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Table of Contents
Abstract ...........................................................................................................................2
Introduction .....................................................................................................................3
Causes .............................................................................................................................3
Effects .............................................................................................................................7
Cases ...............................................................................................................................9
Solutions........................................................................................................................ 15
Abstract
In an evolving social climate, racial disparities highlight flaws within systems that
citizens once believed to be beneficial. Recently, attention shifted to health care and
the unfair disadvantages targeting minorities. This paper focuses on the issues, effects,
and possible solutions to medical discrepancies. Prevalent gaps between ethnic groups
with respect to treatment, mortality rate, and treatment cost; results in minorities
harboring a negative perspective of medical professionals. In addition to the lack of
proper care minorities receive, adverse attitudes toward health care further bolster
health complications that result in unfavorable statistics (HealthyPeople.gov, 2020a).
The unsavory experiences reported by minorities perpetuate distrust for medical
professionals, cultivating tension and fear between the provider and the patient. By
analyzing sources, the paper will discuss how unrecognized bias affects treatment and
how it further preserves racism. Cases in which improper care resulted in dire
consequences will also be used within the paper to support the intentions of the main
idea. The paper will conclude with programs and activism groups that have taken steps
to reduce racial disparities in health care.
Introduction
A disparity is defined as a great difference (Merriam-Webster, n.d.). Within the
medical field, disparities exist in the form of disproportionate diagnoses and mortality
rates between races and ethnicities. This paper discusses the reasons that these
disparities exist, the effects of the disparities, cases of medical discrepancies between
races, and solutions and advocacy groups for medical reform.
The 1985 Report of the Secretary’s Task Force on Black and Minority Health,
organized by the Center for Disease Control and Prevention (CDC), emphasized the
importance of making race-centered health disparities a priority, recommending
solutions. The necessity for a movement dates back to 1950 when the mortality rate for
Black infants was estimated to be twice as high when compared to White infants.
Additionally, during the mid-1980s it is reported that when compared to non-Hispanic
Whites, Mexican Americans were 2.8 times more likely to be uninsured. Furthermore,
analyzing rates of death from unintentional injuries reveal that Native Americans rates
reached significantly higher numbers than other U.S. populations during the
mid-1980s (CDC, 1993).
Causes
Identifying and understanding social determinants of health is necessary to
acknowledge the relationship between population experience and the impact of place on
social and physical health. HealthyPeople.gov is a task force within the Office of
Disease Prevention and Health Promotion (ODPHP) and the U.S. Department of Health
and Human Services. They utilize social determinants and other criteria to provide
public health objectives over a ten year period. Social determinants of health include:
availability of resources to meet daily needs, access to health care services, quality of
education, transportation options, social norms and attitudes, socioeconomic conditions,
access to mass media, and culture. Physical health determinants include: natural
environment, built environment, housing and community design, exposure to toxic
substances, physical barriers, and aesthetic elements. Varying combinations of these
elements affect health within communities (HealthyPeople.gov, 2020b). Healthy People
2020 coordinated a structure demonstrating five crucial areas of social determinants of
health: economic stability, education, social and community context, health and health
care, neighborhood and built environment. Each area mirrors leading concerns that
constitute underlying components of social determinants of health.
It is important to analyze the social aspect of interracial interactions. The causes
of these differences range from explicit to implicit, ingrained, institutionalized, and
intentional or unintentional. Dovidio and Fiske (2012) analyzes the psychological
perception between patient and provider as one facet for imbalanced medical treatment.
The article states that a primary meeting between patient and provider triggers two
adaptive questions. The first question focuses on the cooperative intentions of the other
person. Cooperation solicits a feeling of warmth, whereas defiance comes across as
cold. The second question leads the perceiver to determine whether the other can
execute their positive or negative intentions. Perceived status influences inference of
competence. High status equates to competence and vice versa. The combination of
these two dimensions centrally govern individual reaction to others. This philosophy is
further perpetuated when medical mistrust presents itself between patient and provider.
The expectation from doctors that their Black patients are more likely to be less
knowledgeable and less active results in a lower likelihood for doctors to prescribe
effective medical treatment than what is given for White patients, such as in cases of
coronary bypass surgery (Dovidio & Fiske, 2012).
During a vignette study by Green, et al. (2007), prospective physicians were
tested for their implicit and explicit bias. Actions and behaviors performed at a
conscious level are categorized as explicit bias, whereas implicit bias is demonstrated in
an unconscious mind. Using an Implicit Association (IAT) test, internal and emergency
medicine resident participants from four academic medical centers in Atlanta and
Boston were tested for implicit bias. 287 participants received randomized clinical
vignettes of Black or White patients. The IAT used in this study was structured using a
photo of a Black or White patient with neutral facial expressions. The participants were
then asked to rate the likelihood of coronary artery disease (CAD) when the
hypothetical patient arrives with complaints of chest pain. They were also asked
whether they would prescribe thrombolysis treatment, and the firmness of their
suggestion.
Additional questions regarding negative and positive associations with each
respective race were presented in a rapid manner. Rapid testing reduces the chance of
the participant second-guessing their choice. This way, the results reflect their implicit
bias that occurs without conscious thought. To test explicit bias, the survey asks the
participants to rate on a scale whether they prefer Black or White Americans, their
feelings of warmth toward each group independently, and the belief of Black and
White cooperative nature with respect to medical procedures. The end of the survey
asks participants about the demographics of their region, thrombolysis effectiveness,
and pre- and posttest opinions regarding unconscious bias and IATs. When analyzing
the explicit bias, respondents indicated impartial preference on a five-point scale and
equal measures of warmth on a ten-point scale for Black and White Americans. The
participants also recorded equal cooperative behaviors for Black and White patients
with respect to medical procedures. Queries on general cooperativeness resulted in the
same equal measurements. With respect to implicit bias, the IATs reported that
participants demonstrated substantial association of negative attributes to Black people
than to White people. Further analysis of responses revealed that implicit bias
influenced treatment decisions with respect to the thrombolysis treatment for the
hypothetical patient. When graphing for correlation, the increase in antiblack bias
resulted in decreased thrombolysis treatment for Black patients (Green, et al., 2007).
