Flawed racial narratives make people sick. Literally sick.
Direct examples of this come from medical settings, where it’s been documented again and again that medical staff treat people of different races differently, especially when it comes to cardiac care. These differences are largely reflections of broader inequality, but not exclusively, because these differences remain even after accounting for differences of income and insurance status.
For instance, doctors have rated black patients as less intelligent and less likely to do cardiac rehab. In the U.S., Black and Hispanic patients are less likely than whites to receive cardiac medication or have coronary artery bypass surgery, even after controlling for traits like age, income, and other medical conditions. Black people are more likely than whites to leave emergency rooms without being seen.
This isn’t necessarily because of prejudice. Nurses, doctors, and others are often busy people who, like most of us, use stereotypes because they’re faster. Stereotyping is a basic feature of human cognition, as we’re faced with too much information, too much of the time.
But stereotyping is also potentially dangerous. Doctors, for instance, frequently rely on assumptions and learned patterns about patient behavior, just as some patients might have learned to distrust authority figures because of negative experiences in the past. One stereotype that affects medical relationships might be “Black patients won’t comply with my instructions about taking this medicine, or they won’t be able to afford it. So there’s no point in prescribing it.” Another might be “Pharmacists and doctors have disrespected my family and me before, and shown from what they say that they don’t know what my life is like. So there’s no point to taking any medicine they give me.”
Some of the distrust or hostility in this relationship is due to structural inequalities—such as being far from a hospital, having limited or no health insurance, not being able to take time off work. But again, research has shown that healthcare providers hold onto certain stereotypes even when individuals don’t fit common assumptions.
This narrative that people of color are first and mainly about that color also appears in medical settings. One clinical research study showed that in almost all cases treating Black patients, but only with half of white patients, medical staff mentioned patients’ race. And when staff mentioned Black patients in a negative light, they mentioned the Blackness of all these patients, but only mentioned the whiteness of half of white patients.
So if medical staff have a negative experience with a racial minority, they’re more likely to make note of that person’s race and remember it in their dealings with other people of the same group. They’re less likely to note the whiteness of a patient because that’s so common. This kind of rapid-fire, unconscious memory contributes to unwitting bias. Even when medical staff are unaware of the stereotypes they hold, these unconscious stereotypes affect the treatment they give.
A little boy examines his doctor
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Stereotypes about pain and race
One worryingly common narrative holds that certain groups feel pain less than white people. One study found that compared to white patients, Hispanic patients were twice as likely to not receive pain medication. In another study, of nursing home residents with cancer, African Americans were 63% more likely to not receive pain medication (after controlling for factors like gender and severity of illness).
Interestingly, it isn’t always the case that people of color receive worse care than whites. White kids get more antibiotics, sometimes unnecessarily. Whites may be overprescribed opioids, which has fueled the crisis in opioid addiction among poorer white communities. These patterns aren’t always logical, but then stereotypes aren’t always factual. Psychological research has shown that medical professionals often have subtle biases about Black people abusing opioids, even though opioid addiction is largely white.
Research also shows that many health caregivers believe that pain is experienced differently by different races. One study of white medical students revealed that half believed that Black people feel pain less because their skin is thicker, their nerve endings are less sensitive, or their blood coagulates faster. These stereotypes aren’t new. One from the early 20th century posited that Black people had very hard skulls, and thus could handle blows to the head.
These kinds of biases are spread not just through casual conversation, but through texts that carry the air of authority. Nursing textbooks continue to include broadly generalized content about the differing attitudes to pain held by different groups, such as that “Arabs/Muslims” “may not request pain medicine but instead thank Allah for pain if it is the result of a healing medical procedure.”
Racial stress in mothers and babies
This is cyclical. Many Black women in the U.S. report that medical staff have treated them as uneducated and unworthy based on their race, and regardless of their actual socioeconomic status. Understandably, Black mothers who have been discriminated against or disrespected during pregnancy or childbirth are less likely to visit doctors afterward for checkups. Black women are three to four times more likely to die of complications related to pregnancy and childbirth than white mothers.
