Understanding Long-Standing Racial Disparities in Healthcare
- Black Americans are 1.6 times more likely to trust medical information if they’re told by a Black physician compared to a white physician, according to a new study conducted at NYU Grossman School of Medicine.
- The findings support the need for added diversity in medicine to improve health outcomes for more patients of color.
- The fact that Black men are more likely to be impacted by prostate cancer helped prompt the study, which was designed to learn better ways to reach Black communities for education and outreach.
- Black Americans tend to carry added distrust and apprehension towards the healthcare industry partly because of a long history of unethical medical practices towards Black people, such as the Tuskegee Syphilis Study.
"Sometimes, Black people may not fully believe what white doctors say, just like how they might not fully trust what they see on TV or read online," Jones tells SurvivorNet.Read More
Discussion about racial equity has circulated in medical enclaves for decades but the COVID-19 pandemic brought the issue adversely impacting Black and brown communities to the forefront. Apprehension toward the COVID vaccine was heightened by decades of distrust many Black communities carried with them over generations.
"It's because there's a lot of false information out there that can make it hard to figure out what's true and what's not. They also remember a time when not everyone was treated fairly by doctors, which makes it even harder for them to trust healthcare professionals," Jones explains.
“It all comes down to trust and familiarity,” psychologist and founder of InnoPsych Dr. Charmain Jackman tells SurvivorNet.
“Our shared heritage engenders trust and serves as a first step to Black people trusting the medical field. However, there is still so much inherent bias in the way we are trained, if the Black professional is not doing the work of decolonizing (i.e., removing bias) their practice, my guess is that trust will be hard to keep and the Black patient may not return for care,” Dr. Jackman adds.
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The Barriers Health Professionals Must Overcome
"Prostate cancer affects men of all walks of life but it affects them differently," Dr. Edwin Posadas, Medical Director of the Urologic Oncology Program at Cedars-Sinai, previously told SurvivorNet.
The incidence of prostate cancer in African-American men is 60 percent higher, and they are two to three times more likely to die from the disease.
"Black men are more likely to be diagnosed with and die from prostate cancer. However, in a prior study we found that Black adults are underrepresented in online information about prostate cancer," Dr. Loeb said.
Dr. Loeb says the study, which involved more than 2,900 men and women, found that Black adults had high trust in information from white presenters at 64.3%; however, "significantly more had high trust in information from Black presenters" at 72.7%.
"Increasing the diversity of representation in online content and including more physicians in public dissemination are important," Dr. Loeb says.
However, efforts to get more Black Americans to heed medical information even from legitimate sources becomes easier once past racism in medicine is fully atoned.
Among the most notable instances of racism in medicine include the 1932 U.S. Public Health Service (USPHS) Syphilis Study at Tuskegee. It involved 600 Black men 399 with syphilis and 201 without the disease. The men involved were not offered penicillin to treat the disease. An advisory panel sanctioned by the Assistant Secretary for Health and Scientific Affairs found the Syphilis Study was "ethically unjustified."
Other cases that left Black Americans harmed in medical advancements include Henrietta Lacks who sought medical treatment for what turned out to be a malignant tumor on her cervix. According to Johns Hopkins Medicine, Lacks' cells obtained during a biopsy functioned differently than normal cells.
Her cells also known as "HeLa cellsâ€¦doubled every 20 to 24 hours" while cells collected from other people would die. Her cells have since been used to study the "effects of toxins, drugs, hormones and viruses on the growth of cancer cells without experimenting on humans." Problems arose once word spread physicians kept Lacks' family unaware her cells were being used without consent.
Medical experiments by the "Father of Gynecology" James Marion Sims, the 19th-century physician who developed techniques still used today in women's reproductive health add to the distrust. Despite Sims' development of long-lasting techniques, he did so at the expense of enslaved Black women.