In addition to bias and stereotype, inaccessible health care contributes to racial
health differences. Communication often breaks down and access to appropriate health
information is limited in areas where citizens are impoverished and lack education
equal to other areas. Differences in sociocultural translation of necessities and
principles become lost because of racial bias within the health system. Often, these
mistranslations occur at the hands of White framing. White framing is language that is
purposefully vague and described as “euphemistic or white concealing” (VardemanWinter, 2017, p. 631). The term “racial disparities” is used as an example. Racial
stereotypes, expected images, and ideologies of differing racial groups is connected to
prejudiced practice. These subconscious behaviors endure because of the subtle,
hidden nature within language. Identifying and controlling White framing presents
difficulty due to the evolving face of racism. Health communication study focuses on
racism on account of the suggestion that a privileged group decides meaning and
messages of health for those with less privilege (Vardeman-Winter, 2017).
Most often, The National Institutes of Health (NIH) is more likely to invest
funds into White researchers than to Black researchers. White researchers initiating
studies limits the perspective to a White standpoint. Social and physical distance from
target populations cultivates systemic racism and a lack of participation from people of
color. Communicators stemming from White communities with college education means
that communities experiencing health disparities are not reached. These areas are often
populated by people of color with less education and income compared to the
researchers (Vardeman-Winter, 2017, p. 631).
With respect to medical research, medical mistrust contributes to differential
statistics. Not only do researchers remain within populations from which they are
familiar, populations of color refrain from participating in studies that could level the
data. Because of past exploitation of people of color in the past, such as the Tuskegee
Trials, the Black community considers these offenses unforgivable. Black
communities maintain a suspicion toward any future research for fear of manipulation
(Ridley-Merriweather & Head, 2017).
Effects
Experiences with racism outside of the clinical environment correlates with
reports of poorer health. Negative encounters influenced by race relates to perceived
bias in clinical interactions. Racial and ethnic minorities believe that their race
contributes to unfavorable experiences with medical professionals. Medical mistrust
results from a perception of bias and predicts less favorable behaviors from Black
patients, from which negative provider and care quality reviews emerge. Whether or
not the reviews stem from truth or perception, a breakdown in trust, lower medical
adherence, and utilization of health care services occurs (Dovidio & Fiske, 2012).
Overall, less healthy populations ensue.
Lack of cultural adaptation to mental health attitudes within differing
backgrounds leads to ineffective treatments for groups such as refugees. Because of
stigma within minority groups revolving around mental illness, programs within the
United States must reform and refine themselves to adequately respond to the needs of
refugee groups and others like them (Polonsky, et al., 2018). Programs and treatments
must thoroughly inform groups as well as diversify the staff in order to reach target
audiences to instill trust that the program is effective, promoting participation.
Systemic racism plays a key role in racial disparities, especially in research
regarding myocardial infarctions. Research articulates that states with higher instances
of systemic racism record increased racial disparities in myocardial infarction
diagnosis and treatment methods when compared to states with weakened structural
racism. The authors of the study conclude that “Structural racism may harm the health
of groups that are target with discrimination, but at the same time benefit those in a
position of dominance” (Vardeman-Winter, 2017, p. 630-631).
Potential racial bias from providers may be subtle and unintentional.
Researchers consider sensitivity to bias in Black patients. Trust in medical
professionals following a visit differs between Black and White patients. Prior to the
visit, Black and White patients report similar levels of trust. Following the visit, Black
patients reported less support and partnership, as well as less information presented.
Better comprehension and awareness of interracial interactions can supply researchers
with better acumen into possible bias contributed by both the provider and the patient
to reinforce health care and status (Dovidio, et al., 2008). Research findings into
interracial interactions correlate health disparities with race discordant interactions and
health disparities. Medical avoidance behaviors prevent Black patients from pursuing
care. Fear of perceived discrimination directly affects psychological distress and poor
health status. Patients experiencing negative stereotypes seek treatment less often and
report lower care satisfaction. Positive patient/provider relationships result in patient
engagement, medical information recall, adherence to treatment, satisfaction with care,
and health outcomes.
Cases
A prolific portion of history that is shaping our future is the period of time in
which our world has undergone quarantine from Coronavirus. NPR reported that the
2020 pandemic of COVID-19 targeted communities of color. People of color (POC)
in the United States (US) are reported as more likely to contract and pass away from
COVID-19 when compared to White people and their portion of the population. One
of the causes for COVID health disparities, reported by The GW Hatchet, is
asymmetric access to health services and adequate information. The city of
Washington D.C. reports that three-quarters of COVID-19 deaths have been Black
citizens, in spite of Black people making up less than half of the D.C. population. A
diagram of the wards within Washington D.C. illustrates the concentration of cases.
The wards where more than half of the population are Black are experiencing the
highest number of cases.These disparate health statistics surrounding COVID-19 have
demonstrated the truth of living in poverty and of living as a person of color
(Govindario, S., 2020; Wood, D., 2020).
The CDC records pregnancy-related deaths as mainly affecting Black and
American Indian/Alaska Native (AI/AN) women (“Racial and Ethnic Disparities,”
n.d.). With a two to three times greater chance of dying from pregnancy, and the
preventability of pregnancy-related deaths, racial and ethnic disparities should cease.
However, this statistic remains and has remained throughout time. Between 20072008 and 2015-2016, pregnancy disparity statistics changed only slightly. Black and
AI/AN women over thirty were four to five times more likely to die from pregnancyrelated causes. Pregnancy-related deaths are measured per 100,000 live births, or
pregnancy-related mortality rates (PRMR). States that reported low PRMR, that also
contained women with higher levels of education still record compelling distinctions
in race statistics relating to pregnancy.
According to a study by the Immunization Services division of the National
Center for Immunization and Respiratory Diseases published in American Journal of
Preventive Medicine (2015), Hispanics, non-Hispanic Asians, and non-Hispanic
Blacks compared to non-Hispanic Whites possess lower vaccination coverage of the
influenza, pneumococcal, Td, shingles, and HPV vaccinations. Each race was split into
two age groups (19-64 and 65+) and analyzed for coverage by vaccine. While the
differences between races narrowed for varying vaccines, the divide persisted
following consideration of access to health care and socio-demographics for most of
the vaccines and groups. While these numbers present themselves in racially and
ethnically diverse adults, childhood vaccination disparities in racially and ethnically
diverse children report substantially low to unobserved differences. To enter into the
school system, vaccinations are required in addition to provisions given by the
Vaccines for Children program (VFC). VFC administers vaccinations to children
without insurance, children on Medicaid, and other select populations. These
requirements and programs may contribute to vaccination coverage in children and the
diminished racial and ethnic differences. The perspectives on vaccinations and health
care vary, in addition to access to quality care and vaccination safety (Lu, et al. 2015).
