by Deb Hadley, AIWC Düsseldorf and Health Team Co-Chair
As February is Black History Month, the Health Team wants to highlight the very real and concerning issue that is racial health disparity and note its importance and tragic implications. The World Health Organization (WHO) is taking an active approach to combating racial discrimination in healthcare on a global level,1 and its constitution has always stated that “the enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition.” While written over 75 years ago, those words are still relevant, important and true. In June 2020, The Lancet stated that “racism is a public health emergency of global concern.”
It’s worth keeping in mind that much medical progress has been made to the detriment and at the expense of people of color. The so-called “father of modern gynecology,” Dr. J. Marion Sims, developed his surgical techniques experimenting on enslaved African American women.2 The Tuskagee Syphilis Trial in the 1970s denied black men proper treatment and experimented on them without informed consent.3 Then there’s the case of Henrietta Lacks, whose cells were taken without her knowledge and reproduced billions of times in research and development of the polio vaccine, IVF technology and HIV medication.4 Her cells, known as HeLa cells are still used to further medical research today. This history of systemic racism created stereotypes that still persist to this day.
I’ll never forget the first time I encountered overt racism in a healthcare setting. I was a student midwife and I was looking after a Nigerian lady who was scheduled for a Caesarean section but had gone into labor first. I was instructed to keep an eye on her until the operating theatre was ready. It was clear to me that she was progressing quite quickly and in a lot of pain. She was asking for the spinal anaesthetic to be administered immediately instead of waiting for it to happen in theatre – a perfectly reasonable request, all things considered. I reported my findings to the senior midwife in charge, expecting this would not be an issue. She laughed and told me I was too green and the woman probably wasn’t in labor at all – that “those people” always exaggerate and make a fuss. Sadly, this was the first of many similar experiences throughout my training, many just as overt and so many more covert microaggressions. Unfortunately, it’s these kinds of prejudices and stereotypes that can make our healthcare systems dangerous places for people of color.
Thankfully, in the developed world, death in childbirth is quite rare, but when it does happen, we know that women of color are more at risk. Maternal mortality in the US is 4–5 times higher for women of color.5 In the UK and Ireland, women of color are more than three times as likely to die6 during the perinatal period. Why is this? Women of color report that they are not heard, their requests are ignored and that they don’t feel able to ask for or access help.7 Serena Williams wrote a heartwrenching essay for Elle magazine in 2018, sharing her experience after the birth of her daughter. Her story illustrates quite clearly how she was not listened to and how this detrimentally affected her care and health. It’s aptly titled “How Serena Williams Saved Her Own Life” and makes for stark reading. If this can happen to a world-class and very famous athlete, it doesn’t bode well for women without those qualifications.
Unfortunately, racial disparities in healthcare do not stop with maternity care. The COVID-19 pandemic also proved detrimental to people of color in comparison to white people. From early on in the pandemic, it was clear that more people of color were dying and getting infected. Looking back, we know that even when data is adjusted to take age into account, people of color were twice as likely to die of COVID-19.8 Similar patterns were seen with the HIV/AIDS epidemic and continue to be seen with HIV today.9 We know that people of color are more likely to die of many types of cancers, including breast and prostate cancers.10 In short, people of color receive a poorer quality of care than their white counterparts, even when things like age, class and economic status are taken into account.11
Knowing all this, it begs the question: what can ordinary people do to combat this crisis? Awareness and education play a big part. Under the Skin: The Hidden Toll of Racism on American Lives and on the Health of Our Nation by Linda Villarosa is a gripping read that gets to the crux of the matter and sheds light on the issues and how to address them. We can examine our own unconscious biases in this area and learn how to fight racism. We can talk about the issue among ourselves and address it with our healthcare providers. Next time you’re at the doctor’s office, hospital or clinic, ask them what they are doing to combat racism, subconscious biases and health disparities in their practice. We can support healthcare education for minorities, ensuring that economic disadvantage does not prevent capable and intelligent people from accessing education. We can support organizations that are actively addressing this crisis, like Black Health or The World Health Organization. Finally, we can write to politicians, representatives and health authorities to let them know that we feel strongly about this issue and ask what their administration is doing to combat it.
On a practical and community level we can reach out locally. Perhaps we can help vulnerable people get to medical appointments. We could help to organize or host a vaccine drive or seminar for healthcare providers in our area. Ultimately this affects us all.
2 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2563360/
3 https://www.cdc.gov/tuskegee/timeline.htm
4 https://www.history.com/news/rebecca-skloot-on-the-immortal-life-of-henrietta-lacks
5 https://www.cdc.gov/media/releases/2019/p0905-racial-ethnic-disparities-pregnancy-deaths.html
6 https://www.npeu.ox.ac.uk/assets/downloads/mbrrace-uk/reports/maternal-report-2022/MBRRACE-UK_Maternal_Report_2022_-_Lay_Summary_v10.pdf
7 https://maternalmentalhealthalliance.org/news/black-maternity-experiences-survey-five-x-more/
9 https://www.hiv.gov/hiv-basics/overview/data-and-trends/impact-on-racial-and-ethnic-minorities
10 https://www.cancer.gov/about-cancer/understanding/disparities
Resources:
https://www.un.org/en/fight-racism
https://greatergood.berkeley.edu/article/item/ten_keys_to_everyday_anti_racism
Understanding Racial/Ethnic Disparities in Health