User:Aerynsmith/Medical racism in the United States

Add a section in the "Contributing Factors" section called "Socioeconomic Status"

Socioeconomic Status:

link to the source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1447830/ Medical racism in the United States encompasses discriminatory and targeted medical practices and misrepresentations in medical teachings driven by biases based on characteristics of patients' race and ethnicity. In American history, it has impacted various racial and ethnic groups and affected their health outcomes. Vulnerable subgroups within these racial and ethnic groups such as women, children and the poor have been especially endangered over the years. An ongoing phenomenon since at least the 18th century in the United States, medical racism has been evident on a widespread basis through various unethical studies, forced procedures, and differential treatments administered by health care providers, researchers, and even sometimes government entities. Whether medical racism is always caused by explicitly prejudiced beliefs about patients based on race or by unconscious bias is not widely agreed upon.

^ This paragraph I don't believe needs editing because every sentence is cited and it states the problem pretty well.

Cultural competence[edit]
Physicians not possessing the appropriate level of cultural competence as it pertains to their patient demographic can lead to adverse impacts to those patients due to poor relationship dynamics and contribute to medical racism. Cultural incompetence exists for a number of reasons such as lack of diversity in medical education and lack of diverse members of medical school student and faculty populations. This leads to marginalization of both minority healthcare providers and minority patients.

Medical education[edit]
Studies done on the curriculums of medical schools in the US have found that within the assigned textbook readings, there exists a disparity between the representation of race and skin color in textbook case studies relative to the US population. This is true for both visual and textual lecture materials.

A group of studies done on the representation of race and gender in course slides for the University of Washington School of Medicine, preclinical lecture slides at the Warren Alpert Medical School of Brown University and case studies used at the University of Minnesota Medical School simultaneously showed associations of race as a "risk factor" and a lack of racial diversity.

The study done on the University of Minnesota Medical School employed the use of the concept of hidden curriculum to describe the ways in which lack of representation and informal teachings can greatly influence the minds of aspiring physicians. The interactions had between students and faculty or the transmission of unintentional messages can be just as, if not more, influential than formal lectures. These can include the associations of diseases such as sickle cell anemia as a "black disease" and cystic fibrosis as a "white disease" which leads to poor health outcomes. In this study, the 1996-1998 year one and year two curriculums of the school were analyzed. It revealed that only 4.5% of the case studies mentioned a racial or ethnic background of the patient and when the patient was black or had "potentially unfavorable characteristics" race or ethnicity was more likely to be identified. There was also a greater prevalence of health-related themes discussed when race or ethnicity was identified. Researchers determined that the inclusion of specific racial or ethnic identities in those cases was intended to indicate something about that disease or health condition. Implications such as these contributes to the racialization of diseases.

A study of specific medical textbooks has also yielded much information on minority representation in medical teachings. Based on the required texts of the top 20 ranked medical schools in North America, US editions of Atlas of Human Anatomy (2014), Bates' Guide to Physical Examination and History Taking (2013), Clinically Oriented Anatomy (2014), and Gray's Anatomy for Students (2015) were chosen for the study. Using the total 4146 images from the four textbooks that depicted visible faces, arms, heads, and skin, researchers discovered two of three books were close in diversity to the US population, one book displayed "diversity on basis of equal representation" and one matched neither definition of diversity. On a topic level there were also issues of diversity. When discussing health issues such as skin cancers three of four books included no imagery at all and the one book that did had only imagery of white and light-skinned patients. According to researchers, symptoms might manifest differently depending on skin tone. Missed indicators may go unreported if there is a lack of education on how to recognize these discrepancies.

Some medical students have also done their own research and added to the discourse on underrepresentation in medical school education. They've noted specific examples such as skin infections like erythema migrans being depicted on almost exclusively white skin. As an indicative first symptom of lyme disease, a lack of knowledge on how to detect this rash on patients with darker skin colors means failed diagnoses of the disease. Studies have shown that there is in fact a delay in lyme disease diagnoses for black patients. The lack of representation in medical school lectures risks creating adverse impacts on the health outcomes of minority populations in the US.

Representation in medical field[edit]
According to US Census data, black and Hispanic people account for 13% and 18% of the overall population, respectively. However, they only make up 6% and 5% of medical school graduates, respectively. Black physicians make up only about 3% of American doctors. Black physicians in particular have historically faced numerous obstacles to obtaining membership in the larger medical community. During the 20th century in the United States, groups such as the American Medical Association neglected black physicians and their pursuit of success in the field of medicine. This has led to continued marginalization of black physicians in the US due to their small numbers among other factors and this contributes to the marginalization of black patients. Minorities often perceive medical facilities as "white spaces" because of a lack of diversity at the institutional level.

Racial depictions[edit]
The dehumanization of certain racial groups such as black people can also contribute to disparities in healthcare due to varied perceptions, by physicians, of concepts such as pain tolerance and cooperation – one aspect of medical racism. In American history, social Darwinism has been utilized to justify American chattel slavery among other historical practices and the racist ideas about black people it created persisted into the 20th century. The Three-Fifths Compromise worked also to reinforce the notion that black people were less than human.