Rates of osteoporosis reveal disparities between Black and White women.
Research states that physicians who engage in “high discretion procedures”
(recommending a test, i.e. osteoporosis) bolster disparity appearances (Dovidio, et al.
2008, p. 4). Furthermore, Black women are less likely to be prescribed proper
medication when compared to White women also diagnosed with osteoporosis
(Dovidio, et al., 2008).
Racial discrimination does not limit itself to patients. Although the proposal to
expand diversity in the healthcare workforce benefits minority patients, minority
providers report discrimination in the workplace. Within the physical therapy (PT)
profession, studies conducted in the United Kingdom (UK) interviewed minority and
White providers. The physiotherapists illustrate their perception of lacking diversity
and describe it as a “White profession”. A national UK survey reported 65% of
respondents feel minority groups as underrepresented in PT, 72% of racialized
respondents express that minorities encounter barriers while attempting to progress in
their careers. Additional studies in the UK and the US discovered racial bias in favor of
White students above minority students (Vazir, et al. 2019).
Representation and diversity of medical staff often tilts toward disproportionate
levels. As reported in the field of speech-language pathology, universities observe
minority students failing to carry out the necessary coursework at the baccalaureate
level. Thus the graduating class disproportionately represents the social demographic
with 2016 recording only 7.7% of speech-language pathologists and audiologists selfidentifying as minorities. In a 2018 study involving eleven speech-language
pathologists (SLPs) with varying years of professional experience, interviews and
responses were coded to further analyze and identify patterns and themes. The goal of
the study was to describe systems and techniques that promote academic
accomplishment and provide context to the obstacles facing African American SLPs
(AASLPs). Interviewees expressed microaggressions as one of the challenges
associated with being a Black student in undergraduate and graduate programs.
Microaggressions are subtle or inadvertent actions or assertions that show prejudice
against minority and marginalized groups. Five of the participants, who attended
historically Black colleges or universities (HBCU), did not record any accounts of
obstacles in the way of their education. Participants who did not attend HBCU reported
their experiences with microaggressions from guidance counselors and SLPs who
questioned their education and capability. Upon the interviewer inquiring into their
personal
interpretation of the microaggressions, the participants generally abstained from pegging
the aggressors as explicitly racist (Gingsberg, 2018).
Another contributor to academic adversities include social isolation and culture shock.
Participants illustrated numerous situations in which they were segregated by their
peers and left out of study groups and similar gatherings. The isolation and lack of
social inclusion lead the participants to share that the loneliness and deficient visibility
of Black students cultivates the characterization of speech-language pathology as a
white women’s profession. Along the spectrum of social aspects, “culture shock” acts
as another microaggression for AASLP students. Participants explain the experience of
being treated as a stereotype rather than as an individual. One participant reported her
collegiate years as the first time she felt a shift in the manner she was treated,
describing the treatment as working off of preconceived notions and stereotypes about
African Americans. Microaggressions involving an erasure of individuality on account
of stereotypes is often reported by many SLPs. Another participant detailed an
experience of being the sole Black student in the program, being asked to exhibit
African American dialect. The dangerous rhetoric and actions halting and harming the
academic advancement and social involvement of students of color strips the
professions of the diversity necessary to identify the institutionalized and systemic
racism of the medical fields. Increasing diversity matches the social demographic by
proportionately representing minorities and marginalized groups. Proper representation
fosters and cultivates an environment where clients, patients, and students feel safe,
heard, understood, and inspired (Gingsberg, 2018).
The 2012 ASHA Annual Convention in Atlanta, Georgia included a
presentation by Wright-Harp, et al. (2012) regarding health disparities in minority
populations with communication disorders. The presentation outlined the
disproportionate health statistics of racial and ethnic groups with respect to
quality of family care among children with autism, children with cerebral palsy
(CP), stroke awareness and recognition, among others. Health literacy also
reinforces the presence of disparities. Health literacy creates a barrier between
provider and patient when the patient struggles to obtain, process, and understand
basic health information and services. The presentation offers recommendations
of producing health advertisements in more languages to reach a wider audience.
Furthermore, formal language assessment segregates culturally and linguistically
diverse patients by solely being normed based on the majority language and
culture. Literature astutely condemns testing in this manner for diverse language
populations, further deterred by legislation and legal decisions. Standardized
testing exhibits limitation and bias through underrepresentation of diverse
populations in norming, cultural bias, and language/dialect bias. Because of a
lack of inclusivity of culturally and linguistic considerations, misdiagnosis and
overidentification occur. This leads to disproportionate representation of minority
students placed in special education, and under identifies risk populations. The
presentation provides recommendations for assessment of diverse populations. By
using an ethnographic approach and observing, the provider can interview the
family, consider cultural/linguistic differences, avoid stereotypes, use multiple
sources of data during comprehensive assessment, and modify scoring while
carefully reviewing tests for potential bias (Wright-Harp, et al., 2012).
Solutions
Dovidio (2012) finds that in order for the public to acknowledge racial
disparities, provider discrimination must be recognized as a contributing factor. In spite
of epidemiological reports, only 55% of White providers concede that “minority
patients generally receive lower quality care than White patients.”(Dovidio, 2012, pg.
949). Presentation and comprehension of the perplexing essence of bias, stereotypes,
and affective responses may better prepare providers to administer equitable care.
Dovidio (2012) further proposes mental health habits to
self-regulate bias with hopes that recognition of biased behavior can be automatic.
The Anti-Racism Directorate approximates that racialized individuals will
account for 48% of Ontario’s population by 2036. With this in consideration, the
Ontario Ministry of Education began enforcing Equity and Inclusive Education
Strategies. The goal of this program is to assist educators in properly analyzing and
confronting systemic barriers and discriminatory bias. Vazir’s (2019) study participants
voiced that informative training may be the most effective practice to counter racerelated inequities.
Vazir also proposes that minority knowledge and experience warrants
consultation regarding ways to reduce racism within the profession to improve minority
health. Federal endeavors in Canada plan to reduce health disparities concern mediation
that involves the entire population or aim at particular groups. Policy actors created
targeting programs, i.e. Sisters Together, to promote healthy eating, regular physical
activity, and preventative efforts to reduce risk of chronic diseases. However, targeted
programs may result in resistance if they are perceived as favoring specific groups
rather than the general public (Vazir, et al., 2019).
