Racism, African-Americans, and medical mistrust in AmericaThere have been reports of medical mistrust among African Americans regarding the healthcare system for a long period of time. From the Antebellum era to the 1950s, U.S. medical research has a drawn out history of discriminating and exploiting the African American community (Black Americans Don’t Have Trust in the Medical Health Care System, 2017). Therefore, this indicates that African Americans are required to participate in dissections and medical examinations (Black Americans Don’t Have Trust in the Medical Health Care System, 2017). One factor that contributes to medical mistrust among African Americans is the lack of communication between the patient and the doctor; for example, the Immortal Life of Henrietta Lacks is based on a poor, black, tobacco farmer that has her cells taken from her body without her prior knowledge for use to develop the polio vaccine (Skloot, 2017).
Continuing on, Racism refers to the belief of the superiority that results in prejudice and discrimination based on ethnicity and race (Jandt, 77). African Americans are one of the largest ethnic groups that have been impacted by racism for the past 250 years. Institutional racism and discrimination still exist in America. Since the Civil Rights Movement, African Americans have made significant progress. For example, most African American holds high paying jobs which include:working for their own successful companies (entrepreneurship), doctors, lawyers, and much more.
Furthermore, African Americans lack access to healthcare due to poverty and racial bias. In regards to racial bias, 40% of African Americans encounter lower quality of healthcare compared to 26% of Caucasian Americans which leads to higher death rates and shorter life spans (Disparities of Health Care, 2010). In addition to poverty, black Americans are more likely to die as opposed to whites. Economic segregation tends to be the most prevalent in African Americans (Poverty Leads to Death for Black Americans, 2015). This also suggests that they lack money and access to resources for their health.Moreover, Heart disease is the leading cause of death in the United States and is also the leading cause of death worldwide (American Heart Association 2017). Almost half of black men and women have some form of cardiovascular disease which is twice as much compared to their white counterparts (American Heart Association 2017).
These percentages have resulted in many asking why and how is there such a vast difference. Does racism and medical mistrust play a part in this? The answer is yes, the medical mistrust that African Americans have towards the government has grown since the Tuskegee Syphilis Experiment. Since this experiment, African American participation in medical research trials has declined and therefore most of these medical research trials have been conducted on caucasians and other races which has resulted in the treatment for heart disease to work better on whites and other races than Black people (Gamble 1997). African American men go into their appointments thinking that they are going to be treated differently because of their race and this alone increases their medical mistrust. In an article in the American Journal of Public Health, it was stated that doctors also have preconceived beliefs about their patients depending on what race they are. Doctors are more likely to not let their Black patients know all of the available treatments because they believe they do not care about their health and will not follow directions. Racial discrimination incidents in the doctor’s office has been shown to cause stress which is correlated to an increased risk of cardiovascular disease.
Black women who report few or no experiences of discrimination and respond by keeping quiet, are at a great risk for hypertension (Krieger 1990). One of the reasons why there is a much higher percentage of African Americans with heart disease than everyone else is the difference in socioeconomic status. A big part that has to do with your risk for heart disease is your diet (what you eat and what you don’t eat). Areas of urban development such as many cities in Mississippi are also known as food deserts, which are communities that have restricted access to healthy and nutritious food (Whitacre, Tsai, & Mulligan 2009). Their limited choices leaves them with consuming a poor diet that is very low in nutrients and energy dense.
For nearly a decade it has been argued that socioeconomic status is an independent risk factor for cardiovascular disease. The lower the status, the higher the risk for cardiovascular disease.Aside from cardiovascular disease, illnesses such as Alzheimer’s, hypertension, HIV/AIDS, and certain cancers are more prevalent within the African American race than other races because of lack of clinical research. Clinical trials are very important because these trials measure how certain diseases affect each race and what medication works the best to cure the disease.
Whether it’s a mistrust between physicians or low access to health care, African Americans hold the title of being highest underrepresented ethnic group in clinical trials throughout America. Even though most clinical research sponsors are aware of this shortfall, many of them still do not attempt to request 10-15% of African Americans for their studies unless there’s a special protocol or unless it relates to HIV/AIDS, sickle cell anemia, and certain cancers (African Americans in Clinical Trials, 2011). In efforts to resolve the issue of medical mistrust, a few solutions have been proposed.
Medical professionals and the sponsors of clinical trials need to educate themselves on how to recruit African Americans for clinical trials and how to regain their trust. Any new medical discoveries that could help cure certain diseases in African Americans need to be presented in a way where it offers hope and reassurance in African Americans. Another solution includes developing outreach strategies in African American communities. Doing this could increase the recruitment of African Americans in clinical research by about 2-10% (African Americans in Clinical Research, 2011). Needle exchange programs are programs that are specifically designated for injecting drug users. Their purpose is to reduce the rates of bloodborne diseases, especially HIV by providing sterile needles and syringes in exchange for old ones.