The prices Black Americans paid because of these historic incidents are wide-ranging and still felt today. The distrust discourages Black Americans from engaging in clinical trials in larger numbers. By not participating in clinical trials which test the effectiveness of new medical treatments there is a lack of information on whether outcomes will be the same for these patients.
"[The results of the study] underline the need to ensure that all patients, regardless of their racial or ethnic background, have knowledge of clinical trials and can participate if they are eligible," said Dr. Aisha Langford, an Assistant Professor in the Department of Population Health at NYU Langone.
How to Solve a Long-lasting Problem
According to the Association of American Medical Colleges, "only 5.7% of physicians in the U.S. identify as Black or African American." That small number fuels inequities in medicine and, if addressed, could boost the amount of trust Black Americans have in the healthcare system.
"There haven't always been enough doctors and nurses from different backgrounds. But just like having different people working together in newsrooms makes Black people trust the news more, having more doctors and nurses from different backgrounds can help build trust in healthcare over time," Jones explained.
Josette Gbemudu is the Executive Director of Health Equity at Merck and has advocated for increased diversity in healthcare for years.
"We know that black women and African American women are disproportionately impacted with triple-negative breast cancer: high incidents, high mortality relative to other racial demographics and groups across the country," Gbemudu told SurvivorNet when we sat down with her at the American Society of Clinical Oncology (ASCO) Annual Meeting, the largest cancer conference in the world.
Although the need for more Black physicians is well known, what's stopping more from being trained and entering the healthcare industry?
According to Associated Medical Schools of New York, the "high costs" of medical school and a "lack of guidance and preparation" during undergraduate studies serve as key barriers to entry for would-be Black and brown medical students.
The Education Data Initiative says the average total cost of medical school is $218,792, which is a steep obstacle for many students.
However, the tide could be turning just a bit because Inside Higher Ed reports "Black [medical] students in the 2021-2022 academic year rose by 21 percent, from 2,117 to 2,562."
When It Comes to Cancer, Disparities Linger
African-Americans have the highest death rate and lowest survival rate for most cancers among racial and ethnic groups, the American Cancer Society has reported.
During a 2021 National Comprehensive Cancer Network (NCCN) online meeting, attended by hundreds of doctors, nurses, pharmacists, and other healthcare professionals involved in cancer treatment, overwhelming majorities taking part in snap polls acknowledged there was a problem and vowed to try to take steps to address it.
The group released an Equity Report Card that includes 21 measurable oncological practice changes. They include a better effort toward diversity in hiring and retention of cancer specialists, mandatory anti-bias training, greater involvement with community groups, and trying to make sure minorities are better represented in clinical trials.
"We frequently know many minority patients and at-risk patients from different populations are simply just not asked about participating in clinical trials," said Dr. Robert Winn, director of the VCU Massey Cancer Center in Richmond, Virginia.
Winn cited figures that only 3% of Blacks and 6% of Latinos have been represented in those taking part in clinical trials, which "obviously gives us room for significant improvement."
Dr. Langford suggests one way to improve clinical trial participation begins with inviting more minorities to participate in them.
“One reason that Black men (and other minoritized groups) have not been well represented in clinical trials historically is because they are not routinely asked to participate or made aware of clinical trial opportunities,” Dr. Langford said.
Some of the recommendations come from lessons learned during the COVID-19 pandemic, such as making greater use of data from health information technology. It can be employed to help pinpoint bias in the system.
Data can be used in a way that helps improve conversations and decision-making between providers and patients that helps negate bias.
"Communication was one of those critical areas where there appears to be a great opportunity for improvement," said Shonta Chambers, executive vice president for health equity initiatives and community engagement for the National Patient Advocate Foundation.
“Health disparities persist for multiple reasons, and health communications alone cannot compensate for insufficient access to healthcare services and other structural problems. Nevertheless, health communications are extremely important to increase knowledge and awareness in the community and prompt proactive health behaviors (such as screening),” Dr. Loeb said.