Grier (2020) studied Minnesota’s economic data to analyze the possible
financial benefits of eliminating differential health statistics. The study states that the
economic benefits of eliminating racial disparities would reduce direct medical care
disbursements by $229.4 billion and associated indirect costs by more than $1 trillion.
Nanney (2019) furthers this finding by stating a monetary estimate of saving lives as it
correlates to finances when racial disparities are reduced. Annually, the approximate
number of lives saved ranges from 475 to 812 ($1.2 billion to $2.9 billion). When
referring to the entirety of the U.S., Nanney’s article utilizes a statistic from LaVeist,
Gaskin, and Richard. They state that the yearly expenditures of racial disparities in
untimely death range from $236.1 billion to $243.1 billion (Grier & Schaller, 2020;
Nanney, et al., 2019).
The CDC (1993) held a workshop to identify the issues of using race and
ethnicity in the United States for public health surveillance. The participants were
provided with documents and articles on surveillance of public health. They were then
encouraged to propose advancements for the use of race and ethnicity to address
unbalanced health statistics of the U.S. minority populations. Groups examined the
limitations, exclusions, and restrictions affecting specifically Blacks, Hispanics, Native
Americans, and immigrant populations. Considerable deviations in data collection of
health statistics indicate that categorization of race and ethnicity statistics are
inconsistent. The CDC’s 1993 workshop focused on six criteria to implement a footing
for evaluation and revising the use of race and ethnicity in public health surveillance.
Validity, exclusivity and exhaustiveness, meaningfulness to respondents,
measurability, consistency, and reliability. In terms of validity, the CDC states that
differing populations should be amassed with caution and with required validation.
Exclusivity and exhaustiveness involves statistics representing diverse populations,
surveillance categories should encompass all members of a population and only in one
category. Meaningfulness to respondents consists of the images of race and ethnicity
changing across a varying population. Racial or ethnic classification may be rejected
by parts of the population. Measurability requires reasonable sensitivity, and positive
predictive value. Sensitivity and positive predictive value ensures proper identification
of participant race during habitual public health surveillance. Flexibility of
surveillance systems must respond to inconsistent responses to race and ethnicity
questions. Reliability of data collection across groups materializes in different methods
and measures. Data collection may also vary in terms of vernacular and material (CDC,
1993).
While the aforementioned criteria outline the baseline for assessment and
improvement of racial and ethnic health surveillance, self classification introduces
challenges on its own. The 1990 census only required data collection from four racial
groups (black, white, American Indian and Alaskan Native, and Asian/Pacific Islander)
and one ethnic group (Hispanic). The report on Improving Minority Health Statistics
from Healthy People 2000 and the Public Health Task Force on Minority Health Data
affirm that additional race and ethnicity data within the health field is a necessity
because of the projection of racial and ethnic population growth in the United States.
The Bureau of the Census (BC) verifies that the race and ethnicity questions are
adequate. However, six areas in particular demand consideration. Identification of race,
definitions of Hispanic, consistency of responses, misreporting, overlapping concepts
of race and ethnicity, and classification of persons of mixed race (CDC, 1993). The
CDC’s 1993 workshop called for new methodological and statistical research on
approaches to race and ethnicity to refine public health data. Given the demographic
changes that continue to evolve within the United States, concepts of race and ethnicity
should continue to be disaggregated to ensure that minorities can be properly
represented in public health surveillance. Negative health effects in racial groups
demonstrate the need for an understanding of the detrimental dispersion to better
establish resolutions. Unclear racial classification systems and small participant groups
cultivate inaccurate numbers and limit data analysis within racial groups. Deficient
efforts to correct census undercount and health data alters disease patterns within
specific subgroups. Proper representation allows medical professionals and federal
agencies to competently treat disparate groups with unfavorable statistics. The Center
for American Progress (2015) reports that as the American demographic evolves, as
does the content of the census to collect data on minority populations. The Census
Bureau began holding focus groups and surveys in the mid-twentieth century to gather
information on the Census questionnaire. From these methods of testing, the Bureau
learned to remove improper terms and expand question content to reach minority
populations. Various advocate groups contribute to the changes made within recording
race and ethnicity in data. For example, the advocate groups called for the way target
populations record responses (check-mark boxes, write-in boxes, etc.) to be adjusted to
reduce indistinct data. The write in boxes to detail national origin results in more
specific and targeted data. Additionally, the National Advisory Committee on Racial,
Ethnic and Other Populations suggested to the Bureau that disaggregated data would
produce more accurate representation of minority populations. Multiracial advocacy
groups pushed for the census to allow multiracial identification, the Bureau
implemented this change from 2000 to present day (Ahmad & Hagler, 2015).
In the profession of speech-language pathology, the American SpeechLanguage-Hearing Association (ASHA) includes advocacy for minority members and
clients. ASHA established an outline of goals for the future, with the year 2025
marking the fulfillment of their targets. Included in this statement, ASHA condemns
systemic racism and oppression, addressing its impact on communication, health, and
education. The Association readily welcomes under-represented groups to practice and
learn. Their efforts lie in allowing students and professionals to feel safe, appreciated,
and heard. ASHA recognizes individuality within their membership and acknowledges
the strengths of background, beliefs, and experience. ASHA views their members as
parts of a whole, stating that all of the unique characteristics of speech-language
pathologists and audiologists contribute to the progression of disorders and science as
well as how to practice in a culturally competent, responsive manner (ASHA’s
Envisioned, n.d.).
In addition, Black speech-language and hearing professionals gathered together
in 1977 to discuss the idea of a Black speech-language and hearing association. They
were incorporated as the National Black Association for Speech-Language and Hearing
(NBASLH) the following year. Their mission involves creating a community where the
needs of Black students, professionals, and individuals with communication disorders
could be sufficiently met. Programs and organizations such as this exist to ensure that
proper care is taken for people of color to feel heard, safe, and understood when they
seek professional care (“History,” n.d.). NBASLH works to encourage Black
individuals to come into the profession to increase diversity. Increased diversity means
greater representation to match the changing demographic within society.
With policy actors working to create programs and federal organizations
working to collect more accurate data, the hopes for reduction of racial disparities
increase with time. Eliminating racial disparities requires the collective efforts of all
medical professionals and specialists through education and understanding of the
impact of race and ethnicity on individual health. Creating environments focused on
comfort and understanding will invite more minorities and marginalized communities
into health environments to seek treatment for preventable illnesses. Cultivating
inclusion and focus on race-related health disparities ensures a healthier future for
generations to come.
