the report, 40 percent of first- and second-year medical students endorsed the belief that Black people have thicker skin than white people. The study also found that trainees who believed that Black people are not as sensitive to pain as white people were less likely to treat Black people’s pain appropriately.

Unconscious bias causes some health care providers to dismiss or belittle Black patients’ complaints, Thibodeaux said. In particular, women of color commonly suffer the consequences of these notions and experience adverse — and often preventable — health outcomes as a result, Thibodeaux said.

According to a California Health Care Foundation study, Black women are three to four times more likely to experience pregnancy-related death than white women. These poor maternal health outcomes are a result of barriers to health care access and discrimination and bias, Pasha said. Statistically, women of color are less likely to have their complaints heard and validated by health care providers or to have their pain treated appropriately.

Saramarie Azzun, a pre-med senior at OU, said she has been very intentional in choosing courses that teach about the history of inequities and biases in health care. She said she’s not sure if medical schools prioritize teaching this information.

In some of her classes, Azzun said professors typically don’t address some of the inaccurate or non-inclusive information in the curriculum. During a conversation about eating disorders, for example, Azzun said it was framed as an issue that only affects white women and that her professor only acknowledged that people of color are affected as well as an afterthought.

It’s an example of how people of color often are not researched, she said. It’s important to avoid language that puts one racial group at more risk than another, as it can cause people to be under-diagnosed, Azzun said.

“We’re still fighting to eliminate (these) dangerous tropes,” Thibodeaux said. “The consequences of embracing some of these racist tropes about Black folks could be deadly.”

Deep-rooted distrust 

For many ethnic and racial minorities, Thibodeaux said there is a deep-rooted distrust around the medical industry and health care professionals.

Black people were subjected to experimentation and abuse, their bodies were pilfered from graves for study and Black women were unknowingly sterilized. This tortured history still affects how Black people interact with the system of medicine today, Thibodeaux said.

During the pandemic, Thibodeaux said this distrust caused many Black people to be hesitant to receive a vaccine, although the first dose of the COVID-19 vaccine was administered to a Black woman.

“A lot of Black people said, ‘I’m not taking it. I don’t trust it,’ because there’s a past history of the government using Black people as guinea pigs for experimentation,” Thibodeaux said.

Thibodeaux said some of this fear stemmed from the Tuskegee Syphilis Study, which began in 1932. During the experiment, researchers recruited 600 Black men in Alabama and gave them placebos and other ineffective care to observe the full progression of syphilis. 

“The deceit was that the government claimed to have administered some sort of inoculation, whereas they really didn’t and they just wanted to watch the man’s body sort of morph and change as a consequence of contracting syphilis,” Thibodeaux said.

The distrust that exists is appropriate, Pasha said. The health care industry has not given communities of color a reason to trust it.

Most physicians come from a higher socioeconomic status, which can make it difficult for them to relate to and understand patients from different backgrounds, Azzun said.

“When you’re in the room, it’s not the illness that should just be treated,” Azzun said. “It’s also getting a full picture of who you are and understanding life circumstances.”

To build trust with patients, Pasha said health care providers need to acknowledge their implicit biases, listen to their patients’ concerns and take the time to understand them.

“Doctors swear by the Hippocratic Oath: ‘First, do no harm,’” Thibodeaux said. “We have to ensure that they are doing their best to see each patient as fully human and worthy of the treatment that they would expect for themselves or for their loved ones.”

Social determinants of health

The U.S. remains residentially segregated in some areas along racial and class lines, which creates structural barriers to accessing health care, Thibodeaux said. When looking at majority Black or poor communities, it’s clear there isn’t the same kind of access to medical facilities, education or grocery stores. 

Several of the health issues affecting Black people, such as hypertension and heart disease, are exacerbated by food deserts and a lack of parks and open spaces in these communities, which can make dieting and exercise difficult. 

A physician can tell a patient to eat healthier, but when they don’t have access to grocery stores that sell fresh fruit and vegetables, it becomes very difficult to do, Azzun said. 

In predominantly Black neighborhoods, the medical center, if there is one, offers limited services, and the quality of care is often not adequate, Thibodeaux said. People have to find a doctor or a center to visit elsewhere, arrange transportation and take time off work to go to the appointment.

“(Accessing health care) is a long, tedious process,” Thibodeaux said. “It’s not always convenient for folks who are low-income.”

During the COVID-19 pandemic, these systemic and socioeconomic barriers became very apparent, forcing communities to confront the profound inequities existing in health care today, Thibodeaux said. 

Minorities and low-income individuals were more likely to be essential workers and less likely to work from home. They often lived in higher-density living environments far from testing or vaccination centers and had limited access to insurance and health care, according to the National Library of Medicine.

These issues, combined with common and chronic underlying medical conditions, put minority and low-income people at a substantially greater risk of contracting and dying from COVID-19.

According to a 2020 Washington Post analysis of data and census demographics, majority-Black counties had three times the rate of infections and almost six times the rate of deaths as counties where white residents were in the majority.

In Oklahoma, non-Hispanic Black people make up 12.7 percent of the state population, 6.1 percent of COVID-19-related hospitalizations and 1.9 percent of deaths. In comparison, white people make up 59.3 of the state population, 4.6 percent of hospitalizations and 2.2 percent of deaths, according to the National Library of Medicine.

“(It’s) just a basic question about who lives and who dies, right?” Thibodeaux said. “A lot of it, again, was predicated on who had access to proper health care.”

Racial and ethnic disparities persist because few people use their power to challenge their endurance in society, Thibodeaux said. But that is changing. 

“Health equity has to be considered in every single thing that you do as a health care institution,” Pasha said. “Until that is the way of thinking, we’re gonna have a lot of disappointment and some really bad numbers are gonna continue.”

Pasha said being a doctor is about more than just listening to someone’s heartbeat and prescribing medicine. They need to listen to their patients and find ways to advocate for the communities they serve. 

“We’ve got to understand, we’re not just talking about statistics, we’re not talking about numbers on a graph or on a chart,” Pasha said. “We’re talking about people.” 

Summer 2023 Crimson Quarterly

This story was edited by Alexia Aston, Jillian Taylor and Karoline Leonard. Francisco Gutierrez and Ansley Chambers copy edited this story.