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Inequality in Health Care

4 Barriers Black People Face in Health Care—And How to Advocate for Yourself

SimpleHealth
SimpleHealth
Published: July 30, 2020Updated: February 17, 2021

As we enter Black History Month, we want to take the time to reflect on the unspoken, unwritten ways systemic racism affects the Black community’s access to health care. Within BIPOC communities, we should feel empowered to take charge of our own health care journey, and as a country, we need to be doing so much more to make health care more available for underserved communities. 

While there’s still a long road to correcting the systemic inequalities in health care and in society, educating yourself on how these obstacles came to be is the first step you can take towards advocating for yourself. Here are four of the biggest barriers Black people face in health care, plus a few suggestions for how you can advocate for yourself as a Black person or be an ally for those who need health care.

A shortage of health care providers

Simply put, if there’s not a doctor’s office in your neighborhood, it becomes infinitely more difficult to get care. Because racial disparities in health care are related to zip code, areas where minorities live have less access to fresh food, outdoor space, community resources, and are even more likely to have polluted air and drink lead-poisoned water*. Clinics and hospitals are less available and when they are, they are often publicly funded, overcrowded, and understaffed.

Without a stable network of health care providers and health care facilities, plus a higher likelihood of not having health insurance, minority communities often only go to emergency care settings to seek care, and only when things escalate and it's clear medical attention is needed. Hopping around to different facilities means that you might not have the chance to build a relationship with a trusted doctor—something that’s helpful in tracking symptoms over time to prevent serious health diseases down the line. 

Household income

In 2018, the median annual income for a white family was $70,642, compared to $41,361 for a Black household.* This shocking disparity is likely a major factor in accessing health care. Insurance premiums, co-pays, medical procedures, and other out-of-pocket costs all add up quickly. If your family has to choose between a $60 medical co-pay and $60 worth of groceries, you’ll probably make the choice to skip the doctor—meaning regular testing and check-ups are often skipped, and preventative care isn't a luxury that you can afford. 

This income disparity has another effect for younger, sexually active individuals: access to birth control and contraceptive care. Nearly one in four African American women live in poverty, and as a result, 39% of Black women ages 18-44 could only afford $10 or less for birth control if it was needed immediately.* Without affordable options for birth control, reproductive freedom and control over family planning is only accessible to those who can afford it. 

Implicit biases 

When doctors take the Hippocratic Oath, they pledge to treat the ill to the best of their abilities. However, many doctors and care providers are blind to their own implicit biases when it comes to treating patients of different races. 

These implicit biases are murky: difficult to identify and even more difficult to quantify. However, subconscious biases can have devastating results. For example, non-white patients are less likely to be prescribed pain medications and receive fewer cardiovascular interventions*. The care you get shouldn’t be affected by the color of your skin, but when your treatment isn’t explicitly racist or presents as a much more subtle form of bias, it becomes that much harder to advocate for yourself.

A lack of trust in the medical system

With shameful and horrific events like the Tuskegee airmen syphilis study still lingering in memory, health care providers have a long way to go towards building strong relationships with Black and minority communities*. There is an inherent lack of trust between providers and patients of minority descent, perhaps made even worse by the fact that barely 5% of all U.S. medical doctors identify as Black*.

To that end, minorities are underrepresented in research studies and clinical trials, despite mandates that call for the inclusion of women and minorities in all federally funded studies*. The disproportionate representation of Black people in clinical roles and participation in research creates a vicious cycle of mistrust that very much exists today. 

How to be an advocate for health care equality

While education is the first step towards aligning yourself with equal health care for everyone, there are other things you can be doing to help yourself through the process! Here are a few suggestions.

If you’re Black, Indigenous, or a person of color: File a complaint if you feel that your health care needs are being ignored or mistreated (you’ll probably do this through the office’s patient relations department). Make sure to be specific about everything you can remember from the incident: what day and time it was, who the provider was, what language was used, and more. Details matter. 

Some community organizations offer cultural interpreters and mediators that can help facilitate communication between a patient and a health care official. In this case, someone accompanies you to your appointment and helps advocate for you while knowing the full extent of your cultural background 

And if you suspect implicit bias is at play, you are completely within your power to change doctors at any time—trust your gut and speak up for what you need. 

If you’re a doctor, nurse, or health care provider: Take a questionnaire like the Implicit Association Test to identify your own biases, and encourage your colleagues to do the same. Ask your human resources or continuing education department to host a session on bias training for health care professionals. If you hear a colleague making a racist comment or acting in a way that reinforces subconscious biases, say something.

If you’re a community organizer: Create programs to ensure community members are visiting doctors regularly, taking medicine as prescribed, and going to follow-up appointments. Offer to accompany community members to their doctor appointments to help ask questions and take notes. Design marketing materials that help link community members with free or low-cost resources and educational programs. 

If you’re just a concerned citizen: Start by checking your privilege. Open yourself up to resources that explore which aspects of your identity give you the privilege to see a doctor in your zip code without worrying about the cost. If you have kids, begin conversations about racial equality early (we love this list as a starting point). 

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