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Abstract ...........................................................................................................................2
Introduction .....................................................................................................................3
Causes .............................................................................................................................3
Effects .............................................................................................................................7
Cases ...............................................................................................................................9
Solutions........................................................................................................................ 15
Abstract
In an evolving social climate, racial disparities highlight flaws within systems that
citizens once believed to be beneficial. Recently, attention shifted to health care and
the unfair disadvantages targeting minorities. This paper focuses on the issues, effects,
and possible solutions to medical discrepancies. Prevalent gaps between ethnic groups
with respect to treatment, mortality rate, and treatment cost; results in minorities
harboring a negative perspective of medical professionals. In addition to the lack of
proper care minorities receive, adverse attitudes toward health care further bolster
health complications that result in unfavorable statistics (HealthyPeople.gov, 2020a).
The unsavory experiences reported by minorities perpetuate distrust for medical
professionals, cultivating tension and fear between the provider and the patient. By
analyzing sources, the paper will discuss how unrecognized bias affects treatment and
how it further preserves racism. Cases in which improper care resulted in dire
consequences will also be used within the paper to support the intentions of the main
idea. The paper will conclude with programs and activism groups that have taken steps
to reduce racial disparities in health care.
Introduction
A disparity is defined as a great difference (Merriam-Webster, n.d.). Within the
medical field, disparities exist in the form of disproportionate diagnoses and mortality
rates between races and ethnicities. This paper discusses the reasons that these
disparities exist, the effects of the disparities, cases of medical discrepancies between
races, and solutions and advocacy groups for medical reform.
The 1985 Report of the Secretary’s Task Force on Black and Minority Health,
organized by the Center for Disease Control and Prevention (CDC), emphasized the
importance of making race-centered health disparities a priority, recommending
solutions. The necessity for a movement dates back to 1950 when the mortality rate for
Black infants was estimated to be twice as high when compared to White infants.
Additionally, during the mid-1980s it is reported that when compared to non-Hispanic
Whites, Mexican Americans were 2.8 times more likely to be uninsured. Furthermore,
analyzing rates of death from unintentional injuries reveal that Native Americans rates
reached significantly higher numbers than other U.S. populations during the
mid-1980s (CDC, 1993).
Causes
Identifying and understanding social determinants of health is necessary to
acknowledge the relationship between population experience and the impact of place on
social and physical health. HealthyPeople.gov is a task force within the Office of
Disease Prevention and Health Promotion (ODPHP) and the U.S. Department of Health
and Human Services. They utilize social determinants and other criteria to provide
public health objectives over a ten year period. Social determinants of health include:
availability of resources to meet daily needs, access to health care services, quality of
education, transportation options, social norms and attitudes, socioeconomic conditions,
access to mass media, and culture. Physical health determinants include: natural
environment, built environment, housing and community design, exposure to toxic
substances, physical barriers, and aesthetic elements. Varying combinations of these
elements affect health within communities (HealthyPeople.gov, 2020b). Healthy People
2020 coordinated a structure demonstrating five crucial areas of social determinants of
health: economic stability, education, social and community context, health and health
care, neighborhood and built environment. Each area mirrors leading concerns that
constitute underlying components of social determinants of health.
It is important to analyze the social aspect of interracial interactions. The causes
of these differences range from explicit to implicit, ingrained, institutionalized, and
intentional or unintentional. Dovidio and Fiske (2012) analyzes the psychological
perception between patient and provider as one facet for imbalanced medical treatment.
The article states that a primary meeting between patient and provider triggers two
adaptive questions. The first question focuses on the cooperative intentions of the other
person. Cooperation solicits a feeling of warmth, whereas defiance comes across as
cold. The second question leads the perceiver to determine whether the other can
execute their positive or negative intentions. Perceived status influences inference of
competence. High status equates to competence and vice versa. The combination of
these two dimensions centrally govern individual reaction to others. This philosophy is
further perpetuated when medical mistrust presents itself between patient and provider.
The expectation from doctors that their Black patients are more likely to be less
knowledgeable and less active results in a lower likelihood for doctors to prescribe
effective medical treatment than what is given for White patients, such as in cases of
coronary bypass surgery (Dovidio & Fiske, 2012).
During a vignette study by Green, et al. (2007), prospective physicians were
tested for their implicit and explicit bias. Actions and behaviors performed at a
conscious level are categorized as explicit bias, whereas implicit bias is demonstrated in
an unconscious mind. Using an Implicit Association (IAT) test, internal and emergency
medicine resident participants from four academic medical centers in Atlanta and
Boston were tested for implicit bias. 287 participants received randomized clinical
vignettes of Black or White patients. The IAT used in this study was structured using a
photo of a Black or White patient with neutral facial expressions. The participants were
then asked to rate the likelihood of coronary artery disease (CAD) when the
hypothetical patient arrives with complaints of chest pain. They were also asked
whether they would prescribe thrombolysis treatment, and the firmness of their
suggestion.
Additional questions regarding negative and positive associations with each
respective race were presented in a rapid manner. Rapid testing reduces the chance of
the participant second-guessing their choice. This way, the results reflect their implicit
bias that occurs without conscious thought. To test explicit bias, the survey asks the
participants to rate on a scale whether they prefer Black or White Americans, their
feelings of warmth toward each group independently, and the belief of Black and
White cooperative nature with respect to medical procedures. The end of the survey
asks participants about the demographics of their region, thrombolysis effectiveness,
and pre- and posttest opinions regarding unconscious bias and IATs. When analyzing
the explicit bias, respondents indicated impartial preference on a five-point scale and
equal measures of warmth on a ten-point scale for Black and White Americans. The
participants also recorded equal cooperative behaviors for Black and White patients
with respect to medical procedures. Queries on general cooperativeness resulted in the
same equal measurements. With respect to implicit bias, the IATs reported that
participants demonstrated substantial association of negative attributes to Black people
than to White people. Further analysis of responses revealed that implicit bias
influenced treatment decisions with respect to the thrombolysis treatment for the
hypothetical patient. When graphing for correlation, the increase in antiblack bias
resulted in decreased thrombolysis treatment for Black patients (Green, et al., 2007).
