Critical Race Theory Application: Racism in Healthcare
Introduction: What is Critical Race Theory?
Critical race theory (CRT) is a framework for examining the effects of race and racism. We use CRT to dissect the systems of racism, including how it affects those being oppressed by cultural representations of race. This theory understands the social construct of race as well as intersecting discriminations behind it (Daftary, 2018). Comment by Whitney Olsen: I would use “a” unless it’s the sole definitive framework for this. Comment by Whitney Olsen: Two “it”s in this paragraph can be confusing. Do you know how your professor feels about pronouns? “We use CRT to dissect the systems of racism, including how racism affects…” might be a stronger sentence, but if your professor is a hardcore no-pronouns-in-academic-writing type, that won’t work. 😛 Maybe “Analysts apply CRT to dissect…”?
Racism is defined in the Merriam-Webster Dictionary as a “belief that race is the primary determinant of human traits and capacities and that racial differences produce an inherent superiority of a particular race.” Under this definition, racism is explicitly intentional and a conscious thought process where people decide they are superior to others based on race. CRT challenges this broad idea to investigate the implicit biases that constitute racism today. A better current definition of racism in our society comes from Gillborn (2005),
‘The collective failure of an organization to provide an appropriate and professional service to people because of their color, culture, or ethnic origin. It can be seen or detected in processes, attitudes and behavior which amount to discrimination through unwitting prejudice, ignorance, thoughtlessness and racist stereotyping which disadvantage minority ethnic people.’
This description of racism better explains that a racist intent isn’t necessary to produce a racist outcome.
Critical race theory emerged as “an attempt to expose the ways in which racism continues to affect every aspect of the lives of people living in the United States” (Daftary, 2018). CRT is important because it demonstrates how racism continues to impact our society today in more implicit ways. Critical Race Theory may appear pessimistic, with its central focus on racism, but CRT’s purpose in uncovering racial discrimination is to identify racial inequity and promote change in the system (Gillborn, 2005). With CRT, we can identify the social factors behind biased attitudes and attempt to diminish the extent of oppression experienced in our society today. Comment by Whitney Olsen: Be careful to be consistent. In other places you capitalize all three words when you write it out, so make sure it’s capitalized the same way whenever you write it out throughout the document. Comment by Whitney Olsen: But what IS CRT? As jane is off the street, I don’t understand at this point how CRT is done or how it is used to analyze things. What is the framework/system?
For this paper, I have chosen to use critical race theory to examine our current healthcare practice and its impact on the black American population. Black Americans have reported prejudices and discrimination within the healthcare community for decades. There is a significant difference in how well the black community fares regarding major health indicators in comparison to other racial/ethnic backgrounds in this country (Lewis & Van Dyke, 2018). The health of black individuals and their healthcare outcomes are much lower than those of white Americans or other minorities in the United States. I aim to examine where this disparity came from, and whether there is a deeper cause behind the significant difference in healthcare received by black Americans versus Americans of other racial and ethnic backgrounds. Comment by Whitney Olsen: Are you examining CRT, or using CRT to examine the healthcare situation?
I will use critical race theory to look at the effects that discrimination in health care has had on the black population in America as well as some of the possible reasons behind this discrimination. I will also examine the types of healthcare discrimination that affect the black community as well as the intersecting points of gender, age, and socioeconomic status.
Nearly everyone needs healthcare at some point in their lifetime. Stepping into a doctor’s office, going to an emergency room, or making any other attempt to receive health services creates a power dynamic between the healthcare professionals and the person seeking aid. The healthcare professionals have a great deal of social power on their side: they have a degree, specific knowledge, and the necessary experience to provide a patient with the appropriate services and healthcare outcomes the patient needs. However, when a person of color seeks help from a healthcare professional, the outcome that person receives varies greatly depending on the implicit biases of the professional. When a black patient steps into the office of a white healthcare provider, the power dynamic between professional and patient is even larger – and larger in different ways – than compared to a white patient stepping into that same office.
Identification of Practice: Narrative
Many studies have shown poor patient-provider interactions when a patient is a person of color; these studies have also shown that patients of color have less authority and decision-making power in healthcare settings. In a national survey, 32% of Black Americans reported having experienced racial discrimination in a healthcare setting (Attanasio, 2019). Black patients are frequently given less control over their treatment, given fewer alternative options, and are rarely given the freedom to make decisions regarding their own treatment (Escarce, 2005).
Primary care doctors treat many minorities differently than their white counterparts, including providing poorer medical care and longer wait times for office visits. This has led to many people of color seeking out hospitals and emergency services for care rather than having a regular primary care physician (Hollar, 2001). Unfortunately, this only leads to further discrimination; the chances of being marginalized and dehumanized are higher in an emergency, especially one where the doctor-patient rapport is weakened by the short-term nature of the relationship.
Studies have further shown that a patient’s race can contribute to their diagnosis. Black males are significantly more likely to be diagnosed with schizophrenia than they are with other affective disorders (Hollar, 2001). This marginalization has been occurring for decades and the over-diagnosis of schizophrenia in black males is growing. Whether this over-diagnosis stems from the stereotype itself (Hollar, 2001), or from black males’ cultural mannerisms – i.e., how they express themselves or express certain other mental health issues in ways that are unfamiliar to most white physicians – it is still occurring. Comment by Whitney Olsen: I know it’s late in the game, but if you could get a source for the stereotype of black men being schizophrenic, that would go great here.
