Banner by Shirin Kaye

Bridging the Gap: Exploring Racial Disparities in American Healthcare 

By Zayaan Tirmizi 

When Angela Anderson went to the urgent care near her home, she was having severe pain on the right side of her chest. After a lengthy wait, she was sent to another location that had an X-ray machine on site and was able to fully treat her. “At the second facility, I was greeted with frustration and hostility because the staff didn't appreciate the first facility sending me to them,” Angela explains. “The doctor looked in my nose, told me I was congested…and never took any vital signs.” 

Unfortunately, Anderson’s grievance is not rare. It is not uncommon for a person of color, especially a Black or brown woman, to be seen in an emergency room and have their pain dismissed or minimized. For decades, minorities, especially women, have long voiced their grievances regarding their experiences in health care facilities with their respective providers. Many have shared stories similar to Anderson’s, where they felt they were often not taken seriously and their experiences were not heard.  

Research shows that this issue is far more pervasive than just pain. A report from the National Institutes of Health also found that the discrimination and disparities in access to quality health care are not exclusive to pain. In fact, racial minorities experience discrimination and disparities in health care at nearly every single level—from medication prescriptions all the way up to surgical candidate selection. Antoinette Schoenthaler and Natasha Williams, in The Journal of the American Medical Association (JAMA), explain the reasoning behind this when it pertains to pain specifically. Oftentimes, physicians can be guilty of implicit biases due to which they assume their patients of color, especially Black patients, have a significantly higher threshold for pain. This includes incorrect myths and stereotypes that Black patients have thicker skin, higher pain tolerance, or simply feel less pain than white patients overall. Consequently, these patients are often denied medication— despite explaining their symptoms in great detail to their physicians.  

This phenomenon also extends to being selected for certain medical procedures. A study compiled from the National Inpatient Data Sample (NIS) found that there were lower rates of surgical candidate selection, as well as worse outcomes after surgery across multiple specialties, for people of color. The difference in racial disparities for patient outcomes can be due to a variety of reasons, as socioeconomic factors are also important to consider. However, the literature has shown that there seems to be minimal support for a biological difference or a disparity in actual disease burden. This points to an external cause outside of the actual pathophysiology for why certain patients present differently and ultimately end up with worse outcomes than their peers. Instead, it attributes the majority of differences to cultural beliefs, mistrust of the health care system, risk aversion to newer procedures, and physicians’ implicit biases.  

This creates a problem far larger than just anecdotes and testimonials of patients and their experiences with dismissal at the hands of their health care providers. The issue begins with the fact that these are large subsets of the American patient population, creating a large-scale public health issue in which an appreciative portion of the population is not receiving quality health care consistently. Secondly, trust is paramount when establishing rapport between patient and provider. For a patient to be more likely to accept treatment protocols directed by a physician or provider, there must be some level of trust established between the two individuals. In scenarios where subsets of the population feel dismissed, trust is less likely to be established, leading to greater difficulties in bridging the disparities gap in these socioeconomic and racial groups.  

Disparities have long existed within the health care system, and a wide variety of solutions have been fielded to address this problem. Because of the numerous factors contributing to such disparities, a multifaceted approach is required. This begins with provider education, especially at the physician level, on these disparities and what can be done to diminish them. Medical education that includes a comprehensive background in exploring the prevalence of these disparities over time, what populations they exist in, the baggage they bring to the health care system and patients as a whole, and solutions to combat them, are necessary and urgent. Biases regarding pain tolerance for certain demographics can often affect surgical candidate selection as well, so addressing the cause of the issue can solve multiple problems in health care access.  

Additionally, implementing preventative medicine practices to address risk factors that produce these disparities in the first place are necessary to bring about meaningful change. This includes a drastic change in public health policy from a legislative perspective. Importantly, disparities in access to different procedures and medical facilities are often determined simply by an individual’s place of birth, leaving far too much of one’s fate in the hands of the institutions in which they are brought up. This requires a strong effort on the part of legislators to address issues in access to equitable resources and health care across different communities and ZIP codes. 

Indeed, the problem has remained prevalent for far too long and requires substantial policy changes at both the systemic level as well as the educational level. With this, patients who suffer from these disparities can gain access to better quality health care, and, overall, a higher quality of life.