In addition to bias and stereotype, inaccessible health care contributes to racial
health differences. Communication often breaks down and access to appropriate health
information is limited in areas where citizens are impoverished and lack education
equal to other areas. Differences in sociocultural translation of necessities and
principles become lost because of racial bias within the health system. Often, these
mistranslations occur at the hands of White framing. White framing is language that is
purposefully vague and described as “euphemistic or white concealing” (VardemanWinter, 2017, p. 631). The term “racial disparities” is used as an example. Racial
stereotypes, expected images, and ideologies of differing racial groups is connected to
prejudiced practice. These subconscious behaviors endure because of the subtle,
hidden nature within language. Identifying and controlling White framing presents
difficulty due to the evolving face of racism. Health communication study focuses on
racism on account of the suggestion that a privileged group decides meaning and
messages of health for those with less privilege (Vardeman-Winter, 2017).
Most often, The National Institutes of Health (NIH) is more likely to invest
funds into White researchers than to Black researchers. White researchers initiating
studies limits the perspective to a White standpoint. Social and physical distance from
target populations cultivates systemic racism and a lack of participation from people of
color. Communicators stemming from White communities with college education means
that communities experiencing health disparities are not reached. These areas are often
populated by people of color with less education and income compared to the
researchers (Vardeman-Winter, 2017, p. 631).
With respect to medical research, medical mistrust contributes to differential
statistics. Not only do researchers remain within populations from which they are
familiar, populations of color refrain from participating in studies that could level the
data. Because of past exploitation of people of color in the past, such as the Tuskegee
Trials, the Black community considers these offenses unforgivable. Black
communities maintain a suspicion toward any future research for fear of manipulation
(Ridley-Merriweather & Head, 2017).
Effects
Experiences with racism outside of the clinical environment correlates with
reports of poorer health. Negative encounters influenced by race relates to perceived
bias in clinical interactions. Racial and ethnic minorities believe that their race
contributes to unfavorable experiences with medical professionals. Medical mistrust
results from a perception of bias and predicts less favorable behaviors from Black
patients, from which negative provider and care quality reviews emerge. Whether or
not the reviews stem from truth or perception, a breakdown in trust, lower medical
adherence, and utilization of health care services occurs (Dovidio & Fiske, 2012).
Overall, less healthy populations ensue.
Lack of cultural adaptation to mental health attitudes within differing
backgrounds leads to ineffective treatments for groups such as refugees. Because of
stigma within minority groups revolving around mental illness, programs within the
United States must reform and refine themselves to adequately respond to the needs of
refugee groups and others like them (Polonsky, et al., 2018). Programs and treatments
must thoroughly inform groups as well as diversify the staff in order to reach target
audiences to instill trust that the program is effective, promoting participation.
Systemic racism plays a key role in racial disparities, especially in research
regarding myocardial infarctions. Research articulates that states with higher instances
of systemic racism record increased racial disparities in myocardial infarction
diagnosis and treatment methods when compared to states with weakened structural
racism. The authors of the study conclude that “Structural racism may harm the health
of groups that are target with discrimination, but at the same time benefit those in a
position of dominance” (Vardeman-Winter, 2017, p. 630-631).
Potential racial bias from providers may be subtle and unintentional.
Researchers consider sensitivity to bias in Black patients. Trust in medical
professionals following a visit differs between Black and White patients. Prior to the
visit, Black and White patients report similar levels of trust. Following the visit, Black
patients reported less support and partnership, as well as less information presented.
Better comprehension and awareness of interracial interactions can supply researchers
with better acumen into possible bias contributed by both the provider and the patient
to reinforce health care and status (Dovidio, et al., 2008). Research findings into
interracial interactions correlate health disparities with race discordant interactions and
health disparities. Medical avoidance behaviors prevent Black patients from pursuing
care. Fear of perceived discrimination directly affects psychological distress and poor
health status. Patients experiencing negative stereotypes seek treatment less often and
report lower care satisfaction. Positive patient/provider relationships result in patient
engagement, medical information recall, adherence to treatment, satisfaction with care,
and health outcomes.
Cases
A prolific portion of history that is shaping our future is the period of time in
which our world has undergone quarantine from Coronavirus. NPR reported that the
2020 pandemic of COVID-19 targeted communities of color. People of color (POC)
in the United States (US) are reported as more likely to contract and pass away from
COVID-19 when compared to White people and their portion of the population. One
of the causes for COVID health disparities, reported by The GW Hatchet, is
asymmetric access to health services and adequate information. The city of
Washington D.C. reports that three-quarters of COVID-19 deaths have been Black
citizens, in spite of Black people making up less than half of the D.C. population. A
diagram of the wards within Washington D.C. illustrates the concentration of cases.
The wards where more than half of the population are Black are experiencing the
highest number of cases.These disparate health statistics surrounding COVID-19 have
demonstrated the truth of living in poverty and of living as a person of color
(Govindario, S., 2020; Wood, D., 2020).
The CDC records pregnancy-related deaths as mainly affecting Black and
American Indian/Alaska Native (AI/AN) women (“Racial and Ethnic Disparities,”
n.d.). With a two to three times greater chance of dying from pregnancy, and the
preventability of pregnancy-related deaths, racial and ethnic disparities should cease.
However, this statistic remains and has remained throughout time. Between 20072008 and 2015-2016, pregnancy disparity statistics changed only slightly. Black and
AI/AN women over thirty were four to five times more likely to die from pregnancyrelated causes. Pregnancy-related deaths are measured per 100,000 live births, or
pregnancy-related mortality rates (PRMR). States that reported low PRMR, that also
contained women with higher levels of education still record compelling distinctions
in race statistics relating to pregnancy.
According to a study by the Immunization Services division of the National
Center for Immunization and Respiratory Diseases published in American Journal of
Preventive Medicine (2015), Hispanics, non-Hispanic Asians, and non-Hispanic
Blacks compared to non-Hispanic Whites possess lower vaccination coverage of the
influenza, pneumococcal, Td, shingles, and HPV vaccinations. Each race was split into
two age groups (19-64 and 65+) and analyzed for coverage by vaccine. While the
differences between races narrowed for varying vaccines, the divide persisted
following consideration of access to health care and socio-demographics for most of
the vaccines and groups. While these numbers present themselves in racially and
ethnically diverse adults, childhood vaccination disparities in racially and ethnically
diverse children report substantially low to unobserved differences. To enter into the
school system, vaccinations are required in addition to provisions given by the
Vaccines for Children program (VFC). VFC administers vaccinations to children
without insurance, children on Medicaid, and other select populations. These
requirements and programs may contribute to vaccination coverage in children and the
diminished racial and ethnic differences. The perspectives on vaccinations and health
care vary, in addition to access to quality care and vaccination safety (Lu, et al. 2015).