Black men are not the only ones experiencing discrimination in our healthcare system. The care of black children is also greatly impacted by the healthcare system. Black children are twice as likely as white children to be born prematurely, die before the age of one, and suffer low birthweight (Hollar, 2001). This may be due to the poor care given to their mothers during childbirth and pregnancy. Comment by Whitney Olsen: I kind of want to say “almost certainly” here, but you probably would need a source for that 😛
Black women in healthcare situations have even less authority than black men, especially when in a childbirth setting. Black women aren’t allowed to have an active role in their own care and perceive discrimination from healthcare providers (Attanasio, 2019). Stereotypes abound of black women being promiscuous, aggressive, and having children to gain government financial support. Clinicians could dismiss an assertive black woman as an “angry black woman” and may perceive behavior from a black woman as more aggressive and non-compliant than the same behavior from a white woman. These stereotypes bring implicit, widespread discrimination from practitioners. Black women also tend to be pressured more frequently into cesarean sections, as well as given fewer options in their general healthcare. When these women try to refuse certain care options, clinicians do not react well and often label them as “problem patients,” further adding to the stigma (Attanasio, 2019).
Being questioned or treated differently in a healthcare setting can be further affected by the patient’s insurance. Black women have been exploited and have reported receiving poorer care than white women due to their insurance (Attanasio, 2019). The insurance that a black patient has can be restricted by financial resources and socioeconomic status. If financial resources are limited, the range of healthcare choices (both in insurance and in care providers) may also be limited.
Black Americans are three times more likely than white Americans to have a lower income (Hollar, 2001). This can contribute to the available quality of care for people in these communities. Lack of safe and reliable transportation is also higher in communities of low socioeconomic status (SES), which greatly decreases the ability to get proper care when needed. While socioeconomic status is a contributing factor to our current healthcare crisis, that status also leads back to racism. It circles back to the black communities in this country having fewer resources and lower SES due to the continuous oppression those communities have experienced. Comment by Whitney Olsen: Define
Critical Race Theory Applied: Counter-Narrative
These narratives of the discrimination received by black people in healthcare all appear to follow implicit biases – whether a stereotype, stigma or miscommunication. Further in-depth, this discriminatory treatment could be due to the narrow-minded process of practitioners. The lack of ability to communicate brings physicians to fall back on a routine instead of taking a more individualized approach to breaking communication barriers. Comment by Whitney Olsen: This needs… something.
While doctors tend to report lower empathy towards black patients. Jose´ Escarce (2005), found that “White doctors perceived black patients as more likely than white patients to abuse drugs and alcohol, to be unintelligent and uneducated, and to fail to comply with medical advice, even controlling for patients’ observable characteristics.” This dehumanization of black patients oppresses them into a powerless state when they try to receive healthcare.
The white providers might question a black patient’s ability to make decisions or what they would consider as a “smart choice,” and may view their medical knowledge as making them superior to their black patient. Whether this is intentional or not, these implicit views greatly impact the care given to the patient. When healthcare providers are making choices for their patients instead of presenting the patients with options and information and allowing them to determine their care, the providers exploit the power dynamic in a patient-provider setting.
Black patients will usually choose black healthcare providers when the option is available to them. When being treated by a provider of the same race, black individuals report better quality of care, higher satisfaction with their care, and greater trust in their doctor (Escarce, 2005). While this is a better situation for black patients when the option is available, it is not ideal. Black patients should receive the healthcare they deserve regardless of the race of their provider.
At present, three potential ideas appear to be the best available options to help improve equity and diminish discrimination in the healthcare setting. First, we can and should provide interventions and education on cultural competence for healthcare professionals, as well as acknowledge implicit biases and microaggressions to improve communication between white doctors and patients of color. Second, we need to empower patients of color to strive for better communication with their healthcare providers and be more involved and informed with getting the healthcare that they need despite these oppressive barriers. Third, increasing the number of healthcare providers of color and of different cultural backgrounds in the healthcare field will create a better perspective for those working in healthcare and give patients more options when selecting a healthcare provider (Escarce, 2005).
While race is a social construct, racism is permanent. Implicit and explicit racism affects the lives of minorities in healthcare as well as their everyday lives throughout our society. It is this constant weight of oppression that Critical Race Theory strives to alleviate by determining the causes so that we may prevent further discrimination and undo the damage that has already been done. As a terrible sort of irony, living under consistent oppression leads to greater stress, which increases health risks; the racism in our healthcare systems is working against the people who may need proper healthcare the most. This is a cycle that our society hasn’t yet broken, but I am hopeful that with further analysis and application of CRT, we can develop ways to decrease racial discrimination in our healthcare system. Comment by Whitney Olsen: confusion
- Attanasio, L. B., & Hardeman, R. R. (2019). Declined care and discrimination during childbirth hospitalization. Social Science & Medicine, 232, 270–277. https://doi-org.du.idm.oclc.org/10.1016/j.socscimed.2019.05.008
- Daftary, Ashley-Marie Hanna (2018) Critical race theory: An effective framework for social work research, Journal of Ethnic & Cultural Diversity in Social Work, DOI: 10.1080/15313204.2018.1534223
- Escarce, Jose´ J. (2005) How Does Race Matter, Anyway? Editorial Columns. HSR: Health Services Research 40:1, February.
- Gillborn, D. (2005). Education policy as an act of white supremacy: whiteness, critical race theory, and education reform. Journal of Education Policy, 20(4), 485–505. DOI: 10.1080/02680930500132346
- Hollar, Milton C. (2001) The Impact of Racism on the Delivery of Healthcare and Mental Health Services. Psychiatric Quarterly, Vol. 72, No. 4,
- Lewis, T. T., & Van Dyke, M. E. (2018). Discrimination and the Health of African Americans: The Potential Importance of Intersectionalities. Current Directions in Psychological Science, 27(3), 176–182. https://doi.org/10.1177/0963721418770442