The Quality Of Health Care You Receive Likely Depends On Your Skin Color ~ Erin Schumake

Unequal health care continues to be a serious problem for black Americans.

More than a decade after the Institute of Medicine issued a landmark report showing that minority patients were less likely to receive the same quality health care as white patients, racial and ethnic disparities continue to plague the U.S. health care system. That report, which was published in 2002, indicated that even when both groups had similar insurance or the same ability to pay for care, black patients received inferior treatment to white patients.

This still hold true, according to our investigation into dozens of studies about black health across multiple disciplines. More than any other single group, the black community is most likely to have negative health outcomes, including higher rates of breast and prostate cancer, high incidence of HIV/AIDS, higher rates of infant morality — along with high rates of childhood obesity and asthma in young adults. 

According to Karen M. Winkfield, a radiation oncologist and assistant professor in the department of radiation oncology at Harvard Medical School, racial disparities in health care and health outcomes exist across almost every single disease or condition. 

“In terms of the disparities, it’s universal,” she said. “There are disparities across almost every single disease entity.”


Behind The Numbers

Socioeconomic inequality accounts for much of the difference. Twenty-seven percent of people living in poverty are black, and studies consistently show that the least educated and lowest income peopleare the most likely to be unhealthy. 

“Financial status directly impacts health status,” Winkfield said. “They are inseparable. That’s the problem in this country — people make the assumption that people can just do. Well, you can’t. If you don’t have the resources, you’re not going to be able to care for your health in the appropriate way.” 

This is a Catch-22: People need education and information in order to make these good personal health decisions, two resources that economically disadvantaged individuals are less likely to have. Education is also a factor in making health changes on a community level. It takes education and political connections to effectively lobby local grocery stores to carry fresh fruits and vegetables, or fight to prohibit corner stores from selling tobacco to neighborhood youth. 

But inequality alone doesn’t account for the difference. Policy can address differences in access and income, but research finds that unconscious racism is far more insidious and harder to legislate against. Fully two-thirds of medical professionals display unconscious racial bias. And research has also shown that racial bias can lead to reduced trust between patients and their doctors, and causes black patients feel less respected by their doctors. 

“Layered on top of those social class inequities are racial inequities,” said Dr. M. Norman Oliver, director of the University of Virginia Center on Health Disparities. “While a poor, working-class white or a poor Appalachian white might have the same poor health standards as folks in inner-city Baltimore, the population attributable risk of being in that poor status is much higher in the African-American community. That’s a result of that racist discrimination being layered on top of the class inequities that we have.” 

Closing the gap

Though the numbers are grim, there are efforts to close these gaps. One initiative outlined in a 2014 New England Journal of Medicine study proved that requiring hospitals to report quality of care reduced racial disparities in health outcomes between 2005 and 2010 in 17 categories, including heart attacks, heart failures and pneumonia. And the Affordable Care Act has started to narrow the health insurance disparity, with the number of uninsured blacks expected to drop from 20 percent to 11 percent by 2016. 
These improvements, however, have limits. For individuals who didn’t benefit from the ACA’s expansion of Medicaid, and had to buy health insurance through the health care exchanges, there may be no increase in health care access at all, said Oliver. “It’s a little problematic in that most folks can’t afford anything other than the high-deductible plans,” he said. “Even though they have insurance, it doesn’t necessarily increase their access, because they can’t pay for things out of pocket.”

One way to combat discrepancies is to clearly identify them. In that spirit, we picked five disease areas representing both chronic and infectious conditions — childhood obesity, infant mortality, childhood asthma, breast cancer and HIV infections — to illuminate how much worse outcomes are for African-Americans in nearly every category of health:

Black Women Are More Likely To Die Of Breast Cancer

The research: As The Huffington Post reported in October, despite advances in medicine over the past three decades, breast cancer survival among black women has not improved at the same rate as it has among white women. Today, black women have a 79 percent five-year survival rate, while white women have a 92 percent five-year survival rate. These numbers are particularly striking because white women have higher rates of breast cancer to begin with. 

Why is this happening? Socioeconomic factors including income, education, and occupation can mean fewer resources, less access to quality health care and worse health outcomes. In addition, life-saving clinical trials may be financially impossible for working-class women who can’t afford to miss a shift. As it stands, only five percent of clinical trial participants are black. “The advancements in screening tools and treatment which occurred in the 1990s were largely available to white women, while black women, who were more likely to be uninsured, did not gain equal access to these life-saving technologies,” Bijou Hunt, an epidemiologist at Mount Sinai Hospital in Chicago, told Reuters last year.

HIV Diagnoses Are Nine Times Higher In the Black Community


The research: Of the 46,381 people who received an HIV-positive diagnosis in 2010, approximately half were African-American or Hispanic. People of color were nine times more likely to be diagnosed with HIV than white individuals, and black women were 20 times more likely to be diagnosed with HIV than white women.

