Black Americans are nearly three times as likely as whites to have experienced some form of discrimination by a doctor, other health care provider or their staff in the months leading up to and during the COVID-19 pandemic, according to a new report from the Urban Institute.
The report estimates that 10.6 percent of Black individuals faced such discrimination based on race, ethnicity, disability, gender, sexual orientation or health condition between September 2019 and September 2020, compared to 3.6 percent of whites and 4.5 percent of Hispanics.
The rates were even higher for Black women — 13.1 percent — and low-income Black individuals — 14.6 percent. Moreover, Black women were more than twice as likely as were Hispanic women (4.5 percent) or white women (5.2 percent) to say they experienced such discrimination. Low-income Blacks were also twice as likely to report discrimination as were low-income Hispanics (6.1 percent) or low-income whites (6.2 percent).
"Discrimination and unfair judgment in a health care setting can result in serious ramifications to health and have cumulative adverse effects on people's lives,” Dulce Gonzalez, a research associate at the Urban Institute, said in a statement.
Public Policy Changes Needed
The report suggests that health care providers need to be educated about this pattern of discrimination and taught to acknowledge and recognize racism and other forms of bias.
The COVID-19 pandemic, “has brought to the surface the history of racial discrimination and the historical mistrust in health care institutions, individual providers and government policies,” said Jean Accius II, AARP senior vice president for global thought leadership. “Addressing discrimination is a critical barrier to achieving equity in health as we age. AARP recognizes that there are serious concerns among many people, especially in the Black community, that reflect shameful moments in American history where the medical community violated their trust. That's why AARP has created resources to continue to educate its members and the public about COVID-19 vaccines. If we do not engage in interventions to establish trust, simply providing equal access to services does not help."
The Urban Institute researchers also say more effort is needed to diversify the “racial, economic, linguistic, and educational backgrounds of physicians and other health professionals so that they more closely resemble the communities they serve.” The report recommends targeted scholarships and outreach into underrepresented communities through mentoring and tutoring programs.
"The continued prevalence of discrimination and unfair treatment in health care settings, particularly for Black individuals, cannot be tolerated anymore,” Mona Shah, senior program officer at the Robert Wood Johnson Foundation, which sponsored the research, said in a statement.
Types of Discrimination
The report was based on data from the latest Urban Institute's Coronavirus Tracking Survey, a nationally representative survey of adults ages 18 to 64 that was conducted between Sept. 11, 2020, and Sept. 28, 2020.
Survey participants were asked whether in the last 12 months they had ever felt a doctor, other health care provider or their staff judged them unfairly or discriminated against them based on their race/ethnicity, gender, gender identity, sexual orientation, disability or a health condition.
Race or ethnicity — at 3.0 percent — was the most cited reason for discrimination or unfair judgment, followed by gender or gender identity (2.2 percent), a health condition (2.1 percent), disability (1.4 percent), and sexual orientation (0.9 percent).
Black individuals were more likely than Hispanics or whites to cite race or ethnicity as the perceived motivator behind discrimination or unfair judgement they experienced while seeking health care in the past year. (7.9 percent versus 3.8 percent or 1.1 percent, respectively).
Blacks were also more likely to cite discrimination based on a health condition (5.7 percent versus 1.3 percent or 1.6 percent, respectively) and based on sexual orientation (2.7 percent versus 0.4 percent or 0.7 percent, respectively) than Hispanics or whites.
Findings May Underestimate Discrimination
The study researchers suspect their findings may underestimate how likely it is for patients to be discriminated against by health care providers, noting that survey participants may have avoided health care or received care by telephone or video during the coronavirus pandemic.
"With fewer in-person contacts with the health care system, we would expect the reported prevalence of discrimination or unfair judgment to be lower,” they wrote.
The researchers also pointed to other recent surveys that asked similar questions about discrimination in the health care system. These polls included adults over age 64, who may interact more frequently with health care providers, thus raising the chances of encountering discrimination, the researchers suggested.
A Commonwealth Fund and Harvard T.H. Chan School of Public Health survey found 19 percent of Black adults said that in the past 12 months they or someone in their household had experienced discrimination when going to a doctor or health clinic.
In addition, 20 percent of Black adults said they felt that in the past 12 months they had been treated unfairly while getting health care for themselves or a family member because of their race or ethnic background, according to an October 2020 Survey on Race and Health from the Kaiser Family Foundation (KFF) and ESPN's The Undefeated.
Peter Urban is a contributing writer and editor who focuses on health news. Urban spent two decades working as a correspondent in Washington, D.C., for daily newspapers in Connecticut, Massachusetts, Ohio, California and Arkansas, including a stint as Washington bureau chief for the Las Vegas Review-Journal. His freelance work has appeared in Scientific American, Bloomberg Government and CTNewsJunkie.com.
More on Health Disparities
- How health care gaps have amplified the danger from COVID-19
- Systemic racism and vaccination access
- How race and ethnicity affect Alzheimer's care