Rates of osteoporosis reveal disparities between Black and White women.
Research states that physicians who engage in “high discretion procedures”
(recommending a test, i.e. osteoporosis) bolster disparity appearances (Dovidio, et al.
2008, p. 4). Furthermore, Black women are less likely to be prescribed proper
medication when compared to White women also diagnosed with osteoporosis
(Dovidio, et al., 2008).
Racial discrimination does not limit itself to patients. Although the proposal to
expand diversity in the healthcare workforce benefits minority patients, minority
providers report discrimination in the workplace. Within the physical therapy (PT)
profession, studies conducted in the United Kingdom (UK) interviewed minority and
White providers. The physiotherapists illustrate their perception of lacking diversity
and describe it as a “White profession”. A national UK survey reported 65% of
respondents feel minority groups as underrepresented in PT, 72% of racialized
respondents express that minorities encounter barriers while attempting to progress in
their careers. Additional studies in the UK and the US discovered racial bias in favor of
White students above minority students (Vazir, et al. 2019).
Representation and diversity of medical staff often tilts toward disproportionate
levels. As reported in the field of speech-language pathology, universities observe
minority students failing to carry out the necessary coursework at the baccalaureate
level. Thus the graduating class disproportionately represents the social demographic
with 2016 recording only 7.7% of speech-language pathologists and audiologists selfidentifying as minorities. In a 2018 study involving eleven speech-language
pathologists (SLPs) with varying years of professional experience, interviews and
responses were coded to further analyze and identify patterns and themes. The goal of
the study was to describe systems and techniques that promote academic
accomplishment and provide context to the obstacles facing African American SLPs
(AASLPs). Interviewees expressed microaggressions as one of the challenges
associated with being a Black student in undergraduate and graduate programs.
Microaggressions are subtle or inadvertent actions or assertions that show prejudice
against minority and marginalized groups. Five of the participants, who attended
historically Black colleges or universities (HBCU), did not record any accounts of
obstacles in the way of their education. Participants who did not attend HBCU reported
their experiences with microaggressions from guidance counselors and SLPs who
questioned their education and capability. Upon the interviewer inquiring into their
personal
interpretation of the microaggressions, the participants generally abstained from pegging
the aggressors as explicitly racist (Gingsberg, 2018).
Another contributor to academic adversities include social isolation and culture shock.
Participants illustrated numerous situations in which they were segregated by their
peers and left out of study groups and similar gatherings. The isolation and lack of
social inclusion lead the participants to share that the loneliness and deficient visibility
of Black students cultivates the characterization of speech-language pathology as a
white women’s profession. Along the spectrum of social aspects, “culture shock” acts
as another microaggression for AASLP students. Participants explain the experience of
being treated as a stereotype rather than as an individual. One participant reported her
collegiate years as the first time she felt a shift in the manner she was treated,
describing the treatment as working off of preconceived notions and stereotypes about
African Americans. Microaggressions involving an erasure of individuality on account
of stereotypes is often reported by many SLPs. Another participant detailed an
experience of being the sole Black student in the program, being asked to exhibit
African American dialect. The dangerous rhetoric and actions halting and harming the
academic advancement and social involvement of students of color strips the
professions of the diversity necessary to identify the institutionalized and systemic
racism of the medical fields. Increasing diversity matches the social demographic by
proportionately representing minorities and marginalized groups. Proper representation
fosters and cultivates an environment where clients, patients, and students feel safe,
heard, understood, and inspired (Gingsberg, 2018).
The 2012 ASHA Annual Convention in Atlanta, Georgia included a
presentation by Wright-Harp, et al. (2012) regarding health disparities in minority
populations with communication disorders. The presentation outlined the
disproportionate health statistics of racial and ethnic groups with respect to
quality of family care among children with autism, children with cerebral palsy
(CP), stroke awareness and recognition, among others. Health literacy also
reinforces the presence of disparities. Health literacy creates a barrier between
provider and patient when the patient struggles to obtain, process, and understand
basic health information and services. The presentation offers recommendations
of producing health advertisements in more languages to reach a wider audience.
Furthermore, formal language assessment segregates culturally and linguistically
diverse patients by solely being normed based on the majority language and
culture. Literature astutely condemns testing in this manner for diverse language
populations, further deterred by legislation and legal decisions. Standardized
testing exhibits limitation and bias through underrepresentation of diverse
populations in norming, cultural bias, and language/dialect bias. Because of a
lack of inclusivity of culturally and linguistic considerations, misdiagnosis and
overidentification occur. This leads to disproportionate representation of minority
students placed in special education, and under identifies risk populations. The
presentation provides recommendations for assessment of diverse populations. By
using an ethnographic approach and observing, the provider can interview the
family, consider cultural/linguistic differences, avoid stereotypes, use multiple
sources of data during comprehensive assessment, and modify scoring while
carefully reviewing tests for potential bias (Wright-Harp, et al., 2012).
Solutions
Dovidio (2012) finds that in order for the public to acknowledge racial
disparities, provider discrimination must be recognized as a contributing factor. In spite
of epidemiological reports, only 55% of White providers concede that “minority
patients generally receive lower quality care than White patients.”(Dovidio, 2012, pg.
949). Presentation and comprehension of the perplexing essence of bias, stereotypes,
and affective responses may better prepare providers to administer equitable care.
Dovidio (2012) further proposes mental health habits to
self-regulate bias with hopes that recognition of biased behavior can be automatic.
The Anti-Racism Directorate approximates that racialized individuals will
account for 48% of Ontario’s population by 2036. With this in consideration, the
Ontario Ministry of Education began enforcing Equity and Inclusive Education
Strategies. The goal of this program is to assist educators in properly analyzing and
confronting systemic barriers and discriminatory bias. Vazir’s (2019) study participants
voiced that informative training may be the most effective practice to counter racerelated inequities.
Vazir also proposes that minority knowledge and experience warrants
consultation regarding ways to reduce racism within the profession to improve minority
health. Federal endeavors in Canada plan to reduce health disparities concern mediation
that involves the entire population or aim at particular groups. Policy actors created
targeting programs, i.e. Sisters Together, to promote healthy eating, regular physical
activity, and preventative efforts to reduce risk of chronic diseases. However, targeted
programs may result in resistance if they are perceived as favoring specific groups
rather than the general public (Vazir, et al., 2019).