Why is this happening? Poverty underscores HIV transmissions, since limited access to health care can mean individuals are less likely to be educated about or practice safe sex, less likely to get tested for HIV, and may have less access to antiretroviral therapies than their higher-income counterparts. In addition, the disproportionally high incarceration rate among black men poses an infection risk for the black community. One in seven people with HIV has passed through a correctional facility, where recent reports show that rape and sex between inmates is commonplace.

Real and perceived stigma and discrimination against HIV-positive people of color decreases both the likelihood that individuals will seek treatment and the likelihood that HIV-positive people will be honest with their potential sexual partners about their diagnosis.

The Infant Mortality Rate Is Twice As High For Black Children


The research: Black children are two times more likely to die during their first year of life than white children. In Washington D.C., which, like many other big cities, has a high percentage of African-American and low-income residents, black infants are almost four times more likely to die before their first birthday.

Why is this happening? Devastatingly high infant mortality rates among people of color make it especially clear that not all groups have benefited equally from 20th-century medical advances. Factors such as poor maternal health, inadequate prenatal care, smoking during pregnancy, lack of education, infection, stress and racism may all contribute to infant mortality. 

“We know that one of the leading causes of infant mortality among African-Americans is preterm birth,” Michael Lu, an obstetrician-gynecologist and professor at the University of California at Los Angeles told McClatchy DC in 2007 when studies suggested stress may play a role in the long-stubborn mortality discrepancy. “We know that stress is an important risk factor, and it initiates the release of stress hormones leading to preterm birth and increase susceptibility for infection. The question is, do we think racial discrimination and racism is stressful?”

The answer to Lu’s question is “yes.” While existing peer-reviewed research on the psychological effects of racism on people of color is limited, psychologist Monnica Williams, a professor and director of the University of Louisville’s Center for Mental Health Disparities, believes there is a link between racism and post-traumatic stress disorder. “It’s a natural byproduct of the types of experiences that minorities have to deal with on a regular basis,” she said in a New York Times interview in June. “My training and study has been on post-traumatic stress disorder for a long time, and the two look very much alike.”

Black Children Are More Likely To Be Obese


The research: Compared to white children, black children and adolescents are more likely to suffer from obesity, defined as having body-mass indices greater than 30. This is especially troubling because of the myriad long-term health problems associated with obesity, including coronary heart disease, high-blood pressure, stroke, Type 2 diabetes and cancer. 

Why is this happening? Obesity is a tricky and somewhat circular issue. One possible contributing factor to childhood obesity among black children that they are less likely to be breastfed than white children. According to the World Health Organization, formula-fed infants tend to consume higher protein levels, which can lead to weight gain and obesity development later in life. Breast milk also contains important hormones that may contribute to healthy weight balance. Breastfeeding is not, however, always an issue of personal choice. That black women generally tend to make less money and be less well-educated are barriers “because you can’t access jobs where you might have a maternity leave, or can negotiate a private space to pump, or feel you are able to nurse at work,” Monique Sims-Harper, director of A More Excellent Way Health Improvement Organization and a spokeswoman for the California Breastfeeding Coalition, told the BBC.

Additional factors that can trigger obesity include the lack of access to health foods in low-income communities, limited opportunities for physical activity (people living in high-crime communities may be less likely to let their kids play outside, for example), and a lack of education about nutrition. Bringing the issue full circle, a higher weight is associated with lower earned income, at least among women. 

Black Children Are More Likely To Have Asthma 


The research: Black and Puerto Rican children are more likely to have asthma than any other groups. Moreover, black individuals of any age are three times more likely than white individuals to die from asthma.

Why is this happening? Living in poor-quality low-income housing, which could include lead paint and mold, is a likely asthma trigger, a condition that is not limited to city dwellers. African-American children living in Inner-city and rural low-income areas were found to have equally high asthma levels in a recent study published in the Journal of Allergy and Clinical Immunology

While there may be a genetic component to asthma, poverty seems to be the overwhelming risk factor. As of 2013, almost a third of peopleliving at the poverty level were black. Poverty can also contribute to other health behaviors that can cause or worsen asthma. According to NPR, “Second-hand smoke is also a risk for children, and poor people tend to smoke more. And people in poverty, no matter where they live, also experience day-to-day stress.”

13 Quotes by Black Women on Survival and Critical Self-Preservation ~ Altheria Gaston

In her essay titled “Sin, Nature, and Black Women’s Bodies,” Delores S. Williams writes about “spirit breakers” or “Negro breakers,” those who were hired by slave owners to break the spirit of slaves who seemed to be too confident, too uppity, and too independent. The sole purpose of these “spirit breakers” was to put slaves in their place and to convince them that their status as mere property would never change.

It would seem that the repeated offenses against Black women (and other women of color) serve what is perhaps a similar yet unintended purpose—to break the spirit of advocates and activists working towards equity and social justice. Those with broken spirits may be discouraged, hopeless, and just plain tired. The writers of The Combahee River Collective Black Feminist Statement articulate this point:

The psychological toll of being a Black woman and the difficulties this presents in reaching political consciousness and doing political work can never be underestimated. There is a very low value placed upon Black women’s psyches in this society, which is both racist and sexist.

