Cultural Competency Part 4: health care

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Recently, the NFL agreed to drop race bias in concussion claims. It had previously been settling concussion claims using a “race-based formula that assumes Black players have a lower level of cognitive function,” according to a BBC report. Let that sink in.

My questions are: How is it possible that this is happening in 2021?! And how did this practice not trigger a red flag in any of the doctors’ and insurance claim professionals’ brains? The answer to both questions is rooted in systemic racism, which has a long ugly history in both the medical and health insurance industries. According to a BBC report, “Black players are assumed to possess a lower level of cognitive function than the average White player.” The keyword “assumed” reveals this practice by medical scientists is not based in fact. This is just the latest evidence (in a long history) of racial bias continuing within the medical field.

Dating back to slavery, medical experiments akin to torture were performed on African Americans of all ages. Harriet A. Washington’s book “Medical Apartheid: The Dark History of Medical Experimentation on Black Americans from Colonial Times to the Present” does an excellent job covering the very sobering topic of abuses in care and research performed on the Black population. Washington provides the example of James Marion Sims, who performed experimental vaginal surgeries on Black female slaves without anesthesia and is known to have performed the same procedure on white women while consistently providing anesthesia in those cases. Sims is considered the “father of gynecology.” It is examples like this that embody the foundation for inherent bias in medical textbooks. Unfortunately, these biases still permeate the medical field in grotesque ways. The NFL’s concussion claims protocol is one revelatory example.

It is not only trust in doctors that needs to be rebuilt. Consider the data from research studies and medical experiments that establish the foundations of medical education: This should be thoroughly scrutinized through a culturally competent lens. Many of the foundational studies performed contained systemic bias against people of color, such as the work by Sims. For generations, many, if not most, white doctors believed that African Americans possessed a high pain tolerance; and wisps of this myth continue to linger today.

Today, there are numerous stories of Black women, even notable wealthy Black women, who have experienced dismissive attitudes from medical professionals while in hospital settings, many resulting in near-death experiences. Tennis legend Serena Williams, for example, knew she was experiencing a pulmonary embolism while in the hospital birthing her daughter, but her medical team was dismissive of her claim. No one knows their body better than the person who inhabits it, especially an elite athlete. Another Black woman, Phoenix Jackson, is a friend of mine who went to her OBGYN’s office over concerns that her seven-month gestational unborn baby boy was moving around in an erratic manner; her concerns were dismissed. The baby died two days later because she was not taken seriously. Sadly, stories such as these are far too familiar. Still, the medical establishment protects both the health care professional and the profession itself from widespread scrutiny regarding racial bias in medical practices.

In 2019, the Centers for Disease Control (CDC) publicly acknowledged that systemic racism is the root cause of the disparity in maternal and infant mortality among Black women. Although maternal and infant mortality rates vary by state and city, national data show that Black women are at least three to four times more likely to die during childbirth. Their children have the same mortality rate disparity.

How do we mitigate and remedy these circumstances so that all humans feel seen and heard by medical professionals as they advocate for themselves? It should not be a mystery why distrust runs rampant across the Black community toward a health care system built on a bedrock foundation of white supremacy for the primary benefit of white people. Building stronger trust in the medical industry among nonwhite populations, particularly Black Americans, may take generations and extensive cultural competency reprogramming within the medical system.

The Indiana State Department of Health (ISDH) has launched and/or supports several programs to bridge trust with communities of color, including a doula program that supports women throughout pregnancy, childbirth, and after-care with new mothers until their baby is a year old. Data show using a doula for support during and after pregnancy drastically reduces the maternal-infant mortality rate.

Another support program is the Black Barbershop Health Initiative, which recently celebrated its 10th anniversary. Black males have the highest mortality rate in Indiana. Additionally, high rates of heart disease and diabetes are more common among Black males than any other demographic. The free health screenings held during the Black Barbershop Health Initiative encourage early intervention if there are signs of concern for a man’s health. The barbershop is culturally a trusted location and serves as an ideal place to help bridge the trust gap through informed communication in a safe space. States across the country have their own Band-Aid programs related to health disparities, and I keep wondering how long it will take for this house of cards to collapse.

Of course, adjusting racial attitudes and perceptions throughout the nation’s health care system is a huge task. The question, “How do you eat an elephant?” is answered by, “One bite at a time.” With the history of bias in the health care industry, there’s an enormous elephant of distrust to eat. How do we heal from this? How do we ensure medical professionals do their jobs without biased regard for socioeconomics or the color of someone’s skin? How do we build trust so that individuals are regularly engaging in wellness visits that can reduce the number of emergency room visits? The answer is multifaceted and will require strong cultural competency programming.

When someone feels respected, seen, heard and trusts the people they engage with for medical treatment and care, they won’t wait until their health deteriorates to the point of emergency to seek medical intervention. Imagine the positive ripple of that.

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