Health Care/Joan Retsinas

On George Floyd, Police, Health, and Pogo: Thoughts

Racist police! The verdict in the trial of Derek Chauvin has unleashed not just relief that at last our judicial system has clamped down on the overt racism embedded since our country’s start, but it has unleashed blame that points everybody’s fingers away from themselves. Evoking Iago, the  problem is too easily defined as the motiveless malignity in our midst. “We,” however we define ourselves, are exempt.

Let the verdict spur a bit a introspection.

The racial health disparities are, statistically speaking, old hat. With heart disease, diabetes, kidney failure, cancer, now COVID, black Americans suffer disproportionately.

To date, one culprit has been insurance: African Americans are less likely to have comprehensive health insurance, more dependent on a frayed safety net, less likely to have a primary care physician.

Another culprit has been weight: Americans in general are overweight; African Americans more so. Alcohol, drugs, and tobacco push people of all races down the health-ladder.  Add the social determinants. Disproportionately, black Americans  are poor, live in crowded sometimes substandard housing. And they suffer from the stress that goes with being black in a white-dominated world. (Consider the risks of driving-while-black.)

At first glance, the solution seems obvious: raise incomes, provide health insurance, open inner-city clinics, expand housing and food subsidies, improve public urban schools — the agenda of a few generations of liberal progressives.

Absolutely, we as a nation should do those measures to improve the lives of Americans stuck at the bottom of this country’s ladder to the American dream.

Beyond those measures, though, the data point to a nuanced, implicit, bias of the white health care professionals who treat black patients.

An “implicit racial bias” of providers, especially physicians, skews care. The impact is nuanced. Black patients may wait longer for appointments, see their physician/nurse for shorter visits, receive fewer opportunities for discussion about treatment possibilities (especially if the provider decides beforehand what the patient would accept), fewer discussions with families, less flexibility on skirting some rules (e.g., black patients’ families may be less likely to be allowed to visit patients outside visiting hours in hospitals). In 2005 a National Institute of Medicine study found that even when researchers considered insurance status, income, age and severity of illness, still, physicians gave black patients poorer care. They were less likely to receive kidney dialysis, or the best treatments for cardiac disease, cancer, stroke or AIDS. The researchers’ conclusion: “some people in the United States were more likely to die from cancer, heart disease, and diabetes simply because of their race or ethnicity, not just because they lack access to health care.”

This is not explicit racism, not even explicit bias. It is simply an unconscious reaction to patients of color, particularly to poor patients of color. The malice may well be unintentional.

One solution, of course, is to have more physicians of color, but the data show little hope for that. In 1978, 7.3% of medical students were Black; in 2019, the percentage fell to 2.6.

Another solution is for everybody who works with patients to acknowledge the implicit bias that may steer care.

These last few weeks it has been easy to blame the yahoos, the police, the system. But maybe, as Pogo would remind us, the “we” who denounce racism, injustice, all the social evils are part of the same society, not isolated by good thoughts, good intentions. We have met the enemy, and, sadly,  he is more “us” than we like to think.

Recognizing implicit bias will not raise incomes, provide insurance, or cure diseases; but it will mark a step in shrinking the racial divide.

Joan Retsinas is a sociologist who writes about health care in Providence, R.I. Email retsinas@verizon.net.

From The Progressive Populist, June 1, 2021

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