Since we can’t depend on others to uplift and encourage us, we must do so ourselves. I offer you these quotes on self-preservation and survival to do exactly that—uplift and encourage.  


Audre Lorde in Oberlin College Commencement Address, 1989

“To face the realities of our lives is not a reason for despair—despair is a tool of your enemies. Facing the realities of our lives gives us motivation for action. For you are not powerless… You know why the hard questions must be asked. It is not altruism, it is self-preservation—survival.”

Sherley Anne Williams in “Surviving the Blight,” 1988

“And when we (to use Alice Walker’s lovely phrase) go in search of our mothers’ gardens, it’s not really to learn who trampled on them or how or even why—we usually know that already. Rather, it’s to learn what our mothers planted there, what they thought as they sowed, and how they survived the blighting of so many fruits.”

Elizabeth Alexander in “Praise Song for the Day,” 2009

“Some live by love thy neighbor as thyself / others by first do no harm or take no more than you need. / What if the mightiest word is love?  

Love beyond marital, filial, national, / love that casts a widening pool of light, / love with no need to pre-empt grievance.

In today’s sharp sparkle, this winter air, anything can be made, any sentence begun. On the brink, on the brim, on the cusp, / praise song for walking forward in that light.”

Melissa Harris-Perry in Sister Citizen, 2011

“Sisters are more than the sum of their relative disadvantages: they are active agents who craft meaning out of their circumstances and do so in complicated and diverse ways.”

Angela Y. Davis in an interview with Jennifer Byrne, 1999

“Well of course I get depressed sometimes, yes I do. But at the same time these changes never take place overnight. They always require protracted struggles and I can look back at my life and add all of the struggles I’ve been involved in, and I can see that we made a difference. We really did make a difference.”

Audre Lorde in A Burst of Light, 1988

“Caring for myself is not self-indulgence, it is self-preservation, and that is an act of political warfare.”

Patricia Hill Collins in Black Feminist Thought, 1990

“African-American women have been victimized by race, gender, and class oppression. But portraying Black women solely as passive, unfortunate recipients of racial and sexual abuse stifles notions that Black women can actively work to change our circumstances and bring about changes in our lives. Similarly, presenting African-American women solely as heroic figures who easily engage in resisting oppression on all fronts minimizes the very real costs of oppression and can foster the perception that Black women need to help because we can ‘take it.’”

Layli Maparyan in  The Womanist Idea, 2012

“Self-care is a way of maintaining both wellness and balance in the energetic economy of social and economic intercourse. Activists and caretakers who do not attend to self-care are vulnerable to burnout, and burnout in turn can breed alienation from both issues and communities… Self-care and care of others needs to be balanced.”

Barbara Omolade in The Rising Song of African American Women, 1994

“Women of color warriors are constant warriors who dig in bare earth to feed the hungry child, who pray for health the bedside of the sick when there is no medicine, who fashion a toy to make a poor child smile, who take to the streets demanding freedom, freedom, freedom against armed police. Every act of survival by a woman of color is an act of resistance to the holocaust and the war. No soldier fights harder than a woman warrior for she fights for total change, for a new order in a world in which can finally rest and love.”

June Jordan in “Where is the love?” 1978

“I am a feminist, and what that means to me is much the same as the meaning of the fact that I am Black: it means that I must undertake to love myself and to respect myself as though my very life depends upon self-love and self-respect. It means that I must everlastingly seek to cleanse myself of the hatred and the contempt that surrounds and permeates my identity, as a woman, and as a Black human being, in this particular world of ours.”

bell hooks in Sisters of the Yam, 2005

“Black women have not focused sufficiently on our need for contemplative spaces. We are often ‘too busy’ to find time for solitude. And yet it is in the stillness that we also learn how to be with ourselves in a spirit of acceptance and peace. Then when we re-enter community, we are able to extend this acceptance to others. Without knowing how to be alone, we cannot know how to be with others and sustain the necessary autonomy.”

Shanesha Brooks-Tatum in “Subversive Self-Care: Centering Black Women’s Wellness,” 2012

“Black women’s self-care is also subversive because to take care of ourselves means that we disrupt societal and political paradigms that say that Black women are disposable, unvalued. Indeed, people and things that aren’t cared for are considered expendable. So when we don’t take care of ourselves, we are affirming the social order that says black women are disposable.”

Florynce Kennedy, Unknown Source and Year

“You can’t dump one cup of sugar into the ocean and expect to get syrup. If everybody sweetened her own cup of water, then things would begin to change.” 

We all need refreshing from time to time. It is my hope that these quotes—some lesser known than others—from our foremothers and sisters in the struggle will invigorate your spirits in the days, weeks, and months to come.