They are based in communities through pharmacies, mobile sites, fixed facilities, outreach services, and even vending machines in certain areas. Although they mainly provide sterile needles and syringes, they are not limited to just that. They also offer plenty of information about HIV testing, advice on safer practices, and access to drug treatment every day. If you want to know where a local facility might be, more than likely you can find one in a predominately minority community. Non-drug users assume that providing needles and syringes to people who are participating in injecting drug use promotes the widespread use of drugs and acceptance of the health risks that come with it. These programs do just the opposite of that in these communities. Statistics from the Center for Disease Control and Prevention show that people of color have significantly higher rates of bloodborne diseases and the programs have helped them decrease those rates the most. Naturally, African Americans are the most targeted population for these programs because they have the most drug use/sales and the least amount of access to healthcare.
Without these programs, there would be a greater prevalence in health risks and a higher mortality rate because the drug use will not stop, but it can be practiced safer to protect more lives. Minority communities have always felt like they are treated like their lives are of little significance to society. Specifically, African Americans have little trust in public health authorities and the government because of this very reason. There are a few theories as to why this reason is valid.
One theory is that there has been what is called a race and drug war since the 1980s. This is the most agreed upon theory between African Americans. It is believed that the abundance and availability for drugs in their communities is not a coincidence. There are more corner stores and drug houses than in predominantly white communities. Drugs and racial discrimination in African American communities are believed to be more prevalent for a genocidal purpose by the government “by design, not coincidence”. With all of the high incarceration rates based on racial discrimination, it is now wonder that this theory is the most believed.Another factor that contributed to medical mistrust among African Americans and the healthcare system would be the Tuskegee Syphilis Study. The study was conducted by the U.
S. Department of Public Health along with the aid of the Tuskegee Institute, with the goal of studying the natural history of syphilis in hopes to develop treatment programs for African Americans. At the beginning of 1932, the experiments were exercised on 600 African American males 301 with syphilis and 199 without syphilis. The study was projected to last six months but lasted for 40 years. As papers about the study became available to the public, the Assistant Secretary of Health and Science Affairs, became suspicious about the study and how the conductors were treating the participants.
In 1972, the Assistant Secretary of Health and Science Affairs advised an Ad Hoc panel to investigate the study. The Ad Hoc panel concluded that some of the participants were not given penicillin (which became the treatment for syphilis in 1947) because the conductors of the experiment wanted to see the effects of the virus during the different stages of syphilis. The panel also found that the subjects were not given information and facts about the experiment to fully consent to the study (i.e., all of the subjects with syphilis thought they were going to treated for the disease, but some of them were not). Last the subjects were not given the option to quit the study, which forced them to take part in the study even if they wanted to quit. In 1972, the study was deemed “ethically unjustified” and was discontinued.
In the years following the Tuskegee Syphilis Study, researchers found that mistrust among African Americans had spiked. Researchers also found that the distrust was so severe, that life expectancy among African American men had decreased by 1.3 years compared to white men by 1980. Other studies have shown different findings of racial disparities among African Americans and the healthcare industry. An example of racial inequality is the rate of coronary artery bypass surgery among black men compared to white men. It was found that although black men are diagnosed the same way as white men, it was shown that most black men were not given the option of coronary artery bypass surgery (even though it is cheap and is covered by most insurance companies).
Although the Tuskegee Syphilis Study was ethically unjustified towards African Americans, there are other factors other than the Tuskegee Syphilis Study that has led to mistrust among blacks and the medical industry. Social inequality amongst African Americans and other minorities also plays a major role in the distrust of the healthcare system. During the Jim Crow era, hospitals were segregated by color and blacks were forced to only see black doctors. Unfortunately at this time black doctors were undeniably scarce due to the inequality in the education system. This often led to African Americans being denied basic health care needs by racist physicians.
According to Dr. Nancy Krieger, a professor of social epidemiology at Harvard University, black infant deaths during the Jim Crow era were significantly higher than they are today due to that type of inequality and discrimination. Stories of these bad experiences can be passed down to children and to their children’s children, instilling distrust in all of the generations to come. Although nowadays racism is not as transparent, unconscious racial bias in the healthcare industry is prevalent in modern society. According to a 2002 report from the institute of Medicine 2/3rds of physicians showed signs of racial biases against minorities.
These signs will normally include a doctor dominating a conversation while talking to a minority, making the patient feel less involved and/or respected like they should be and can lower a patient’s trust. A study done by the Institute of Medicine showed that minorities are less likely to receive needed services. A sample of 70,000 veterans with schizophrenia of White, African Americans and Hispanics were taken and it was concluded that African American and Hispanics were less likely to receive the newer, more effective antipsychotic. Instead they were given the riskier alternative. ReferencesDisparities in Health Care Quality Among Racial and Ethnic Minority Groups | AHRQ Archive.
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