Do People of Colour Face Racism in the Health Care System?

Note: This previous article was updated in August 2021

Black Lives Matter

Despite the restrictions of the COVID-19 pandemic, the Black Lives Matter protests are ongoing. And that’s a good thing. It reminds me of the #Time’sUp and #MeToo movement, when things reached a tipping point and there was no turning back. No-one could pretend any longer that there wasn’t a real problem and that things absolutely had to change.

The same has happened since the death of George Floyd at the hands of a Minneapolis police officer. The conviction of Derek Chavin for Mr. Floyd’s murder and his 22-plus year sentence was a rare instance of justice in an otherwise horribly biased situation, in which people of colour in Canada and the US continue to be killed at the hands of white police officers who then face little-to-no consequences.

As a white woman of privilege, I see this moment as an opportunity to listen and to learn, about my own implicit biases and my own assumptions; about all that I take for granted in my own life, and about the lived experiences of people who don’t happen to look like me.

It’s also important to speak out in the best way I can, by using my platform to address the impact of racism on health and health care.

Racial bias in health care

I’ve always felt grateful for living in Canada and being able to benefit from our health-care system. Its principles dictate that health care is for everyone, rich or poor, young or old, BIPOC or white, and in the ignorance born of my own ‘White Privilege,’ I had always believed that this was the case — at least until recently.

Over the past few years I’ve been listening to BIPOC-identified people — whether patients of mine, friends, colleagues or acquaintances — and I’ve been learning about the vast inequities in the health care BIPOC people have traditionally been receiving — even here in good old Canada.

Faiza Amin wrote in CityNews online in 2019 about how racial bias had reached a tipping point in the Canadian health care system, documenting the horrifying story of John River who was treated with contempt at multiple hospitals, as he unsuccessfully sought care over a period of two months for a serious medical condition.

Ms. Amin wrote an earlier article in 2018, documenting the case of Serena Thompson, a black woman with sickle cell disorder, who worried less about how she was feeling during a medical crisis and more about whether she’d be able to receive the appropriate pain medication treatment, because she’d had so many experiences as being labeled and then dismissed as drug-seeking.

Jake Miller wrote an article in Harvard Medicine about implicit bias and the way that people of colour receive poorer medical care than non-racialized populations. Mr. Miller wrote that a study done in 1993 and published in JAMA showed that Latinos with a broken limb were “two times less likely to get pain medicine in a Los Angeles emergency department than whites with similar injuries.”

This same article mentions a 2003 report about racial and ethnic disparities in health care, and quotes the authors of the report as saying that “bias, prejudice, and stereotyping on the part of healthcare providers may contribute to differences in care.”

Hannah’s 10-year fight for care

In my own experience, a psychotherapy patient of mine – let’s call her Hannah – recently shared a story with me about her own health care journey. She recounted how, as a woman of colour, she had spent ten years trying to find a surgeon who would operate on her uterine fibroids.

By the time Hannah received her surgery, her fibroids had grown to thirty pounds of excess bulk, in and around her uterus, and her bladder had been so severely compromised that it was taking her two hours to relieve herself every morning. Incidentally, I’ve had several white patients over the years who suffered from fibroids and each of these women was scheduled for surgery within a few months of seeing a physician.

Hannah’s experience matches up with that of Mr. River and Ms. Thompson, and what they all have in common is their race. Sadly, the health implications of racism don’t stop at people of color receiving sub-standard care. Evidence is showing that the experience of racism can have an adverse effect on a person’s overall health.

Racism can make you sick

An article in Psychology Today from June 2020 details how racial discrimination “can contribute to health problems, including depression, anxiety, insomnia, heart disease, skin rashes and gastrointestinal problems –just to name a few.”

The article quotes researcher Dr. Anthony Ong who says that “chronic exposure to unfair treatment or day-to-day discrimination increases the risk for poor health.” Dr. Ong added that “coping with chronic experiences of… mistreatment can elicit a cascade of responses that over time…damage the physiological systems that regulate the body’s stress response.”

Dr. Ong also referred to another of his studies in which people who experienced “racial microaggressions… were more likely to experience poor sleep quality on nights after they reported experiencing mistreatment.”

In the Harvard Medicine article, David Williams, a professor at that university, was quoted as saying that “people who report high levels of everyday discrimination have elevated levels of coronary artery calcification, blood pressure, inflammation, and sleep problems; more rapid decline in cognitive function during aging and premature mortality.”

Of course, as a psychiatrist, it would be remiss of me not to mention the fact that the daily experience — or anticipation — of microaggressions (or overt ones) can lead to mood disorders and stress disorders, such as major depression, generalized anxiety, adjustment disorders and post-traumatic stress disorder.

Depressed While Black:

Recently I came to learn about an organization called Depressed While Black. Founded by a mental health activist by the name of Imade, this organization offers support and helps to find black therapists for BIPOC people who are suffering from mental health conditions.

I learned of this organization when I recently interviewed actress and activist, Carlita Victoria, on my Ruthless Compassion podcast. Not long ago founded a group called Darkness Rising Project in response to her own difficulties in having her mental health struggles taken seriously by white practitioners.

Carlita shared with me how near-impossible it was for her find a mental health provider, while in the midst of a suicidal crisis. She also shared that tragically, her story is all-too familiar in the BIPOC community. The discrepancy between the care available to white communities and that available to BIPOC communities is vast.

It’s time to become part of the solution

These are terrible problems and I’m ashamed to say that despite the decades I’ve spent working in the health care system, I’ve been unaware of them. What I’m seeing now is how easy it is to be ignorant when living a life of privilege and in so doing, unconsciously contribute to the problem.

Today, I am determined to remain ignorant no longer. As the world wakes up to the realities of racism, both systemic and implicit, I will keep on learning and listening and I pledge to do my best to become part of the solution, as opposed to being part of the problem.

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