Racism in Health Care

Five leading healthcare and health experts in Houston led a virtual discussion on racism and inequity on June 17, 2020. Excerpts from each of the speakers are below, followed by the video of the event.



History of Mistrust of Health Care in Black Communities

Dr. Ann Barnes, Chief Medical Officer, Harris Health Systems:

“[I]t’s important that we in the healthcare system also reflect on whether or not as an organization we are engaging in practices that might make members of our community, our African American community feel undervalued or ignored, especially as it relates to their health status. So thinking about the history of mistrust of healthcare entities in the health system, we often go back to the Tuskegee Study… [African American men] were enrolled in a study for 40 years even when a treatment was available…[T]here was an identified treatment that could help them clinically and from a health standpoint, and that was withheld from these gentlemen. So a lot of historical reasons why communities of colors would be unwilling to openly trust health institutions… Patients who mistrust are less likely to engage in routine medical care.”

A personal story of implicit bias

Dr. Charlene Flash, CEO, Avenue 360 Health and Wellness:

“I’ll take a moment and tell a brief story about a family member. My husband’s mother was at home, and she wasn’t answering her phone, so her daughter goes to the house to check on her, and she finds her down on the ground. She calls 911, and the ambulance comes and says, “Goodness. It looks like she may have had a stroke or something is wrong,” and so her daughter says, “Well, can you please take my mother to the emergency room?” And they say, “Well, maybe we shouldn’t do that because there’s so much COVID in the hospital that, potentially, it’s dangerous for her to go to the hospital.” So her daughter picks up the phone and calls me. I was on my drive to work, and says, “Charlene, what do you think about this?” And I said, “Please turn to the ambulance driver, and ask him if that’s what he would do for his own mother. If he thought his mother was having a stroke, would he leave her in the living room or would he take her to the hospital?” So they took her to the hospital. When they got to the hospital, the emergency physician conducted a cat scan to evaluate her brain, and so the daughter called me again and said, “They’re discharging us. She’s had a cat scan and everything looks good,” and I said, “Well, how does your mom look? Does she look good?” “No, she still is having difficulty speaking, and she still has an unequal face.” So I said, “Well, the way to diagnose a stroke is an MRI. Tell them you’re not leaving until she gets an MRI.” Well, long story short, she gets her MRI and she indeed, had had a stroke. So then it came time for her disposition, and the hospitalist said, “Well, she can walk.” and we’d initiated treatment for her, but I don’t want to discharge her to rehab because she might catch COVID at the rehab and we know that the rehabilitative care that people receive in those first days after a stroke are critically important.

“Ultimately, she did get the care that she needed, but she shouldn’t have had to access a CEO of a health system in another time zone to get the care that she needed. None of these individuals were people who were wishing to harm her, but I believe that implicit bias did play a role in how this black woman, first immigrant from Haiti who was speaking her native tongue at the time because she was scared and had difficulty navigating the health care system, how she was treated had a lot to do with where she comes from, how she looked, and whether or not she was able to navigate the health care system.”

Racism and Disproportionate

Elena Marks, CEO, Episcopal Health Foundation:

“[W]hat we know from decades of research is that the conditions in which people live and work and play and pray, define their opportunity for good health. And racism, right there with poverty and intermingled with poverty, is at the root of virtually the bulk of the health inequities and health disparities that we see. And until we can deal with racism…we’re not going to have the conditions in which people lived that allow them to live a health life. And we’re seeing this in COVID right up front and center…Non–white populations [are] at a disadvantage just for being able to contract the condition in the first place. And then you add on top of that, the underlying health disparities, the prevalence of chronic conditions like diabetes and hypertension and asthma that make a person who gets COVID in the first place even sicker. Those conditions are more predominant in non-white populations. And so the non-white populations is more likely to catch the virus in the first place and is more likely to get sicker and to die from the virus if they do contract it. And all of that goes back to community and social and economic conditions. It has nothing to do with healthcare.”

Lack of Health Insurance (Cost)

Lisa Wright, CEO, Community Health Choice:

“Texas is not only the leader in uninsured overall, but we’re also the leader in uninsured for kids and we’re also the leader in uninsured for women of childbearing age. And so when you couple this together and you think about the five million people that are underinsured here in Texas, and you add in the COVID impact, now uninsured is an additional two million. You have over seven million people here in Texas that are uninsured and when we think about health equity, I always think about, at the very least, everybody deserves basic health coverage. Everyone deserves basic access to health insurance and, when we start thinking about cost as a driver and we couple in our safety net providers, Texas is fortunate to have quality safety net providers that are able to really drive and deliver care… [But] Texas has continued to say no to the expansion of Medicaid understanding that, if we did expand Medicaid, over one and a half million people would then have access to coverage here.”


Elena Marks:

“[A] partial solution in the health care space is implicit bias training and one of the things that a physical health foundation has supported is a lot of different kinds of implicit bias training, whether it’s based on race and ethnicity, even for adolescents and how they encounter the health care system. But the fact that it is implicit is what tells you that it is embedded in the culture and so a training that says say this and don’t say that is better than not doing it, but it’s really just the beginning and I think the more conversations we have where white people have to accept– so here’s the way I framed it in my head. It’s not my fault, but it is my problem and I have power that I can use to help solve it, and I think for white people to get past feeling guilty and ashamed, okay, it is what it is. If you stop there and try to defend yourself as I’m a good person and I only mean well, and I don’t have any explicit biases. That’s great. But you’re not solving the problem. And so, you have to be able to accept that that is the system. I didn’t build it, but I live in it, which means I’m a part of it. I’m a beneficiary of it. But that gives me the power to change it. And I think the more [inaudible]. We have to own this. It is ours to solve.”

Dr. Charlene Flash:

“[W]hat’s amazing about the discussion today is the level of comfort. It’s people, it’s white America saying, “How can I help? What do I need to do? How can I make a difference? I didn’t understand.” And so some of this makes me start thinking, we’re training up our physicians, how are we training up our physicians? How are we helping instill in our physicians that these biases do exist? How are we making them more sensitive to it and helping them understand that when sometimes you’re just doing your general communication, the person that’s looking across from you, just because of language and readability level, they don’t understand what you’re saying.”

Dr. Ann Barnes:

“I just wanted to add that I think on the healthcare side, we get comfortable saying we’re doing the same thing for everybody. But we’re not setting our goals on are we getting the same outcomes across all people because I think if the outcome was the real goal and a positive outcome was the real goal, then the lengths we would go to to ensure that a person gets that good outcome would depend on what their needs are. And we would go above and beyond for some of our more vulnerable populations than we do right now.”

Dr. Kimberly Pounds, Texas Southern University (moderator):

“I know there are hospitals across the country now that are actually inviting community members to be a part of their board because by the time you get down to the exam room and try to institute a model of shared decision-making, it’s really not as effective as when you have a community member at that table helping to shape the policy or even the training that needs to be done for the physicians.”