By: Monica Kao
As public health students, we are often called to give special consideration to those health inequities that stem from racism. In general, racial minorities are reported to have shorter life expectancies and to experience poorer health outcomes, which are most often attributed to a variety of social determinants of health–unequal distribution of income, poor education, substandard housing, and exposure to violence, as well as differential access to employment opportunities, nutritious (and affordable) foods, and quality healthcare, among others. Since social institutions are inextricably linked with and often reflect societal norms, much of the blame for racial inequities in health has been ascribed to institutional racism, the effects of which are known to be both pervasive and persistent. And because individuals respond to and are heavily influenced by societal norms, institutionalized racism is also thought to have a significant role in fostering internalized and personally-mediated racism. However, new findings in a recent study at the University of Wisconsin-Madison are beginning to shed a different light on racism in health care, and they raise some interesting questions about how personally-mediated racism might come about–as well as how it might be combated [New perspective diminishes racial bias in pain treatment].
The study centered on varying degrees of racial bias in pain treatment and found that caregivers tended to go to greater lengths to ease the pain of patients who were of the same race as themselves. This racial bias was seen in white caregivers as well as in their black counterparts. Brian Drwecki, who headed the study, commented, “I want to be very clear about this: We’re not saying health care professionals are racist. This is not racism. Racism is a conscious act of hate. We find it very unlikely that health care professionals are aware that they are making these biases, let alone trying to actively hurt black patients.” The findings of the study suggest that personally-mediated racism may occur not only as a result of institutionalized racism, but also naturally or as an unconscious act, as a person may simply find it easier to relate to someone of the same race.
In certain aspects, the outlook appears bleak–in addition to throwing off the pervasive influence of institutionalized racism, caregivers and health professionals must also fight a natural inclination towards racial bias. However, the study went on to find that the pain-treatment gap was reduced significantly when caregivers were asked to take a few moments to think about how the patient felt about his or her pain and how it might be affecting his/her life. The implications of such findings are that personally-mediated racism might be resolved with nothing more than a little empathy. Skeptics might argue that the solution to health disparities lies not in combating personally-mediated racism, but in ending institutionalized racism, as its effects are more far-reaching. The population impact of institutionalized racism is undeniable, and initially, it may be difficult to see how changing one’s perspective could equalize the social determinants of health and reduce disparities that occur across all dimensions of health–in types of care, representation in clinical studies, access and quality of care. After all, what can empathy do about economic opportunity for minorities, or housing? What about insurance coverage? The answer is, “more than we might think.” The sweeping issues that face today’s society and disproportionately contribute to poor health outcomes in minority populations will require strategic planning and concerted efforts to effect change; however, such change begins with collaboration among health professionals and civic leaders at the local and community levels. A little empathy can go a long ways, particularly when the moral considerations that accompany it are brought into discussions of social issues, and so the potential impact that could be had with just a change in perspective should not be underestimated by any means.