Grier (2020) studied Minnesota’s economic data to analyze the possible
financial benefits of eliminating differential health statistics. The study states that the
economic benefits of eliminating racial disparities would reduce direct medical care
disbursements by $229.4 billion and associated indirect costs by more than $1 trillion.
Nanney (2019) furthers this finding by stating a monetary estimate of saving lives as it
correlates to finances when racial disparities are reduced. Annually, the approximate
number of lives saved ranges from 475 to 812 ($1.2 billion to $2.9 billion). When
referring to the entirety of the U.S., Nanney’s article utilizes a statistic from LaVeist,
Gaskin, and Richard. They state that the yearly expenditures of racial disparities in
untimely death range from $236.1 billion to $243.1 billion (Grier & Schaller, 2020;
Nanney, et al., 2019).
The CDC (1993) held a workshop to identify the issues of using race and
ethnicity in the United States for public health surveillance. The participants were
provided with documents and articles on surveillance of public health. They were then
encouraged to propose advancements for the use of race and ethnicity to address
unbalanced health statistics of the U.S. minority populations. Groups examined the
limitations, exclusions, and restrictions affecting specifically Blacks, Hispanics, Native
Americans, and immigrant populations. Considerable deviations in data collection of
health statistics indicate that categorization of race and ethnicity statistics are
inconsistent. The CDC’s 1993 workshop focused on six criteria to implement a footing
for evaluation and revising the use of race and ethnicity in public health surveillance.
Validity, exclusivity and exhaustiveness, meaningfulness to respondents,
measurability, consistency, and reliability. In terms of validity, the CDC states that
differing populations should be amassed with caution and with required validation.
Exclusivity and exhaustiveness involves statistics representing diverse populations,
surveillance categories should encompass all members of a population and only in one
category. Meaningfulness to respondents consists of the images of race and ethnicity
changing across a varying population. Racial or ethnic classification may be rejected
by parts of the population. Measurability requires reasonable sensitivity, and positive
predictive value. Sensitivity and positive predictive value ensures proper identification
of participant race during habitual public health surveillance. Flexibility of
surveillance systems must respond to inconsistent responses to race and ethnicity
questions. Reliability of data collection across groups materializes in different methods
and measures. Data collection may also vary in terms of vernacular and material (CDC,
1993).
While the aforementioned criteria outline the baseline for assessment and
improvement of racial and ethnic health surveillance, self classification introduces
challenges on its own. The 1990 census only required data collection from four racial
groups (black, white, American Indian and Alaskan Native, and Asian/Pacific Islander)
and one ethnic group (Hispanic). The report on Improving Minority Health Statistics
from Healthy People 2000 and the Public Health Task Force on Minority Health Data
affirm that additional race and ethnicity data within the health field is a necessity
because of the projection of racial and ethnic population growth in the United States.
The Bureau of the Census (BC) verifies that the race and ethnicity questions are
adequate. However, six areas in particular demand consideration. Identification of race,
definitions of Hispanic, consistency of responses, misreporting, overlapping concepts
of race and ethnicity, and classification of persons of mixed race (CDC, 1993). The
CDC’s 1993 workshop called for new methodological and statistical research on
approaches to race and ethnicity to refine public health data. Given the demographic
changes that continue to evolve within the United States, concepts of race and ethnicity
should continue to be disaggregated to ensure that minorities can be properly
represented in public health surveillance. Negative health effects in racial groups
demonstrate the need for an understanding of the detrimental dispersion to better
establish resolutions. Unclear racial classification systems and small participant groups
cultivate inaccurate numbers and limit data analysis within racial groups. Deficient
efforts to correct census undercount and health data alters disease patterns within
specific subgroups. Proper representation allows medical professionals and federal
agencies to competently treat disparate groups with unfavorable statistics. The Center
for American Progress (2015) reports that as the American demographic evolves, as
does the content of the census to collect data on minority populations. The Census
Bureau began holding focus groups and surveys in the mid-twentieth century to gather
information on the Census questionnaire. From these methods of testing, the Bureau
learned to remove improper terms and expand question content to reach minority
populations. Various advocate groups contribute to the changes made within recording
race and ethnicity in data. For example, the advocate groups called for the way target
populations record responses (check-mark boxes, write-in boxes, etc.) to be adjusted to
reduce indistinct data. The write in boxes to detail national origin results in more
specific and targeted data. Additionally, the National Advisory Committee on Racial,
Ethnic and Other Populations suggested to the Bureau that disaggregated data would
produce more accurate representation of minority populations. Multiracial advocacy
groups pushed for the census to allow multiracial identification, the Bureau
implemented this change from 2000 to present day (Ahmad & Hagler, 2015).
In the profession of speech-language pathology, the American SpeechLanguage-Hearing Association (ASHA) includes advocacy for minority members and
clients. ASHA established an outline of goals for the future, with the year 2025
marking the fulfillment of their targets. Included in this statement, ASHA condemns
systemic racism and oppression, addressing its impact on communication, health, and
education. The Association readily welcomes under-represented groups to practice and
learn. Their efforts lie in allowing students and professionals to feel safe, appreciated,
and heard. ASHA recognizes individuality within their membership and acknowledges
the strengths of background, beliefs, and experience. ASHA views their members as
parts of a whole, stating that all of the unique characteristics of speech-language
pathologists and audiologists contribute to the progression of disorders and science as
well as how to practice in a culturally competent, responsive manner (ASHA’s
Envisioned, n.d.).
In addition, Black speech-language and hearing professionals gathered together
in 1977 to discuss the idea of a Black speech-language and hearing association. They
were incorporated as the National Black Association for Speech-Language and Hearing
(NBASLH) the following year. Their mission involves creating a community where the
needs of Black students, professionals, and individuals with communication disorders
could be sufficiently met. Programs and organizations such as this exist to ensure that
proper care is taken for people of color to feel heard, safe, and understood when they
seek professional care (“History,” n.d.). NBASLH works to encourage Black
individuals to come into the profession to increase diversity. Increased diversity means
greater representation to match the changing demographic within society.
With policy actors working to create programs and federal organizations
working to collect more accurate data, the hopes for reduction of racial disparities
increase with time. Eliminating racial disparities requires the collective efforts of all
medical professionals and specialists through education and understanding of the
impact of race and ethnicity on individual health. Creating environments focused on
comfort and understanding will invite more minorities and marginalized communities
into health environments to seek treatment for preventable illnesses. Cultivating
inclusion and focus on race-related health disparities ensures a healthier future for
generations to come.
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