[ More than 25% of survey respondents have avoided care fearing
how they would be treated, and nearly one third reported that they had
been treated unfairly.]
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HEALTHCARE AGAINST BLACK AMERICANS: A HISTORY OF MEDICAL MALTREATMENT
CONTINUES TO KILL BLACK AMERICANS  
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Mark Kreidler
January 20, 2023
LA Progressive
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_ More than 25% of survey respondents have avoided care fearing how
they would be treated, and nearly one third reported that they had
been treated unfairly. _

, Photo by Klaus Nielsen

 

The early months of the pandemic exposed vulnerabilities among
multiple races and ethnicities in California, perhaps none more
profoundly than the state’s Black residents. The first wave of COVID
killed Black people at disproportionately high rates
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with a combination of working and living conditions, existing health
problems and inadequate testing in their communities likely leading to
spread of the disease.

The bigger story was far deeper and longstanding
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then-California Surgeon General Dr. Nadine Burke Harris put it
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the time, “Because of the true and unfortunate history of medical
maltreatment of different groups of people, but especially African
Americans in the United States, there are real issues of trust between
the African American community and the health care system.”

Those issues persisted through the development of COVID vaccines,
which Black Americans were far more reluctant
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receive than white, Latino or Asian Americans. In California, one
result was that death rates for Black residents went up tenfold
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a period in which vaccines were widely available.

It was a nationwide health emergency. But the problems of trust that
it underscored are not new, and certainly not confined to a single
virus.

As a recent report suggests, they’re not fading, either.

An ambitious survey
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the California Health Care Foundation (CHCF) found that nearly one
third of Black Californians say they’ve been treated unfairly by a
health care provider because of their race or ethnicity. More than 25%
of the respondents have avoided care due to concerns about how
they’ll be treated.

For those who do use their health systems, two-thirds say they
research their condition before speaking with their physician. More
than a third report tailoring their speech or their behavior to make
their care provider feel more at ease.

That is all done in an effort to avoid a negative experience with
their health systems, says Katherine Haynes, a senior program officer
on CHCF’s People Centered Care team. And it’s all backward.

“People are taking actions to minimize their race by changing their
language, how they speak, how they dress,” Haynes told Capital &
Main. “They may not ask questions, or they may ask fewer questions,
so as not to be thought of as ‘difficult Black people’ – which
is not their job, right?”

The survey was part of a larger CHCF project, Listening to Black
Californians
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included one-on-one interviews with Black residents about their health
care experiences and thoughts, along with 18 focus groups that
included both potential health system users and key stakeholders. The
statewide survey of 3,325 people represents, the foundation says, one
of the largest of its kind with respect to Black Californians and
their use of health systems. The survey was conducted by EVITARUS, a
Black-owned public opinion research firm based in Los Angeles.

A couple of themes are evident, said Haynes, who directed the project.
On one hand, Black Californians are keenly interested in their health
outcomes, with 92% having seen a doctor or other health provider in
the last year. Those interviewed also expressed an understanding and
appreciation for the pressures that health care providers have been
under since COVID’s arrival in the state.

On the other hand, the trust factor is low, and born from past
personal experience: 38% of Black Californians overall, and 47% of
Black women, said there has been a time when a health care provider
did not treat their pain adequately. Some 47% of those with mental
health conditions and 43% of those who identify as LGBTQIA+ said
they’ve been treated unfairly because of their race or ethnicity.

Haynes said that older Black residents “seem to be much more
satisfied with their care than younger people,” perhaps because many
of them use Medicare and visit their doctors more often, and have
developed relationships with their providers. Younger Black
Californians, she said, are more likely to use urgent care or an
emergency department, avoiding care until something is really wrong.

“At that point, you’re most likely to see a stranger or to be a
stranger” to the system, Haynes said. “You have no relationship
with your provider. And yet many people with whom we spoke articulated
what they yearned for, which was relationship-based care — to know
their providers.”

Black Americans have long-held mistrust
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medical systems given their historical mistreatment by some of those
systems, and less access to quality care
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viewed by the survey respondents as the top reason for generally worse
health outcomes for Black people in the U.S. Those are national
truths, hardly confined to California. But the state’s richly
diverse population argues for a better way.

One road, though unquestionably a long one, is more adequate
representation within the health industry. Among those surveyed, 85%
said it was extremely or very important to increase the number of
Black health care leaders in the state, and 80% said the same about
increasing the number of Black doctors, nurses and other providers.

A 2021 UCLA study found that the share of physicians who are Black men
in the country has gone virtually unchanged since 1940
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In California, about 6.5% of the population is Black, but only
about 3% of its physicians are. (The situation for Latino residents
is even more dramatic: They comprise 39% of the state’s population,
but only 5% of its physicians
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California also has a shortage of ways to put more physicians in the
pipeline, let alone those of color. “There are not enough
residencies, not enough medical school seats, in the state,” Haynes
said. Los Angeles’ Charles Drew University, the state’s only
historically Black university, last October was approved
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begin a medical school program, and Kaiser Permanente opened its own
medical school
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Pasadena three years ago, but in general the state doesn’t produce
or recruit doctors in proportion to the need: it ranks 21st
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physicians per 100,000 residents.

“Particularly after COVID, the health care system is reeling,”
Haynes said. “We have to lead from where we stand, with the
workforce that we have.”

Among those surveyed by CHCF, 84% strongly favored an expansion of
community-based education programs about health care — including
some of the basics, like how to navigate it. Understanding how to use
one’s own health care system, researchers say, often directly
correlates with how often that system is actually used.

And that may be the short-term answer. The results of the
foundation’s survey reflect an unwillingness by many Black
Californians to use a health system that they find either pointlessly
difficult or biased against them. Aggressive community outreach and
education is empowering, whether it’s aimed at helping people find
doctors or helping them understand that they can fire a doctor they
don’t like.

“There is access and then there is _access_,” Haynes said.
“What this work shows us is that we really need to invest so that
people do have meaningful access, along with advocacy, if they need
it.” In the absence of that, the status quo remains — and it
won’t do.

_This article was produced by Capital & Main
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_MARK KREIDLER is a California-based writer and broadcaster, and the
author of three books, including Four Days to Glory. He writes
for Capital & Main [[link removed]]._

 

* Healthcare
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* racial disparities
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