Older Black and Hispanic Americans Feel Discrimination by Health Providers

Among the survey findings:

• Women across all racial and ethnic groups are more likely to believe the health care system discriminates based on race and ethnicity — none more so than Black women, at 49 percent, compared with 40 percent of Black men. Among white respondents, 37 percent of women and 26 percent of men reported this, as did 34 percent of Hispanic women and 16 percent of Hispanic men.
  
  
• Twenty-five percent of Black and 23 percent of Hispanic respondents said they had been treated unfairly or felt that their health concerns were not taken seriously because of their racial or ethnic background. The same was true of just 3 percent of older white adults.
  
  
• Nearly half of those who experienced such discrimination reported being in fair or poor health, twice the rate of those who did not experience discrimination. Three-quarters of adults who have felt discriminated against have three or more chronic conditions or need help with daily activities.
  
  
• More than 4 in 10 respondents who reported discrimination said they are somewhat or not at all satisfied with the quality of their care, about double the rate for those who did not report discrimination.

Disparities appear greatest in U.S.

Older adults in the U.S. were significantly more likely to report racial and ethnic disparities in the health care system than those in 10 other high-income countries. In the U.S., 32 percent agreed the health care system treats people differently because of their race or ethnicity — nearly double the percentage in Canada, the country with the next-highest rate, at 17 percent. Adults age 65 and older were also surveyed in Australia, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland and the United Kingdom.

“What we’re seeing is that racial and ethnic discrimination in the U.S. health care system is not uncommon — in fact, it is dramatically more common than in other high-income countries,” said Laurie Zephyrin, M.D., study coauthor and Commonwealth Fund vice president for advancing health equity.

Findings reaffirm earlier studies

• A 2021 analysis of health care spending in the U.S., published in JAMA, found stark disparities across racial and ethnic lines in how medical resources are divided. Non-Hispanic white Americans accounted for 72 percent of the $2.4 trillion spent on ambulatory, inpatient and emergency care, nursing facilities, prescribed pharmaceuticals and dental care in 2016. No other single racial or ethnic group received an outsize piece of the health care pie.
  
  
• A 2021 Urban Institute report found Black Americans were 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. It estimated 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.
  
  
• A 2021 report from the Alzheimer’s Association on “Race, Ethnicity and Alzheimer’s in America” found race and ethnicity are barriers to quality medical care among the 6 million older Americans living with the disease.

What to do?

The report authors suggest that health care organizations should recognize the problem and do their part to address the discrimination found across the system to improve health equity and outcomes for patients of all ages.

“Biases against older people of color are experienced throughout the health care system, and they need to be intentionally rooted out. Health care organizations must be accountable for treating all patients equitably. Policies and practices can help ensure this accountability,” Zephyrin said.

Among some of the report’s recommendations:

• Identify instances of discrimination and publicly report discrimination data. “Older adults of color, particularly those with health concerns, have many interactions with health personnel. Allowing them opportunities to reflect on how they were treated and to report their experiences with discrimination are important steps.”
  
  
• Medical students should be taught the history of racism in the health system to better understand their own perceptions of race and implicit biases that could affect their treatment recommendations for patients.
  
  
• Promote racial and ethnic diversity in the health system’s workforce.
  
  
• Offer translation services and create medical forms in multiple languages for patients who aren’t fluent in English.