Physicians and Patients Both Have a Role to Play in Eradicating Health Disparities Among African-Americans

Over the past several months, COVID-19 has exposed deep chasms in care and relationships between patients, physicians, and the entire medical system. Even more so, the gaps between the quality and accessibility of health care delivery for white patients compared to those who are African-American have especially been evident while COVID-19 has rippled across the country.

The COVID-19 crisis has acutely revealed the disparity in morbidity and mortality rates among African-Americans -- often due to disregard of Black patients by physicians, or lack of preventative efforts in Black communities. But sadly, COVID-19 is not the first disease to disproportionately affect Black patients. Prostate cancer, for instance, has twice the incidence and death rate among Black men. And, the systemic recurrence of purposeful malpractice in medicine – from the infamous and horrific Tuskegee syphilis study, to the purposeful disregard for Henrietta Lacks and her legacy, and the many more medical injustices that may never come to light -- paints an unfortunate picture of how Black patients have historically been treated by this country’s medical establishment. These tragedies are the unstable foundation supporting the subpar treatment of African-Americans in today’s medical system – a topic that we wrote about recently in a prior blog.

Now, the time is past due to eliminating long-existing health disparities and improving the health outcomes of African-Americans. These oft-documented inequities– such as poor or non-existent health insurance coverage, inconsistent access to services, and the minimization of Black patients’ pain – are the result of systemic racism. Many studies have shown conscious or subconscious racial biases slip into many aspects of health care and result in the poor treatment of Black patients. Because of these societal ills, Black patients receive worse quality care, especially for chronic or potentially fatal conditions, such as prostate cancer -- which is a disease that affects Black men at a double rate than white men.

Both physicians and patients must work to tear down these barriers to quality and access to care for African-Americans. Medical professionals must not deny that health care delivery is influenced by a patient’s race or ethnicity, which thus affects the patient’s medical interventions and treatments. Medical professionals must add this promise to the Hippocratic Oath: “My patient’s health care should not depend on who they are, what they look like, or the socioeconomic circumstances – I will provide the utmost care, regardless.” After acknowledging that these disparities exist, medical professionals must then admit it is unacceptable for anyone to experience poorer health outcomes because of their race, ethnicity, or other societal factors.

For African American patients, several factors may lead to the breakdown in care: justified mistrust of the medical community, concerns about privacy, lack of insurance, religious beliefs, misinformation, lack of health literacy, lack of physicians who represent them racially/ethnically, and stigmas about needing help all have been shown to contribute to a lack of adequate care in studies.

Given the understandable patient concerns, we present suggestions that both medical professionals and patients can take to better protect and serve the Black community:

1. Demonstrate sensitivity to a patient’s situation to help ensure that they receive the highest quality of care when African-American patients have limitations such as inadequate health insurance coverage.
2. Ensure that every patient has a positive experience so that they are more likely to proactively engage in their own health care in the future.
3. Actively work toward diversification of the medical workforce. With only 5 percent of American physicians and 6 percent of nurses identifying as Black (according to the Association of American Medical Colleges), the majority of Black patients are often treated by clinicians of a different race. This being despite the fact that African-American patients are more likely to have better outcomes and report higher patient satisfaction when treated by a racially congruent physician.
4. Encouraging African-Americans to register with clinical trials through community engagement, education, and diversification of trial designers and investigators. African-Americans are significantly underrepresented in cancer clinical trials, and efforts to improve this disparity will allow researchers to better ensure the safety and effectiveness of new, potentially life-saving treatments that could save the lives of Black patients.
5. Create systems that make it easier for African-American patients to manage their health information technology. Some studies have shown that significant amounts of African-American patients lack consistent access to computers and internet resources. By creating more opportunities for Black patients to access, manage, and control their health data, Black patients can feel a deeper sense of ownership of their treatment path and medical history.
6. Increasing access to preventative care is proven to improve health. In prostate cancer, for example, studies have shown links to the doubled rates of diagnosis and death of Black men (when compared to white men). This significant difference in survival rates for a highly treatable disease is due to a difference in prevention and education efforts. By discussing the disease, regular testing, making Black men aware of their risks, and encouraging a healthy lifestyle, the rampant racial disparities we see in prostate cancer may finally subside.
7. Further support opportunities for African American caregivers. Studies have shown that African American caregivers bear more of a burden in the caregiving experience than their white counterparts since fewer resources are often not available. Additionally, cultural traditions have made it uncommon or unwelcome to express vulnerability, hardship, or emotion among African American peers. African American caregivers are welcome to find support, empathy, and a safe space with ZERO’s Caregiver Connector Program, which pairs experienced caregivers with those new to the unique and difficult experience of caregiving.
8. And finally, the medical field must improve culturally competent communication. Medical professionals need to listen to their patients. They need to call out their coworkers when they see prejudicial care or treatment. They need to speak to universities, medical boards, and standard-setting organizations to reinvent the standards of care so that they truly become standard for all. And, unfortunately, Black patients need to continue raising their voices and documenting their unequal and unfair treatment. Ask questions. Get a second opinion. Report doctors who are not taking your concerns seriously. Reach out to other patients when you need validation or support.

By creating opportunities and easing patients’ ability to engage in their own medical journey, patients can become more confident, prepared, and less anxious in dealing with the medical system. For medical professionals, increasing awareness and knowledge around appropriate patient-provider communication, as well as cultural competencies can allow physicians to better advocate for their patients with less bias.

It’s time for Black patients to receive the same care and preventative measures that white patients would receive for any disease -- COVID-19, prostate cancer, or otherwise. Second rate health care is not acceptable, no matter the illness or condition.