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Bias, disparities and long-standing mistrust of the health care system

WCVB Boston logo WCVB Boston 6/24/2020

Systematic racism exists in all different areas of life, including when it comes to actual health care.

Black people die from COVID-19 at more than two times the rate of white people.

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Dozens of studies prove there is disparity in care based on skin color.

"There is this idea of implicit or unconscious bias, which is those biases that we don't know that we have that are evident in our treatment of patients, for example, but are not known until someone else points it out," Dr. Fatima Cody Stanford, a physician and scientist at Massachusetts General Hospital and Harvard Medical School says.

Stanford says this bias happens because racism is a learned behavior, even with people who don't believe they're racist.

"For example, let's say you're watching television with your child and you're in a white household," Stanford said. "Every time a Black woman appears, you don't say anything negative, but you also don't say anything at all. And every time a white woman appears, it's like, oh, that's gorgeous And that's beautiful. She's amazing looking."

"I haven't taught my children that I don't like Black people," Stanford said. "What I did say without saying it is that I don't value them in the same way because I never called them beautiful or amazing or whatever positive adjectives."

Stanford says bias is just one factor in a long-standing mistrust of the health care system.

"A lot of that's really borne in this idea of systemic racism that has been here for 400-plus years in this country," Stanford said. "They do not see people, individuals that look like myself rendering the care that patients need."

It's not just bias. There is a history of disparities in general health, too.

CDC statistics show 48% of Black people have obesity, compared to 37% of white people. Forty percent are more likely to have high blood pressure than white people. Black people are 60% more likely to have diabetes.

Nearly half of all Black women will have heart disease.

Doctors say some of this is genetics, but another massive factor is the stress of racism. Studies have proven it again and again.

"When a Black person experiences racism and they internalize that meaning, they feel the pain associated with it," Stanford said. "Whatever that encounter is, they have increased stress, which leads to increased inflammation in the body, that increased inflammation in the body leads to storing of additional fat. It leads to worsening of arteries. It leads to higher blood pressure."

The stress leads to earlier death.

Black people are 30% more likely to die from heart disease, CDC statistics show. Black men are twice as likely to die from stroke. Black mothers are at least four times more likely to die during pregnancy or childbirth.

In Boston, life expectancy in the predominantly white Back Bay is 90 years, while in Roxbury, where half the residents are Black, it is only 59.

Doctors say these communities traditionally have less access to regular health care.

"If you don't have that established because you don't feel as though there's a place for you to establish that often, you're getting kind of piecemeal care," Stanford said. "So, you may seek your care in urgent care settings or emergency department where there's no continuity."

"There's two health care systems," John Griffith said. "The health care system for white people who are kind of like automatically listened to, automatically respected automatically, you know, like cared for in a in a more holistic sense. Then there's a health care system for Black people, which is just really different."

"There are a lot of hopeful signs that I am cautiously optimistic that we are going that way and going the way of," Aina Adler said. "I think the hope is like seeing this racism as a product that is not like something for Black people to deal with and white people that empathize with, but actually white people to figure out like how to dismantle. So that's my hope."


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