There’s also a link between racial discrimination and infant mortality. Multiple public health studies have shown that Black babies have a much higher chance of dying than white babies, and that this isn’t due to education, income, or genetics. What’s key, as listening to Black mothers shows, is their experience of racial discrimination, starting with being called racial slurs. This causes a build-up of stress in the body, which adds to the stress hormones already present in pregnant women. This makes Black mothers more likely to give birth prematurely.
So even before a child is born, racially discriminatory ideas and treatment affects its chances of growing up healthy.
The risks of even positive stereotypes
XinQi Dong is a doctor who’s been leading research into the health of older Chinese Americans living in the Chicago area. The high rates of depression and other health conditions he’s found are surprising to those who only see the narrative of Asian American success. As Dong has explained, “People usually think of the U.S. Chinese population as a ‘model minority,’ which hides the physical and psychological health challenges this population faces.” The story of silent success can make it hard for elderly Chinese Americans to seek out help, or for such help to be offered to them proactively.
The model minority myth about Asian Americans also glosses over differences among them. For instance, among men in the U.S. with stomach cancer, rates are highest for Koreans. And rates of cervical cancer are highest among Vietnamese American women. Seeing all Asians as the same could make it less likely that certain people will be diagnosed quickly.
Assumptions about minority healthcare workers
Chronic stress linked to racial bias affects other groups as well, including medical professionals themselves. A doctor who’s assumed to be a parking valet, just because he’s Latino, experiences an uptick in stress. Over time, these little incidents of stereotyping and name-calling add up, and the chronic stress is correlated with accelerated aging.
Take plotlines and news stories and jokes that don’t include professionals of color, that typecast blacks as violent offenders. This leads to unconscious skepticism that certain people can be doctors, for instance. Tamika Cross, a Black OB/GYN, found this out in October 2016, on a Delta flight. Cross reported that when a fellow passenger experienced a medical emergency, she had the classic “Is there a doctor on the plane?” moment. She went to help, but the flight attendant assumed Cross couldn’t actually be a medical professional, and demanded to see her credentials. But when a white man, saying that he was also a doctor, appeared, the flight attendant immediately accepted his help, without asking for his credentials, and dismissed Cross.
Cross isn’t alone. Other Black doctors report being patronized or dismissed in emergencies by flight crews whose bias keeps them from getting sick passengers all the help they need. Even in life-and-death situations, harmful assumptions are being made.
But in this situation, it’s not just down to the doctor and the flight attendant. During an incident like this, another flight attendant could intercede, gracefully thanking the doctor for her help. Afterward, other passengers could support the doctor, who might be feeling shaken up, or complain to the airline, which might then implement bias training.
The medical professions are already pretty ethnically diverse, but ensuring strong representation of different population groups among medical staff is one way of reducing linguistic and cultural obstacles to equal care. This isn’t enough on its own, though.
Toward better communication and representation
It’s not just outright bias, whether implicit or explicit, that affects encounters between patients and medical providers. Surveys have shown that medical staff feel more uncertainty in interactions with non-white patients, and that there are medical communication gaps with patients of color. As with so many things, feeling uncomfortable when talking about race just makes it more likely that people will only talk about it unproductively (for example, when a Black hospital patient is belligerent). Increasing dialogue and comfort in talking about these things, in order to unearth hidden beliefs that have real-life consequences, is important.
Clearly medical education is lacking if half of medical students believe that Black people feel pain less than white people, or if medical staff administer painkillers to Black patients less because they’ve internalized stories about Black addicts. Yet even though in some surveys, a majority of doctors report that language and culture are important factors in patient care, a majority also haven’t had any cultural competency training. Some states now require medical staff to have this sort of training before obtaining their certifications.
More attention needs to be paid to the content and effectiveness of this kind of training—for instance, whether clinical outcomes actually improve for minority patients. Such training would also be useful for educators, to get at what biases are common, what biases are being spread through language used with impressionable students, and how to overcome them.