However, this has not just been relegated to the past. As recently as the 1990s, California state police came under fire for referring to cases involving young black men as "N.H.I" or no humans involved. One police officer involved in the Rodney King beating in 1991 was cited as saying that a domestic quarrel between a black couple was "something right out of Gorillas in the Mist." This comparison has historical prevalence in that it stems from early theorizations about the evolution of primates. Proponents of this social Darwinistic theory believe that white people are the most advanced humans, descended from primates, and that black people must fall somewhere in the middle of the two.

In a study on whether or not the association of black people with apes influences the perceptions and behaviors of whites and non-whites, it was found that even without explicit knowledge of that historical association people implicitly related one with the other. This study was done in the context of criminal justice and aimed to reveal whether these animal associations impacted the likelihood of jurors to give the death sentence. Researchers were able to conclude that, "The present research foregrounds dehumanization as a factor in producing implicit racial bias, and we associate it with deadly outcomes."

^ I am planning on adding a paragraph about the socioeconomic status and how that plays a role in how African Americans and other minorities get treated in the doctors office or in any other medical office or situation. My paragraph:

 Socioeconomic Status: (NEW PARAGRAPH BY ME) 

Studies also show that social class is critical to the effects of racial disparities in health care, due to the correlation and relationship between health status and health insurance or the absence of. There was an interview study of 60 African Americans whom of which had one or multiple illnesses and the results showed that those of whom fell under the low-income category expressed more dissatisfaction with their health care than their fellow middle-income respondents. Socioeconomic status is very entangled and highly associated with racism, which thus restricts many members of minority groups in various ways. Low SES (socioeconomic status) is an important determinant to quality and access of health care because people with lower incomes are more likely to be uninsured, have poorer quality of health care, and or seek health care less often, resulting in unconscious biases throughout the medical field.

A recent study at the Institute of Medicine reported that Whites are more likely than African Americans to receive a broader range of medical specific procedures while African Americans are more likely to receive undesirable procedures such as amputations and not as many options. Of the study, respondents reflected their socioeconomic status, their professions, if they were homeowners, if they had medical insurance, versus those who lived in public housing, had no medical insurance, etc. The study showed that SES directly correlated with health insurance status due to the fact that people that considered themselves as low-income, had a history of either being a medicaid recipient or had no health insurance overall.

Discrimination based on race is among those of who fall into a minority category, especially being of low-income due to the fact that medical practitioners tend to have more racial biases towards people of color.

I am planning on adding another paragraph about real life examples from different people and their experiences.

 Personal Experiences: (NEW PARAGRAPH BY ME) 

Racial discrimination occurs on many different levels in a variety of different ways and contexts for everyone. The severity of the discrimination varies slightly based off of certain determining factors such as income, education, socioeconomic status, and location.

Participants from eight different focus groups varying in race, discussed their experiences within health care and health care services they received. Some participants stated that they often felt that the quality of the health care they received, directly stemmed from stereotyping, which in most cases, does not directly reflect who they are. They said that they often felt that providers of health care, treated them differently because of the assumption that they were less educated and poor, and that meant that they could be treated with less respect based off of the color of their skin.

Some participants felt it was difficult to pin point exact situations or moments of discrimination that they have encountered in their health care experiences, but they did agree and were certain that the discrimination was there.

Quotes from various racial groups were provided from the focus groups that show specific examples of encounters that participants had with their providers who made stereotypical assumptions about them.

"My name is ... [ a common Hispanic surname ] and when they see that name, I think there is ... some kind of a prejudice of the name ... We're talking about on the phone, there's a lack of respect. There's a lack of acknowledging the person and making one feel welcome. All of the courtesies that go with the profession that they are paid to do are kind of put aside. They think they can get away with a lot because 'Here's another dumb Mexican.'" (Hispanic participant)

"I've had both positive and negative experiences. I know the negative one was based on race. It was [with] a previous primary care physician when I discovered I had diabetes. He said, “I need to write this prescription for these pills, but you'll never take them and you'll come back and tell me you're still eating pig's feet and everything… Then why do I still need to write this prescription.” And I'm like, “I don't eat pig's feet.” (African American participant)

"My son broke my glasses so I needed to go get a prescription so I could go buy a pair of glasses. I get there and the optometrist was talking to me as if I was like 10 years old. As we were talking, they were saying, “What do you do,” and as soon as they found out what I did [professionally], the whole attitude of this person changed towards me. I don't know if they come in there thinking, “Oh this poor Indian does not have a clue.” I definitely felt like I was being treated differently. "(Native American participant)

"If you speak English well, then an American doctor, they will treat you better. If you speak Chinese and your English is not that good, they would also kind of look down on you. They would [be] kind of prejudiced." (Chinese participant)

"I felt that because of my race that I wasn't serviced as well as a Caucasian person was. The attitude that you would get. Information wasn't given to me as it would have [been given to] a Caucasian. The attitude made me feel like I was less important. I could come to the desk and they would be real nonchalant and someone of Caucasian color would come behind me and they'd be like, “Hi, how was your day?” (African American participant)