When George Floyd was held down by Derek Chauvin's knee on his neck, repeatedly calling out "mama" and ignored until he died, the Black Lives Matter movement sprung into action. People were outraged by his unnecessary suffering and ultimate wrongful death.
The sad fact is that disproportionate rates of unnecessary suffering and death occur within the Black community. African Americans were 2.8 times more likely than white Americans to be hospitalized due to COVID-19, and twice as likely to die from it. Some of this difference is attributed to factors beyond our control such as differences in vitamin D absorption. Living and working conditions also put many African Americans at greater risk for contracting COVID-19. We cannot absolve ourselves from all responsibility to help fix these issues.
Differential outcomes predate COVID-19. Black patients have to wait longer for pain medication in emergency departments compared to white people with identical injuries. They are not the only ones: Hispanic patients are seven times less likely to receive opioids in emergency departments than non-Hispanic patients with similar injuries. This is in comparison to white men who are perceived by doctors as reluctant to report pain, as if all white men are tough Arnold Schwarzeneggers, when in fact, many are Jason Schwartzmans.
Medicine is an interaction, and I have found that patients value their physicians' personality and demeanor as much as they value their care. When the interaction is impaired, so is health. Black patients consistently experience poorer communication quality, information-giving, patient participation and participatory decision-making than white patients. The differential outcomes are indisputable. The all-cause mortality rate of Black populations was 24 percent higher than among white populations nationally. This was true for over 10 years: between 2009 and 2018, resulting in 74,402 excess Black deaths annually in America's 30 biggest cities.
The health disparities come with emotional hardships. African American lupus patients adhere much less to their medications compared to Caucasians (with some immunosuppressants the gap is 26 percent versus 75 percent). Their low adherence is associated with perceiving fewer compassionate respectful interactions with health care providers. All patients need their doctors to care about them. Like children who need their parents' care, when patients don't receive the care they need, they may respond with self-harm. This happens by not taking their medication as prescribed, even if they are diabetics, or HIV patients.
Doctors should be committed to reducing suffering and saving lives—all lives. They should want to change these differential care outcomes, but that is more difficult than it seems. Doctors are human, and as such, are susceptible to implicit bias—the tendency to act on cultural stereotypes about social groups. This bias occurs subconsciously and can be at odds with a person's explicit beliefs. Furthermore, since doctors constantly read scientific material, they tend to believe that their judgments are impartial, and have less motivation to examine their own actions, treatment choices and communication.
Patients should want to change this reality. But this is also more difficult than it seems. In a study of 137 patients with known or suspected lung cancer, investigators found that Black patients received less information, but not because the doctors volunteered less. Black people were less likely than their white counterparts to push their doctors for more information during consultations, but they are not to blame for it. Asking for information and being critical of the information you receive are important aspects of health literacy. In theory, anyone can do this. Just like anyone who suffers excruciating pain and receives no medication in the ER can demand help. In practice, standing up to a health professional, or to anyone who is refusing to listen is exceedingly hard, especially when that person is in a position of authority. It takes what French sociologist Pierre Bourdieu called "embodied cultural capital." This represents the long-lasting dispositions of your mind and body, and the way you carry yourself in the world, thanks to where you come from.
Let's look at college enrollment rates. In 2019, they were 41 percent for white people and 37 percent for Black people. But not all colleges are equal. Black and Hispanic graduates generally attend institutions that have less money to spend on offering a quality education. Compared with 18 percent of white graduates, under 13 percent of Black students attended nonprofit four-year institutions, like Ivy League schools, MIT and Caltech.
Homeownership, another mark of stability and status, is lower among African Americans. In fact, 2019 saw the largest home ownership gap between white non-Hispanic Americans and Black Americans since 1994. For many Black Americans, the future holds no promise of rectifying this situation: projected home ownership rates in 2040 for Black Americans in Texas, California and Minnesota remain below those of all other races. This can affect one's sense of standing in the world.
If doctors are not trained or incentivized to fix patients' information gaps, and patients cannot fix them on their own, health systems need to step in. One way to do this is to suggest unified protocols for pain management, among other measures. Another way is to introduce health and wellness materials at a basic readability level, so it is widely intelligible, through mediums like video messages, helping everyone, including those who do not stand up for themselves and can't demand more information to take good care of themselves. Health care systems need to ensure that we are all communicated to in a way we can understand, and that we are all treated with evidence-based, not bias-based, medicine.
Black lives matter, of course. So do Hispanic lives. So do female lives. Any life matters, regardless of race and gender. And everyone deserves to receive the best possible care, regardless of race or gender.
Talya Miron-Shatz, Ph.D. is a top medical decision-making expert and the author of YOUR LIFE DEPENDS ON IT: What You Can Do to Make Better Choices About Your Health (Basic Books, 2021).
The views expressed in this article are the writer's own.
