The insidiousness of racism is not only that it is enduring, but that it is ubiquitous. Right now, hundreds of thousands of us mourn in the streets for Breonna Taylor and George Floyd, as we protest a pattern of police brutality toward Black Americans. At the same time, we enter another month during which we’ll be fighting COVID-19. This pandemic has revealed all the ways in which racism infiltrates our medical systems, too.
While training to become an epidemiologist, my colleagues and myself were taught about medical racism in an abstract way, despite it being a very tangible threat. Science and medicine are considered by many to be pure, and immune from “qualitative” biases. However, Black Americans, who make up around 13% of the total United States population, represent a full 23% of COVID-19-related deaths in the United States, reports the Centers for Disease Control and Prevention. That is not a coincidence.
From the beginning of the SARS-CoV-2 pandemic, racism has been at the forefront of the national conversation. We watched as the world rendered Chinese people the culprits and carriers of a global plague. Their culture and humanity were placed on trial. The Asian community in America is still reeling from this dangerous attack, and likely will be for some time.
Later, when enough epidemiological data became available for states to see the demographics of COVID-19 morbidity and mortality, it became clear that Black Americans were being inordinately affected. While the blame for this was quickly placed back on their own shoulders, this disparity highlights many of the ways Black people are harmed by the medical system.
The American Medical Association estimates that 56.2% of active US physicians are white and 17.1% are Asian; just 5% are Black. As such, the majority of Black Americans receive their healthcare from non-Black people. It’s naive to ignore the implicit racial biases that these providers take with them into physician-patient relationships.
Black women with white physicians are less likely to be educated by their providers on preventative care, less likely to be preventatively tested for maladies, and less likely to be referred to “state-of-the-art” specialty facilities like their white female counterparts, according to a 2013 meta-analysis performed by sociological researchers at Texas A&M University. A dual study that was part of the meta-analysis, published by the National Institute on Minority Health and Health Disparities and Columbia University, found that, “Black patients with problems comparable to whites got less attention from nurses, fewer tests, and less sophisticated or no heart treatments.”
Despite this empirical evidence, growing bodies of research aimed at answering why racial biases permeate medicine have found that white and white-adjacent healthcare providers view medical racism differently — if they acknowledge it at all. White physicians find Black patients, and low-income patients, less intelligent than white patients and patients of higher income, found a study performed by the University of Albany School Of Public Health. When doctors and nurses were given an anonymous survey asking them to explain racial inequalities in healthcare, most providers saw Black patients as “passive” and unintelligent, and blamed them for not making pointed care requests of their providers, reports the Journal of Ethnic and Racial Studies.
Americans were shown a blatant example of this phenomenon when the U.S. Surgeon General Jerome Adams received immense backlash for publicly lecturing Black Americans for not adhering to stay-at-home policies. Many felt that the implication was that the Black community had only itself to blame for its disproportionate rates of COVID-19 deaths and hospitalisations. Never mind that Black Americans are the demographic that make up a disproportionate amount of American essential workers, are the most likely to use public transit, and are the most likely to suffer from comorbidities while having less access to healthcare. Medical racism kills you and blames you for your own demise.
We’ve seen this type of reframing for generations. We’re seeing it now, even as we continue to mourn the deaths of those killed by police in America. Black women and men are 1.4 times and 2.5 more likely to be killed by the police, respectively, than their white counterparts. Yet, no matter what, the blame is placed on the deceased for the end of their life.
After Breonna Taylor was shot in her own home, law enforcement tried to justify the killing, pointing to a search warrant they’d obtained — though it didn't include Taylor's name, and she had committed no crime. After George Floyd was asphyxiated, preliminary results from an autopsy conducted by the state’s medical examiner pointed fingers at “other significant conditions,” besides a police officer’s knee on his throat. When Ahmaud Arbery was shot while jogging, neither of his assailants were charged for more than two months.
As we enter the second week of protests, and the middle of the two- to 14-day COVID-19 incubation period, many are concerned that the recent uprisings will manifest into nationwide spikes in COVID-19 cases, hospitalisations, and deaths. Los Angeles County, CA, Lee County, FL, and multiple testing facilities across the states of Pennsylvania and Illinois have suspended COVID-19 testing. Each municipality has cited the recent uprisings against police brutality as the reason for the suspension of testing.
The Huffington Post reported that 2,000 masks, paid for by The Movement for Black Lives, that were destined for protestors in Oakland, Washington DC, St. Louis, Minneapolis, and New York City were seized by federal authorities.
I'm a physician and I agree with this. I've experienced medical racism as a patient and I'm a physician! I've also been the target of anti-black acts from my physician colleagues. Medical racism is not a joke y'all.— Dr. Monifa M.D. (@DrMonifaMD) May 31, 2020
With the suspension of affordable COVID-19 care access and the blatant dismantling of organisational efforts to keep communities safe from viral transmission, Black communities will continue to bear the brunt of the virus’s impact. All because Black Americans dare ask that our humanity be recognised and that police be brought to justice for our unlawful murders.
In the midst of an unprecedented public health crisis, medical racism has been bolstered by police interference and systemic violence perpetuated by public health leaders.
Because numerous scientific studies over decades and hundreds of years of human history have shown us that internal biases create macrocosms of deadly consequences, we must contend with how all these forms of oppression work together with the pandemic. Nurses are already publicly speaking out about how they feel the actions of protesters affect the lives of healthcare workers on the frontlines.
But how do we teach people that racism is as deadly as any pandemic? When it comes to George Floyd, one little fact remains stuck in my mind: The Hennepin County Medical Examiner’s Office revealed that Floyd had tested positive for COVID-19 in April — only to die at the hands of systemic racism just one month later.
Gabrielle A Perry is an infectious disease epidemiologist based in Louisiana